
Class 
Book. 



Rett 



■ H?g> 



Copyright W 







COPYRIGHT DEPOSIT. 



■4 



r m p T^te^&i 

HEHTIOUS-. HOp E f«S, 




DR. HOOD'S 



PLAIN TALKS 



If 



ABOUT THE 

HUMAN SYSTEM— THE HABITS <OF MEN AND WOMEN— THE CAUSES AND 

PREVENTION OP DISEASE— OUR SEXUAL RELATIONS 

AND SOCIAL NATURES 

EMBRACING 

Common Sense Medical Adviser 



APPLIED TO 

CAUSES, PREVENTION AND CURE OF CHRONIC DISEASES— THE NATURAL 

RELATIONS OF MEN AND WOMEN TO EACH OTHER— SOCIETY 

—LOVE— MARRIAGE— PARENTAGE, ETC. 



G. Durant Hood, M. D., Ph.D. 



Embellished with Hundreds of Illustrations. 




CHICAGO 

THE HOOD MEDICAL BOOK CO. 

Publishers 



THE LIBRARY OF 

CONGRESS, 
T-vo Copies Received 

28 1902 

Copyright entry 
CLASS ^XXc. No. 
COPY 



Copyright, 

190?, 

HOOD MEDICAL BOOK CO, 



3 I 



•* * • «• 1 \ . j j . . 1 •,**' 2 



CONTENTS 



P4.6B 

DISEASES OF CHILDREN . . 1 

Bed- wetting . • »■'■-•'»••' 
Chafing .•••••* 
Chicken Pox •••••* 

Chilblains ..••«•• 

Child-crowing (see False Croup) 

Children's Paralysis « » 6 

Chorea (w* St. Titus's Danes) 

Constipation in Children • « 7 

Cou-^vilsions • • 9 

Consumption {see Tuberculosis) 

Croup . . . . . . ,12 

False Croup ,15 

Spasmodic Croup . • • • .16 
Dentition ...... 18 

Diarrhoea and Dysentery ... 21 
Falling-down of Bowel ... 23 
Fits (see Convulsions) 

Gangrenous Ulceration of the Cheek . 24 
Hydrocephalus (see Water on the Brain) 
Incontinence of Urine (see Bed- wetting) 
Infantine Paralysis (pee Children's Paralysis) 
Measles ...... 25 

"^enl-igitis (&e Tuberculosis 

Mumps . ^ € . 28 

Sftgbl Terroti . , . . 81 



DISEASES OF CHILDREN 
Bed Gum 
Rickets . • 

Ring-worm . • 
St. Vitus' s Dance. 
Scald Head . 
Scarlet Fever • 
Scrofula . . 
Sore Throat and Cold 
Spinal Disease 
Stammering . 
Thrush 

Tonsils, Enlargement of 
Tuberculosis 
Ulceration of the Gums 
„ » Mouth 

Yaccinatioa . 
Water on the Brain 
Whooping Cough » 

Wbcms . . • 



(continued) : 



il 

32 
86 
39 
41 
41 
46 
60 
64 
65 
55 
67 
58 
63 
63 
64 



n 



DISEASES AND THEIR TREATMENT 
Abscesses ...... 77 

Acidity ...... 73 

H™ *• 

Altx foo aaa. • # « * $■ * ® 



CONTENTS. 



FACtX 

DISEASES {eontinued): 
Anaemia ...... 92 

Aneurism .•••.. 97 
Angina Pectoris . « • . . 100 
Aphysia .••••. 105 

Apoplexy . • • • • .107 

Asthma . • . . .111 

Biliousness and Liver Disorders . .127 
Bleeding from the Bowel . . .137 
„ „ Stomach . . .137 

Blood-spitting , . •'-.!.• .141 

Boils 144 

Brain Diseases . • • * .147 
Bright' s Disease » « • 149 

Bronchitis . • • • • .154 

Bronzed Skin • • . . . 164 
Bruises ...... 165 

Bunions • •»••• 165 
Cancers ...... 167 

„ in the Stomach ... 170 
Carbuncles . t . . . , . 171 

Catalepsy 173 

Chilblains and Chapped Hand* • .175 

Cholera .177 

Colds 182 

Cold Feet 184 

Colic ....... 185 

Constipation • • • • .188 

Consumption • • • • .194 

Corns ....... 202 

Coughs 204 

Debility 207 

Delirium Tremens • • . .211 
Derbyshire Neck . • . . .213 

Diabetes 217 

Diarrheas . . . 228 



DISEASES (continued)'. 
Diphtheria ...... 233 

Dropsy. ...... 241 

Dysentery ...... 241 

Ear, Diseases of ...» 248 

Ecstasy 259 

Enlarged Glands ..... 260 

Epilepsy ...... 261 

Erysipelas ....... 271 

Expectoration • • • • . 275 

Fainting ...... 276 

Flatulence ...... 279 

Flushing of the Face . . • .282 
Gall Stones ...... 283 

Giddiness ...... 287 

Gin-drinker's Liver .... 290 

Gout 293 

Gravel ....... 298 

Hay Fever . . . • . .301 

Headache .905 

Heart, Diseases of • . • .314 
Hiccup, or Hiccough . • • .317 
Hydrophobia . . • • .318 
Hypochondriasis . • • . .328 

Hysteria 329 

Indigestion 340 

Influenza ...... 352 

Itching at the Anus .... 358 

Jaundice ....•• 361 

Joints, Diseases of ... • 367 
Loss of Appetite . • • • .368 

„ Voice 370 

Lungs, Diseases of • • • .372 

„ Inflammation of . . . 383 

Megrim, or Sick Headache . • . 386 

Neuralgia ...... £99 



CONTENTS. 



DISEASES (continued): 








Night Sweating . . , 






408 


Obesity , 






409 


Obstruction of the Bowela , 






, 413 


Offensive Breath . . , 






. 416 


Old Age . 






417 


Pain in the Musclee • , 






424 


Palpitation • , 






432 


Paralysis . . • , 






436 


Piles 






440 


Pleurisy •-•.-•• 






444 


Pyrosis • • • < 






448 


Quinsy • 






. 450 


Relaxed Sore Throat . 






453 


Rheumatic Fever . • 






. 455 


M Gout . . , 






461 


Rheumatism, Chronic . ( 






464 


„ Muscular , 






469 


Scurvy. . , 






. 473 


Sea Sickness • • , 






478 


Shaking Palsy . , , 








Sleeplessness • • 






. 483 


Somnambulism . . , 






493 


Sore Throat, Clergyman's 






. 498 


„ Ordinary . 






500 


Sores or Ulcers . • 






501 


Sunstroke . • • . 






. 503 


Tetanus • • , 






507 


Toothache . . • 






. 509 


Typhoid and other Fevers 






514 


Ulcer of the Stomach . 






553 


Vomiting . . • 






. 559 


"Warts . . . • . • •< 






. 565 


Wasting Palsy . • 






. 566 


Worms . . . 






. 669 


Writer* 8 Cramp . . 






673 



PRESCRIPTIONS. . . . . 677 

INDICATION OF DISEASE: 
Temperature and the Clinical Thermo- 
meter ..•••• 68ft 

The Pulse 698 

The Tongue . • • • . 600 
The Urine . . '. . . .602 

Pain .607 

Facial Expression • • , . 609 

NURSING AND CARE OF THE SICK: 
Qualifications and Duties of a Nurse . 611 
Management of the Sick Room . .617 
Practical Details of Nursing . . 624 
Administration of Medicine « .641 
Invalid Diet . . . • . 669 

NURSING OF CHILDREN: 

General Principles of Management . 673 
Infants' Food . . . . .675 
Mean Composition of the Milk of various 

Animals ..... 676 
Management After Weaning . . 687 

DOMESTIC SURGERY: , 

Haemorrhage ...... 69S 

Wounds, Bruises, and Sprains . . 695 
Fractures, Dislocations, Burns, and 

Scalds 703 

Suspended Animation . • . .709 

Teething 716 

Bunions, and Affections of the Feet and 

Legs 720 

Various Local Ailments . . . 723 



rft 



OOHTKBTTt. 



MATERIA MJHMGA: 

Introduction . t • • . 731 

Acids .741 

Alkalies .•••*. 7« 
Alum . • • . ... 747 

Aloes ....... 748 

Arnica ..•••• 744 

Bark and Qoinint • • • .754 
Belladonna . .... 759 

Bismuth ...... 763 

Box 764 

Bromide of Potassium • . . 765 

Bryonia . • • • 766 

Calabar Bean «... 767 

Calumba 768 

Camphor 769 

Cantharides, or Spanish Fly . .770 
Carbon, or Charcoal . . . .773 
Castor Oil— Croton Oil . . .774 
Catechu — Kino — Bhatany Boot . .776 
Chamomile . . , . v * • 776 

Chloral 776 

Cimcifuga . . « , . .778 

Cod-Liver Oil 778 

Coffee . . . . . .780 

Colchicum 781 

Digitalis 783 

Epsom Salts, and other Saline Purga- 
tives 785 

Ergot . . . . . . .786 

Fern Boot — Santonine — Pomegranate — 

Spirits of Turpentine . . . 787 
Friar's Balsam — Balsam of Peru — 

Balsam of Toln . . . .788 

Gentian . . . # . .789 
Guaiacum ...... 790 



turn 

MATEBIA MEDIC A (eontinmd) i 

Gelseminum 791 

Hamamelis Virginias. . * • .792 

Hellebore ...... 793 

Hemlock ...... 793 

Henbane . . • • l . 796 
Hydrastis . . . * . .796 

Indian Hemp , . . 796 

Iodide — Iodid* of Potassium • . 800 

Ipecacuanha • . 802 

Iron , 805 

Jalap and Scammony .... 810 

Lead ....... 810 

Lobelia ....•• 815 

Lettuce and Hops . • • . 815 

Lime-water and Chalk . . . 816 

Magnesia 818 

Marsh Mallow — Horehound — Elecam- 

pagne — Coltsfoot Liquorice . . 819 

Mercury, or Quicksilver . • . 820 

Mustard 831 

Nitro-Glyoerine, or Glonoine . . 832 

Nitrite of Amyl ..... 833 
Nitre, or Saltpetre, and Chlorate of 

Potash ..... 834 
Naz Vomica and Strychnia . . 836 
Oak Bark— Gall Nuts— Tannic Acid- 
Gallic Acid 839 

Opium ...... 842 

Sal Volatile • . | . 865 

Sarsaparilla . . . • . 866 

Senega and Squills .... 866 

Senna ...... 867 

Stavesacre 868 

Stramonium ..... 868 

Sulphate of Zinc and Oxide of Zinc . 869 



CONTENTS. 



MATERIA MEDICA (continued) 

Sulphate of Calcium . 
Sulphur, or Brimstone 

Tar and Creosote • 

Tartar Emetio • • 

Tea ... • 

Tobacco • • 



HYGIENE { 
Food . 
Water 
Air . 
Exercise 



871 
872 
874 
876 
877 



934 
950 
961 



HYGIENE (continued)-. 
Cleanliness and Clothing 
Baths and Mineral Water* 
Sewage and Drainage . 
Infection and Disinfection 



968 
972 
983 

987 



SKIN DISEASES. . . ■ . .991 

BONE SETTEES AND « BONE SET- 
TING" . . . . . .997 

TABLE OF DOSES « . 1003 

INDEX 1013 






\ 



INTEODUCTION. 



Disease may be defined as being any condition of the organism which limits life in 
either its powers, enjoyments, or duration. This, we admit, is not a strictly 
scientific definition, but it is, we believe, as good a one as can be given in the present 
state of our knowledge. It is obvious that we cannot give a strictly accurate defi- 
nition of disease until we possess a satisfactory definition of " health," and this we 
are not likely to arrive at until we can express in words the idea that we entertain 
of the still more fundamental fact of " life." 

Fortunately for us it is possible to study the principles of health and disease, 
without being called upon to define what we mean by these terms. It is not always 
easy to express our meaning in a few set words, nor is it necessary that we should do 
so. We all understand that in health we recognise the natural or standard condition 
of the living body. We all know that it implies freedom from pain and sickness, and 
freedom from all those changes in the natural fabric of the body that endanger life or 
impede the easy, regular, and effectual exercise of the vital functions. Health does 
not signify any fixed and immutable condition of the body, for the standard varies in 
different persons according to age, sex, and original constitution, and even in the same 
person from week to week, and day to day. Health does not necessarily imply the 
integrity of all the bodily organs, for a man may be perfectly healthy who has lost 
an eye, or even an arm or a leg. If we can only form a clear conception of what 
we mean by health we shall have no difficulty in understanding what is meant by 
disease, for disease, as we have already seen, is some deviation from the normal 
standard of health. By disease we understand some uneasy or unnatural sensation 
which is manifest to the patient, some embarrassment of function which he or his 
friends may perceive, or some unsafe though hidden condition of which he may be 
quite unconscious. 

It should be borne in mind that by disease we mean the sum total of certain 
morbid changes that take place within the body. The mistake is often made of 
supposing that disease is a something which has a distinct entity, that it is something 
that is taken into the body, and may be cast out again by appropriate remedies. 
You often hear patients, and even doctors, talk of " driving the disease off through 
the kidneys," or "sweating it out of him." Many people seem to regard disease 
as being aomething which has distinct physical properties, something that can be felt 
and seen. It is common enough to hear people say that " he threw the disease off 
his stomach, just for all the world like a lump of currant jelly," or for them to use 
some expression showing equally conclusively that they regard disease as having a 
distinct entity. 

As has been very truly said, disease under all circumstances and to all degrees, k 



Xii INTRODUCTION. 



the lowering of life, and even in its most trivial forms it must be regarded a& the 
" shadow of death." Some diseases are, however, of very much greater moment than 
others. A corn is a disease, and so is a cancer, but they differ so widely in their 
effects on the constitution, that we seldom recognise the fact that they are both 
expressions of a damaged existence. 

We estimate the importance of a disease by the power that it possesses of 
limiting life in its utility, its enjoyment, or its duration. Some diseases have a 
tendency to cut short life suddenly, as, for example, certain diseases of the heart, and 
that frightful malady known as angina pectoris, or suffocative breast pang. Then 
other diseases, although they never arrest life suddenly, have a tendency to shorten 
its duration. Cancer is probably the best example of this class. Consumption not 
only shortens life, but sometimes, when copious bleeding from the lungs ensues, 
kills immediately. Then there are certain other diseases which, although they do 
not cut short life suddenly, or limit its duration, make it almost useless. Thus 
many a sufferer from chronic bronchitis or winter-cough is afraid to go out in the 
open air on a cold day, and an asthmatic is completely helpless as long as his attack 
lasts. Epilepsy is a disease which prevents the unfortunate sufferer from following 
many occupations. A man is, we will suppose, a carman, or a porter on a railway, 
and he has a fit He is forthwith discharged ; there is no help for it, the safety of 
others demands it. The fit may occur at any time and without a moment's warning, 
and it is impossible for hiin to obtain another place, for every one is afraid to employ 
him. The result is that he rapidly becomes reduced to a condition of poverty, and 
ultimately drifts into the workhouse. These cases are by no means uncommon, and 
several have come under our immediate observation. Here the disease has no 
tendency to shorten life, and is of importance simply because it prevents the sufferer 
from following his occupation, and makes him a burden on the working portion of 
the community. Then again, there are other complaints which are of importance 
simply because they interfere with the enjoyment of life. A man becomes hypo- 
chondriacal, he has nothing the matter with him, but he fancies he is suffering from 
all kinds of diseases. His life is a misery to him, and he is a nuisance to every one 
else. His condition in no way interferes with his capability of earning a livelihood, 
and he may perform his duties in the most exemplary manner, but his very existence 
is hateful to him. We estimate the importance of any particular disease by our 
power of placing it under one or other of the categories we have mentioned. 

The number of diseases from which a man may suffer in the course of a life- 
time is very great, and, indeed, if we include all their differences in kind and 
degree, is scarcely calculable. These diseases are, of course, recognised by distinctive 
names. The nomenclature of diseases is, to say the least of it, a very mixed one. 
Some time ago an attempt was made to introduce the binomial system into medicine, 
but the difficulties were insurmountable, and it had to be abandoned. The 
proposition was to give every disease a generic and a specific name, so as to make it 
assimilate with the nomenclature adopted in botany and zoology. The attempt, as 
we have said, was a failure, and on the whole we are not sorry for it, for we get 
along very well with our old-fashioned names and terms, many of which have been 
in use for centuries. It is very curious to notice in what diverse fashion* diseases 



THE NAMES OF DISEASE* 



have been named. Some are called after a prominent By. 
as whooping-cough and writer's cramp. Some are named 
present, as nettle-rash, small-pox, scarlet fever, and so i 
that the disease is characterised by a certain change occn 
organ or region of the body, thus we speak of bronchitis, wi 
the bronchial tubes, and of peritonitis or inflammation 
termination itis in these cases signifying inflammation. Th/ 
certain diseases end in cemia, as, for example, anaBmia, leucoc} 
bo on, the termination in these cases signifying that it is the bio 
at fault This is undoubtedly a bad way of naming a complaint 
diseases, such as small-pox and scarlet fever, there can be no doub. 
essentially affected. It occasionally happens that a disease is 
physician who first recognised it, or who devoted special attention . 
of its nature and treatment, and we have familiar examples of t 
disease and Addison's disease. 

The terms " functional," and " structural " or " organic," are 
employed in connection with disease that it is absolutely necessary tha 
arrive at some definite idea as to what we mean by them. We will r. 
any formal definition, but will endeavour to convey our meaning by one oi 
simple illustrations. In ulcer of the stomach and in cancer of the stomach a cer 
change takes place in the organ in question, which is at once recognised. There % 
something there which we can see and which we can feel. This is something 
tangible, something having distinct physical properties, something we can point to 
and say, this is the cause of death. Now this is what we call organic disease. 
But, on the other hand, a man may have suffered for many years from indigestion 
and marked derangement of the stomach, and yet after death the most practised 
anatomist, with all the means and appliances of modern science at his command, 
may fail to discover any change to account for them. This is what we call functional 
disease. To employ a very rough simile we may say that in the one case our engine 
is rusty and won't work, and in the other the piston is broken. As a rule an 
organic disease is of more importance, and is more likely to interfere with the 
duration of life than a purely functional one, but it is not always so. It may be 
more trouble to take the whole of an apparatus to pieces and clean it, than simply 
to restore one part that happens to have suffered. 

Then again we speak of " general " or " constitutional," and " local " disease, but 
this is not a strictly accurate division For example, we know that pneumonia is 
inflammation of the lungs, but it is absurd to call this a purely local disease. Look 
at your patient ; his face is flushed, his tongue is furred, his skin is hot, his pulse is 
quick, and, in fact, he is ill all over. It is not only the lung that is at fault, but 
the whole body is suffering. You must treat the man, and not the lung. Doctors 
too often forget that they have to treat the patient, and not the disease. Now 
take the case of gout. No one supposes for a moment that this is a local disease. 
No one would maintain that if we were to cut off the patient's big toe we should 
relieve him of his pain, or cure him of his malady. And so it is with many 
complaints that are supposed to be locaL The local signs or symptoms ar« 



• ,-T nTTEODUCTIOK. 



eneral constitutional disturbance. The whole brunt 
falls upon one particular part, but if that part were 
Isplay itself in some other region. 

ices that practical medicine has made during the last 

recognition of the fact that you cannot treat a local 

d the constitution of the patient For example, in 

& prognosis and treatment would be greatly modified by 

at the little one came of a consumptive stock, or was the 

} in Bright's disease our opinion would be influenced if we 

,id suffered from gout or syphilis. So in regard to many 

iccessful treatment of which a knowledge of the constitution 

diseases we recognise the fact that some make their entrance 

j. without, as, for example, scarlet fever, measles, and chicken-pox, 

ot be traced to external poisonous influences. A man has an 

xtism or gout, but we never suppose that he has caught it of any 

at it is something peculiar to his constitution, either hereditary or 

3 so-called local disease we classify according to the organ primarily at 

s we speak of. diseases of the nervous system, of diseases of circulation, 

, and so on. Then these may be further subdivided ; for example, in 

aseases we speak of affections of the brain, of the spinal cord, and of the 

. aow pass on to the consideration of the " etiology " or causation of disease, 
sometimes it is quite easy to discover the cause of a malady, or of any particular 
attack, and sometimes it is veiy difficult and well-nigh impossible. Let us take a 
very simple case, where the cause of the disease is readily recognisable. A child is 
brought into a room where some one is ill with scarlet fever, and after a certain 
interval the disease makes its appearance and runs its usual course. Here we have 
no hesitation in saying that the cause of the fever was contagion — the child caught 
it. But it must be remembered that if half a dozen children had been taken into 
the sick-room, they in all probability would not all have caught it, some would have 
escaped, though they had never had it before, and were equally exposed to the infec- 
tion. Tnis is quite in accordance with our general experience, for we know that 
there are certain people or certain constitutions apparently unsusceptible to -certain 
poisons. There are people who have been vaccinated over and over again, but who 
" never take," however often it may be tried, or however varied may be the source 
from which the lymph is obtained. Then, again, physicians know that among the 
students in the fever-wards the slightest exposure will in certain instances ensure 
an attack, whilst others, even more diligent in their attendance on the sick, escape 
altogether. There is even in some families a certain proclivity to fever, of which 
probably most of us have met with examples, whilst others escape from even the 
closest exposure to concentrated contagion. How do we account for this 1 What 
is the explanation of it 1 We don't know. All we can say is that certain people 
are " predisposed " to certain kinds of disease, whilst others are indisposed, or not 
predisposed. When a person has already suffered from a fever, we know that he 



THB 0AT7SJLTI0W OT D»,A«IL XT 



is " protected n from a second attack, or no longer predisposed to take it again, but 
this absence of predisposition is undoubtedly present in many instances where there 
has been no previous attack. These constitutional peculiarities, if we may so term 
them, are not unknown in other departments of nature. On some sunny slope, weU 
drained, and well exposed to wind and rain, uniformly cultivated and manured, 
sown with the same seed on the same day and by the same hands, we find inequality 
of produce ; the fair expanse is marred by some one spot where the crop is 
dwarfed, insufficient, or altogether absent. We cannot account for this, for it may 
occur at some spot where on former years there has been from the same materials 
of labour and seed an abundant result, nay more, where next year or a year or two 
later there may be, under identical circumstances, an exceptionally fine crop. From 
this it would appear that there must be something more than a prepared soil and 
healthy seed, something more than an intense contagion and direct exposure to its 
influence, and this something we call " susceptibility or predisposition." 

In many instances it is very difficult to say what the cause of a disease has been. 
For example, a child is attacked with St Vitus's dance ; there has been no previous 
illness, we cannot learn that the child has been frightened, and we are absolutely in 
the dark as to why those peculiar symptoms should have made their appearance. 

Then again the same cause is in different people often followed by very different 
results. For example, half a dozen people partake of an indigestible meal, one of 
them is none the worse for it, a second suffers from indigestion, & third has a fit, a 
fourth gets an attack of gout, a fifth has an attack of asthma, whilst the sixth has 
diarrhoea. Here the exciting cause, the indigestible meal, is the same in all, but the 
results are widely different, and we say that this depends upon the constitution. 
We recognise the fact that certain people are liable to suffer from certain diseases, in 
other words, they are subject to them, and anything that throws them off their 
equilibrium is likely to induce an attack of the disease to which they are " pre- 
disposed." 

We must now consider briefly what are the predisposing causes of disease. 
Some people are hereditarily predisposed to certain complaints. The son of a gouty 
parent is very likely to become gouty unless he specially guards against his 
predisposition by strictly abstemious habits. Cancer is more or less hereditary, and so 
is consumption That consumption may be transmitted from parent to child is one 
of the best-established facts in medicine. The extreme frequency of consumption in 
some circumscribed country districts is, in part at least, explicable by the frequency 
of intermarriage amongst persons living in such districts ; and conversely, the 
exemption of particular circumscribed districts from this disease is in part due to 
the same cause. In the one case, from some special circumstances, consumption has 
been introduced into the district, and then spread in it from frequent mtermarrying. 
In the other case, the freedom of the district from the disease at any given time is 
the cause of its continued freedom. Intermarriage of the inhabitants, the disease 
being present, spreads it far and wide, intermarriage of the inhabitants, the disease 
being absent, prevents its introduction. This circumstance has not been sufficiently 
recognised in estimating the causes of the relative frequency of consumption in 
different localities. 



tM IITTRODUCTIOI. 



Syphilis, as we all know, is communicated by the parent to his offspring, and 
a frightful legacy it is. The mystery of original sin, the punishment " to the third 
and fourth generation," are paralleled and vindicated by the observations of the 
physiologist. On the other hand, certain diseases are not in the slightest degree 
hereditary. A man may suffer for years from most distressing dyspepsia, and yet 
his children may exhibit no predisposition to stomach disturbance. Why certain 
diseases should be transmitted and others not we do not at all know. We all 
recognise the fact that certain conditions of the body are transmissible, that a son 
may exhibit, not only the features, but the tone of voice, and even the very walk of 
one of his parents. Hereditary transmission enters into the moral as well as into 
the physical order of the world. It is common enough to hear it said of a man, 
that he is a " regular chip of the old block," and we all believe more or less in family 
likenesses, and that certain peculiarities of feature run in families. We say that a 
boy has " his father's nose," or " his mother's eyes," as the case may be. 

Then, again, we know that features, form, frame, peculiarity of constitution, 
susceptibility to certain agents, not to speak of character, mental and moral, the 
passions and the intellect, are often derived from progenitors many steps upwards 
in the ancestral tree. Individually we are combinations of many ancestors. The 
actual traits of the parents may or may not be seen in their offspring, and it is more 
common to find that one or two only are represented in each child. The remainder 
are doubtless derived from some ancestor long forgotten, whose intellectual powers or 
defects, infirmities or vigour of body, whose faults and follies, whose brilliant powers 
or miserable failings, may be reflected in a remote descendant, as he himself has 
derived them from some distant ancestor. We are accustomed to say that gout may 
skip a generation, and why may not it skip four or five 1 Hereditary tendency is 
probably of far more remote origin than is commonly supposed, and is a reflection of 
the tendencies of untold numbers who have preceded us in the family tree. It is & 
frightful thing thus to look back on the sins of our forefathers and to recognise the 
transmitted punishment, but it is in accordance with other facts of moral origin and 
highest dictation. 

It is sometimes asserted that when people live together, or are intimately asso- 
ciated, they grow like each other, and we know that school-boys are apt to catch any 
peculiarity of habit or expression of their tutor or schoolmaster. This is undoubtedly 
the case, but it is a very different thing from heredity. Physical peculiarities 
acquired accidentally are not transmitted. A man loses a leg, but hi* children are 
born with their proper complement. For generations past it has been customary to 
cut off the ears and tails of certain breeds of dogs, but it has not resulted in the 
establishment of a race of animals unfurnished with these useful appendages. On 
the other hand, when by a curious freak of nature a man is born with a supernumerary 
finger or toe he may transmit this peculiarity to his children. It sometimes happens 
that children of one sex exhibit an hereditary taint whilst those of the opposite sex 
escape it. The boys " take after " the father and the girls after the mother, and a 
tendency to disease may be more or less powerful as the child resembles one or other 
parent. 

It would seem that certain conditions have a tendency to develop the hereditary 



HEREDITARY DISEASE, XYli 



taint. Privation, excesses, errors in habits of life, sedentary occupations, the 
pernicious influence of certain trades, grief, anxiety, and the other wasters of vital 
power, are undoubtedly important factors. The development of a constitutional 
predisposition is favoured by those errors of life, those sins against natural laws 
which we are all of us committing so frequently. To this class belong all excesses 
which waste the vital powers ; undue carefulness and anxiety, over-watching, the 
exciting race after wealth and distinction, and the ineffectual struggle against 
poverty. The over-nursed in close and luxurious chambers; the student outstepping 
his powers on a short Alpine holiday ; the sorely -taxed governess, toiling all day and 
sitting up half the night to enjoy the luxury of solitude and converse with books 
and absent friends ; the scantily-clad lady undergoing, in ill- ventilated rooms, the 
dangerous excitement of the ball ; — these are all labouring thoughtlessly to prepare 
the way for the development of any latent but hereditary taint to which they may 
be subject. 

Diseases that are hereditary usually make their appearance at a much earlier age 
than when acquired. Gout, for instance, is extremely rare before the age of twenty, 
but in cases of marked family predisposition it may be met even in boys at school. 
The mistake is often made of supposing that because in a certain case a disease is 
hereditary there is little or nothing to be done for it in the way of treatment. On 
the contrary, so far from relaxing our efforts to effect a cure, we should treat it all 
the more promptly and energetically. 

Strictly speaking, age cannot be said to constitute a predisposing cause of disease, 
although it carries with it certain things which may be. We meet with people of 
all ages who are free from illness and discomfort of any kind. It is not uncommon 
to hear a man say that he has not had a day's illness for the last forty years. We 
might conceive the possibility of a person passing from the cradle to the grave with- 
out suffering from anything but the most trivial ailments. Practically, such instances 
are not often met with, for at some point or other in the long course of life, the 
chain of good succession is broken by a faulty link or an unexpected blow, and then 
follow one or other of the many ills that make up the miseries of common life and 
average health. 

Although age is not per se a predisposing cause of disease, there are certain 
disorders which are far more common at some periods of life than at others. In 
infancy there is very little power of resistance, and a very slight disturbing force 
will serve to upset the equilibrium of health. Infants have but little power of 
maintaining the bodily temperature, and if exposed to cold suffer much more than 
adults. Errors of diet readily irritate the delicate mucous membrane of their 
stomach, and they are especially liable to suffer from diarrhoea. Then, again, the 
process of teething is often accompanied by convulsions and other signs of marked 
disturbance of the nervous system. In boyhood there is, on the one hand, the risk 
of accident resulting from high animal spirit unrestrained by discretion, and 
on the other the fear of excessive mental labour, as in working for examina- 
tions and other objects of early ambition. Later on, when he comes of age, 
toe is anzisais about his future prospects, about the profession or business 
he is about fee «nter, and for which he is preparing, and there are many 
b 



xviii nrrsoDucnox. 

temptations of all kinds to which a young man is exposed, often without 
the power of resisting them. Still a few years later he has a wife and family to 
Drovide for, and realises the fact that the struggle for wealth and honour, and even 
for very existence, is a hard one. Between forty or fifty he has made his mark or 
has failed in the attempt ; in the former case he relaxes his efforts, takes things 
easily, and does his best to enjoy the reward he has so dearly won ; in the latter 
case he is crushed, and soured by his want of success, and suffers not only mentally 
and morally, but also physically. In old age the strong man becomes a child again, 
and is once more dependent on the kindness and attention of those about him ; as 
at the other extremity of life, he is peculiarly susceptible to cold, and if not properly 
cared for, his small remnant of vitality is readily extinguished. It will be seen that 
these circumstances must of necessity exert a powerful influence on the diseases 
which are incidental to the different periods of life. 

Sex can hardly be said to be a predisposing cause of disease, although 
undoubtedly many diseases occur far more frequently in one sex than the other. It 
is sometimes said that every disease is common to both men and women, but this 
is not quite true ; for instance, no one would maintain the proposition in the cases 
of diseases of the womb. Hysteria is almost confined to women, although undoubted 
cases are occasionally met with in men who have been pulled down by excesses 
either of work or the reverse. Hypochondriasis, on the other hand, is seldom met 
with in women, and it would seem almost as if these two complaints had made a 
compact to respect each other's territory. Clergymen's sore throat is chiefly a man's 
disease, but ladies who have to speak or sing in public often suffer from a closely 
analogous complaint. 

The nervous, mental, and moral endowments of the two sexes are more or less 
influenced by social considerations, and the customs and habits of society. Women, 
as a rule, stay at home, men go out to business ; women devote themselves to 
individuals, men to principles. The woman's life is sedentary, the man's active." — In 
women functional disturbances of the nervous system predominate. How all this 
would be if the woman went in for a more active life, and the man stayed at home to 
nurse the baby, we cannot say, but there is no doubt that if women were brought up 
in a more manly fashion there would be less hysteria. We have no hesitation in 
saying that as far as their physical well-being is concerned it would be much better 
for girls if they were more frequently treated like their brothers. Before the age 
of thirteen or fourteen, the difference between the sexes is comparatively slight, and 
many a young lady would be considerably benefited if she were made to run, and 
walk, and swim, and row, instead of being prevented from taking healthful exercise 
and recreation. 

It is a curious circumstance that women far more frequently have a second 
attack of scarlet fever, measles, and other acute diseases than men. It is possibly 
explicable by the circumstance that they are more frequently brought into intimate 
contact with children. 

One of the commonest predisposing causes of disease is drunkenness, that fierce 
rage for the slow and sure poison that oversteps every other consideration, that 
casts aside wife, children, friends, happiness, and station, and hurries its victims 



TEMPERAMENT. XIX 

madly on to degradation and death. Some are impelled by misfortune and misery 
to the vice that is ruining them — the failure of worldly expectations, the death of 
those they loved, the sorrow that slowly consumes, but will not break the heart, 
drives them to it, and they present the hideous spectacle of madmen dying by their 
own hands. Others with open eyes plunge into the gulf from which he who once 
enters never rises more, but sinks deeper and deeper down until recovery is 
hopeless. 

Temperament is not without its influence on disease. We all recognise the 
existence of different varieties of temperament ; even the least observant mentally 
contrasts the typical nervous, excitable Frenchman with his dull, heavy, phlegmatic 
Dutch confrere. Many temperaments are readily recognisable. First, there is the 
man with sanguine temperament ; he is quick and lively in his manner, has an 
excitable pulse, a florid skin, a flushed face, eats and digests well, and sleeps quickly. 
He is generally thought to be predisposed to inflammation, but this is not so in 
reality, and almost the only thing he is especially likely to suffer from is an accident, 
the result of his pluck, daring, and impetuosity. Then there is the man of phlegmatic 
or lymphatic temperament, with his cold hands, pallid skin, and fair complexion. 
He usually eats well, has a fair amount of ability, and a cool, calm, calculating dis- 
position. He is rather liable to suffer from the effects of cold, and in winter often 
has chilblains. Next there is the bilious or melancholic individual ; he is usually dark, 
both physically and mentally ; he has dark hair, and dark eyebrows, and a sallow 
complexion. He is a heavy sleeper, and is often languid and tired. He suffers 
from disturbed digestion, a coated tongue, constipation, and flatulence. He is not by 
any means a good patient, and when he gets typhus or typhoid fever it is apt to go 
hard with him. Lastly, there is the nervous man, fidgety, restless, easily excited, 
easily depressed, up one moment and down the next. He is impulsive, but soon 
gets tired of his hobby, and takes up something elsa He is usually a short sleeper, 
and any excitement or anything wrong with his affairs will often keep him awake 
all night. He is a likely Bubject for tic and spasm of all kinds, and is on the whole 
not an unlikely person to become hysterical. These are the chief forms of tempera- 
ment, but it must be remembered that two or more may be combined in the same 
individual. Fortunately, we are not all built on one of these four types. 

In connection .with temperament, we must explain the meaning of " diathesis." 
It means almost the same as temperament, but is a newer word. It is often used 
in a vague way, and without any very definite meaning. When we speak of a man 
as having the gouty diathesis, we generally intend to convey the idea that he is a 
middle-aged, full-blooded, red-faced individual, who is likely at some time or other to 
become the subject of gout Many doctors make a point of always treating the 
diathesis. Thus, in the case we have supposed they would always give the patient 
colchicum, whatever he might complain of 

For the maintenance of health, it is necessary that the body should receive a 
definite supply of food. When people are below par from defective feeding, they are 
very liable to contract contagious diseases from the slightest exposure to infection. 
It is a good practical rule not to go into a room where there is fever on an empty 
stomach. Army doctors know that if u battle is fought before breakfast, or after % 



INTRODUCTION. 



long-sustained fast, the wounded are far more likely to suffer from lock-jaw. It is a 
good plan to serve out rations before an engagement, if possible ; the worst stomach 
for a fight is an empty stomach. Then, again, in civil life, we constantly find that 
the over- worked and poorly-fed supply the largest number of cases of hysteria and 
neuralgia. How frequently neuralgia is met with in half -starved needlewomen! What 
half these people want is food, not medicine. Even among the middle and upper 
classes of society there are many people who fail to take enough food, although, it 
must be confessed, that usually the fault is the other way. Many people do not 
eat simply because they take little exercise, and have no appetite. Many perforce 
lead solitary, sedentary lives, and will not eat simply because they are alone, and 
they are tired of seeing the same things and same kinds of food put on the table day 
after day. There is no doubt that bad cooking has a great deal to answer for as a 
predisposing cause of disease. Many people go without food from religious motives, 
and those who do this are usually the least fitted for the strain that it involves. 
Many people take absolutely enough food, but take no care to ensure variety. Some, 
for instance, never take fruit in any shape or form. They regard it as a luxury ; it 
is not put on the table habitually, and they never think about it. Then, again, 
many people never eat fat, and this is especially the case with those who have a 
tendency to consumption. Children very commonly cut off the fat from their meat, 
and leave it on their plates. They should be encouraged to take a fair proportion 
of fat with their food, but if they show a positive dislike to it, it is of no use trying 
to force them. Even when hot fat cannot be eaten, the fat of cold meat is often 
relished and easily digested. People who have a tendency to consumption should 
take plenty of butter, and more especially milk. Consumptives often take as much 
as eight pints of milk in the twenty-four hours with decided advantage. It should 
be remembered that the milk is then to be used as an article of diet, and not for the 
purpose of relieving thirst, and it should be taken at regular intervals like the meals, 
and not in a hap-hazard fashion. We believe that no better plan could be adopted 
in threatened consumption than (where means and the season of the year permit) to 
take up a summer residence in the Adirondacks, N.Y., in some of those numerous 
open valleys, in the pure air of the middle region, where the pastures are rich, and 
with daily exercise in proportion to strength to try the ingestion of large quantities of 
milk of the purest quality. For people who will not take fat in other forms, fat 
bacon for breakfast will often supply the want. White haricot beans or lentils with 
rich butter sauce often, in these cases, form a valuable article of diet. Many indi- 
viduals, if they fail to get their proper quantum of food, get weak, not only of muscle 
and nerve, but also mentally weak. Some people do well on what is called 
" Bantingism," whilst others suffer considerably under this regimen. Some 
people get fat on the most abstemious diet, whilst others are always eating, 
and as their friends say, never seem a bit the better for it. The absence of 
vegetables, or of the vegetable acids in some form or other, is a powerful 
predisposing cause of scurvy. Many people, especially women, do not take enough to 
drink, and suffer, in consequence, from constipation. As we shall see when we 
come to speak of this complaint, even long-standing torpidity of the bowels may be 
removed by the practice of taking a tumblerful of cold water the first thing in the 



THE GERMS OF DISEASE. Zzl 



morning. An absence of salt produces an unhealthy condition of the skin, and, it is 
supposed, has, at all events in damp countries, like Holland, a tendency to favour 
the development of worms. Then, again, there may be a deficiency of another kind 
of food, for the patient may not get enough fresh air, and oxygen is even more 
important for the maintenance of life than beef and mutton. "We know that many 
vegetables, when grown in the dark, lose their colouring matter, and we know how 
pale and flabby people become who spend their lives in underground, badly-lighted, 
ill-ventilated kitchens and cellars. In our large over-crowded cities, and more 
especially in the metropolis, it is no unusual thing to find from seventeen to twenty 
people living, eating, and sleeping in a room not more than ten feet square. The 
filthy and miserable appearance of many parts of large cities can hardly be imagined 
by those who have not witnessed them. Dickens's description of a London slum is no 
exaggeration, as we can testify. " Wretched houses," he says, " with broken windows, 
patched up with rags and paper ; every room let out to a different family, and in 
many instances to two or even three — fruit sellers and ' sweetstuff ' manufacturers in 
the cellars, barbers and red-herring vendors in the front parlours, cobblers in the 
back, a bird-fancier on the first-floor, three families on the second, starvation in the 
attics, Irishmen in the passage, a * musician ' in the front kitchen, and a charwoman 
and five hungry children in the back one — filth everywhere — a gutter before the 
houses, and a drain behind — clothes drying and slops emptying, from the windows, 
girls of fourteen or fifteen with matted hair, walking about barefoot, and in white 
great coats, almost their only covering ; boys of all ages, in coats of all sizes and no 
coats at all ; men and women, in every variety of scanty and dirty apparel, lounging, 
scolding, drinking, smoking, squabbling, fighting, and swearing." Even people who 
work chiefly by artificial light, as miners and post-oflice sorters, suffer from a chain 
of evils which soon bring them below par. They become nervous, depressed, and 
low-spirited, and in the long run often take to drink. 

There are certain diseases distinctly due to the introduction of some deleterious 
matter into the system either with the food or air. We are not now referring to the 
slow poisoning produced by the inhalation of minute particles of arsenic given off 
by arsenical wall papers, or to other similar cases where the injurious effect is the 
result of some recognised animal or vegetable poison. We mean rather those 
equally deadly, but far more subtle poisons, which are the cause, or supposed 
cause, of many of our fevers, as cholera and typhoid. It has been conclusively 
proved that the germs of typhoid may be introduced into the organism by means of 
impure water, and that the poison of cholera and some other diseases may be carried 
for immense distances by currents of air. What the exact nature of these germs 
may be we do not actually know, we have not been able to isolate them, or to 
recognise them by any chemical or microscopical test, and know them only by the 
startling effects they produce on the animal economy. We all know that many 
diseases are contagious, that is, are capable of being transmitted from one person to 
another. It would serve no useful purpose to discuss the primary origin of the 
various contagious poisons, or their capability of being re-developed if once 
exterminated. It is probable that now-a-days the development of any case of 
contagious disease de novo is infinitely rare, and that in nearly every instance it 



zxii anmo-o&m&a 

has been communicated from some other person suffering in a siteHar K.*nn«r. 
When small-pox, for example, breaks out in a house we all believe that it has beea 
caught from some one else, and if we fail to discover the mode of communication we 
see no grounds for altering our opinion, but believe that in that individual case our 
information is defective. The majority of contagious affections with which we have 
to deal are communicated from one human being to another, whilst a few, such as 
hydrophobia and glanders, are communicated by the lower animals. It has been 
suggested that possibly the poisons of some contagious diseases may be derived from 
plants, but no conclusive evidence has been adduced in support of this view. The 
contagious particles must exist under many different forms, and be given off in 
many different ways. Some affections are caused by obvious parasities, and of this 
we have familiar examples in itch and ringworm. Most of our contagious poisons 
have no palpable existence, but are given off in the various exhalations and 
excretions of the body, but especially in those emanating from the lungs and skin. 
Some are supposed to exist in the breath alone, as in the case of whooping-cough, 
whilst others seem to be present in all the exhalations. Hydrophobia is an instance 
of a contagious malady transmissible only through a special secretion — the saliva. 

Many contagious affections are conveyed from one individual to another without 
the necessity for any immediate contact between them. The contagion is given off 
into the surrounding atmosphere, and thus passes to the unaffected person, being 
inhaled, or swallowed, or absorbed by the skin. Diseases that can be thus com- 
municated are said to be " infectious," whilst the term contagion is usually limited 
to instances in which the disease is communicated by actual contact. The contagious 
principle often becomes attached to articles of clothing, bedding, hair, and so on, and 
in this way disease is propagated. These particles retain their vitality or activity 
for immense periods of time, and may in this way originate several epidemics at 
long intervals. Persons passing between the sick and healthy often carry a conta- 
gious disease to the latter. A contagious poison may also be conveyed by clothes 
sent to the wash, or sent home from an infected school, or by letters, cabs, and 
numerous other agencies. The careless manner in which many people help to pro- 
pagate infectious diseases is something startling. We recently heard of the case of 
a lady who left the bed-side of a child suffering from scarlet-fever, took a cab, and 
went to church, probably sitting side by side with healthy unprotected persons. The 
contagious principle often becomes attached to furniture, or to the floor and walls of 
rooms, and thus infection may arise after an indefinite interval, if the precaution 
has not been taken of having the apartments properly disinfected. It has been 
asserted that flies and other insects may be the means of disseminating contagious 
diseases, by alighting first on infected and then on healthy individuals, and such a 
mode of propagation is quite possible. There are marked differences with regard 
to the facility and certainty of transmission of contagious diseases. For example, 
scarlet fever is less contagious than measles or whooping-cough, but far more so than 
either typhus fever or dipththeria. The probability of a contagious disease being 
communicated is in direct proportion to the dose, that is to the quantity and strength 
of the poison which reaches the system, but it must be remembered that in many 
instances a very small quantity sufiicea. Most contagious poisons are destroyed bj 



EPIDEMICS, XYiil 

extremes of temperatures, hence the rationale of baking clothes and boiling linen 
which has been in use in the fever-room, and the explanation of the disappearance 
of many epidemics during the colder months of the year. Many of these poisons are 
also destroyed by disinfectants, such as chlorine, and the vapour of burning sulphur. 
Their intensity seems to increase with overcrowding, as in those horrible " fever 
dens " of which we hear so much. 

We have mentioned the term epidemic. By an epidemic disease we mean one 
that travels from place to placa Cholera is a striking example of an epidemic 
diseasa It is always present on the banks of the Ganges, but at times it breaks 
its bounds, and travels all over the civilised world. It usually travels along the 
lines of human intercourse, and its rate of progress varies considerably in different 
epidemics. It may take two or three years to spread from India to America, or 
may do so in as many months. It is said that epidemics travel very much faster 
than they used to, but that even now in Russia, where in many places human inter- 
course is very limited, their progress is comparatively slow. Epidemics usually 
make their entry in this country at either of our large sea-ports. Sometimes an 
epidemic of cholera will miss certain places apparently on its direct line of march, 
and then go back and invade them later. Sometimes an epidemic of cholera dis- 
appears abruptly after a high wind, just as if it were blown away : but generally it 
departs slowly and gradually, and in a manner more compatible with its dignity. 
Cycles of epidemics are sometimes observed, one disease being after a time followed 
by another, this by a third, and so on. 

Some diseases are not epidemic at all, but are what is called endemic — that is, 
they confine their attention solely to their place of origin. If you want ague you 
will have to go to it, it will not come to you. Endemic diseases never spread from 
one person to another, and never go away from the locality except in the person of 
the individual. 

We have shown that for the maintenance of health it is necessary that certain 
things should be taken into the body, and it is equally essential that certain other 
things should be given off from it All waste materials must be got rid of, for if 
retained they would soon interfere with the working of the delicate mechanism of our 
organisms. The non-elimination of the urine for even twenty-four hours would be 
attended with the most serious results. Many people neglect their bowels, and the 
result is that the health always suffers sooner or later. We all know the untoward 
symptoms occasionally following a " sudden chill," or in other words, following 
arrest of the functions of the skin. Illness is occasionally produced by the abrupt 
cessation of some long-accustomed discharge. Women whose periods have been 
arrested by cold or exposure often suffer severely for some days subsequently. It 
is the rule in animal life that a certain amount of work must be done in return for 
the crude force taken into the system in the shape of food and drink. 
If a man were to take his accustomed quantum of food, but instead of 
working were to remain in bed all day, and do nothing, he would quickly suffer for 
it. The muscles of the limbs, if not used, very soon waste away, or get converted 
into fat. People who, although they may not remain in bed all day, take too little 
exercise, are seldom in really good health. They get fat and bloated, the extremities 



XXTV INTRODUCTION. 



are cold and flabby, the circulation becomes irregular, and there is considerable 
shortness of breath. In addition, they get loss of appetite, dyspepsia, flatulence, 
palpitation, and all manner of evils. The only thing is to make them take more 
exercise. Plato had such a high opinion of exercise that he said it was a cure even 
for a wounded conscience. A distinguished London physician recently stated that 
no young man could hope to keep in " good form " who did not walk at least ten 
miles a day, or take an equivalent amount of muscular exercise in some other form. 
Many people say that they cannot do this because they have not time, but attention 
to health is very good economy of time. Then, again, in addition to physical work, 
a man must do a certain amount of mental labour, for if he doei not his intellect 
soon suffers. It is often said in the case of a delicate child that he or she should not 
be allowed to read or learn anything, and that the brain must be kept quiet That 
is all nonsense ; you cannot put the brain up in a splint, as you would a broken leg. 
The brain is incessantly working, and it would be all the better for having some 
healthy employment. Of course, what it wants is gentle exercise, and care should 
be taken that it is neither over-worked nor reduced to a state of stagnation. Then, 
again, when a man has been over- worked, he is told he must go down in the country 
and keep quite quiet, and not do anything. The result is that his life is a misery 
to him ; he has been an active, busy man all his life, and now you cut him off from 
his old friends, his letters, his paper, and, in fact, everything that makes his existence 
enjoyable. The time hangs heavily on his hands, the days are like weeks, and the 
weeks pass like years, and the result is that he soon gets heartily sick of it, and 
instead of getting any better, rapidly gets worse. No, what you want to do in a 
case like this is to change his mental sphere, and not to knock off his work alto- 
gether. Try and get him to take an interest in farming, in the rotation of crops, 
botany, zoology, geology, archaeology, agrarian outrage, or anything he likes, but, 
at all events, give him something to do that he can take an interest in, and do not 
leave him to wander about all day with his hands in his pockets. This is apropos 
of the necessity for brain-work in some shape or other. 

We have pointed out the necessity for the elimination of certain materials from 
the blood, but this elimination must not be excessive. It may be very good for a man to 
have a motion every day, but it does not follow that it would be twice as good if he 
had two motions daily. Excessive elimination is always an eviL Nothing more 
quickly pulls a man down than persistent diarrhoea Women whose periods are 
too profuse are seldom healthy, and it may be stated in general terms that an 
excessive or long-continued discharge of any kind has a tendency to reduce the 
vital power. Over- work is another form of excessive secretion of force. We know 
that by the inordinate use of certain muscles, or sets of muscles, we may get either 
spasm or wasting. Of this we have examples in the diseases known as writers' 
cramp and wasting palsy. Then the over- work may be mental rather than physical. 
It would seem that some people are not adapted to all kinds of mental work, and it 
is probable that in many of ua certain faculties practically remain undeveloped. 
Many people who are good classics could not work the simplest problem in Euclid 
to save their lives. If a man has no capacity for doing a certain thing it is useless 
to try and make him do it If a man wants to be soldier, it k no good trying fee 



WOE* A2TD QTMiWCMUL m 



drive him into the church. This is a mistake that parents often make, and the 
results are usually disastrous. 

The amount of work some people get through ia simply enormous. Few people 
are harder worked than a family physician in active practice. We know a doctor 
who seldom gets more than four hours' sleep out of the twenty-four. He says that 
it is not that he couldn't do with more, but it is as much as he can get. Many busy 
men are constantly at work of some kind or the other from eight in the morning 
till past twelve at night. Some of course break down, but others can do this year after 
year, apparently without any detriment to their health. Instances are known of 
professional men who have not slept for five days together, and who have not been 
in bed for three weeks at a time. These sound almost like travellers' tales, but they 
are true, although, of course, they are exceptional cases. It is astonishing what 
interest and energy will do, in enabling a man to dispense with rest. It has been said 
that the twenty-four hours might be advantageously divided into three equal parts, 
eight hours for sleep, eight for meals, exercise, recreation, &c., and eight for mental 
work. Few men really require more than eight hours' sleep, but the majority of us 
have to do considerably more than eight hours' work in the day. It is not so much 
that a man wishes for the work, as that it is forced upon him. He, perhaps, is the 
only person who can perform a certain duty, and when, as is often the case, it is a 
question of life and death, it is almost impossible to refuse. Many people can never 
force themselves to do more than a certain amount of mental work, they get 
nervous, and headachy, and then is it all over with them. Forced work, as a rule, 
tells on a man much more rapidly than purely voluntary work, for in the former 
case it is usually associated with anxiety. Real over-work gives rise to loss of 
memory, a general sense of fatigue, and particularly of discomfort about the head, 
poorness of appetite, lowness of spirits, and other similar symptoms. It is worry 
that injures more than real work — care killed the cat. Some people are so happily 
constituted that they never worry much about anything, whilst others are in a fever 
of anxiety on every trivial occasion. 

To get the maximum amount of mental work out of yourself you must be very 
abstemious in everything. You will find that men who by their brains have made a 
name for themselves have nearly always been small eaters and drinkers. Some of 
the finest scientific work of the century was done by a man who at the time was 
living almost exclusively on oatmeal porridge. The custom of taking a heavy meal 
in the middle of the day is fatal to all real work. People who have to live by their 
headpiece should never dream of taking either wine or beer for lunch. It is a small 
matter, but practically they will find that they can do twice as much in the afternoon 
if they substitute a cup of coffee for the alcohol. People who feel drowsy and 
stupid, and disinclined for mental exertion after a meal, may take it as an indication 
that they have been either eating or drinking too much. At the same time 
there is not the slightest objection to a glass of beer or a glass or two of wine with 
dinner after the greater part of the day's work is done. Those who are worried 
about tneir work may derive considerable comfort from a cigar or pipe. There is no 
reason why we should not avaii ourselves of Nature's gifts, provided the^ in no way 
impair our capacity for work. For those who have much writing to do the practice 



JJLV1 INTRODUCTION. 



of getting up early in the morning is a most valuable one. Yoa are fresh, and are 
quite sure to be free from interruption. In summer it is very enjoyable, and even 
in winter one soon gets used to it. It is just as easy to get up at four or five as it 
is at half -past eight. Some people display considerable anxiety to have the world 
properly aired before they abandon the welcome refuge of the bed-clothes, but when 
a man has work to do the sooner he sets about it the better. Barristers, statesmen, 
doctors, litterateurs, and theologians often suffer most frightfully from the effects of 
over-work. Too frequently a man cannot give up a part of his work without giving 
up the whole of it He must either do it or throw it up entirely. Sometimes, 
however, little modifications in the details of work will afford considerable relief 
Sometimes a man may be able to sleep out of town, even if he cannot do anything 
else. Or why should not he take his books, or his picture, or whatever it may be, 
into the country and work there for a month or two 1 Even when this cannot be 
done, some assistance might possibly be obtained in the more mechanical parts of his 
work. Why should he not get some one to read to him instead of reading himself ? 
Or why should he not get some one to write his letters and papers from dictation 
instead of wielding the pen with his own hand 1 One of our most accomplished 
novelists dictated some of his finest passages before getting up in the morning. A 
good shorthand writer is in many of these cases an invaluable aid. Of course this 
involves a certain pecuniary expenditure, but when people have bo much to do their 
incomes are usually proportionately large. 

This, then, concludes our account of the causation of disease, and we now proceed 
to the consideration of what we call "symptoms." This is a term which is in 
constant use, and one which hardly requires explanation. A simple example will 
serve to illustrate its meaning. A man gets an attack of rheumatic fever, and we 
say that his chief symptoms are high temperature, quick pulse, thirst, loss of 
appetite, profuse perspiration, and pain, swelling, and redness of the joints. These 
are, of course, parts of the disease, but we call them symptoms, because it is by their 
occurrence that we are enabled to recognise the nature of the disorder from which 
the patient is suffering. We sometimes speak of " premonitory n symptoms, by 
which we mean the earlier symptoms of a disease which indicate that the patient is 
ill, but are not sufficiently characteristic to point out the nature of the complaint. 
For instance, a child may be suddenly seized with shivering or vomiting, and on 
examination he may be found to be very feverish. Now these symptoms are pre- 
monitory of many diseases, and all we can say is that the child is "ailing for 
something," and that it is probably going to have scarlet-fever or measles, or some 
other acute illness. 

Then, again, we talk of " subjective " and " objective " symptoms. A subjective 
symptom is one that the patient communicates to the doctor, whilst an objective 
symptom is one that the doctor can find out for himself. For instance, a patient 
says that he suffers from palpitation and pain in the left side, these are subjective 
symptoms, but if the doctor listens to the chest, and finds that the heart is beating 
irregularly, or that the sounds are not clear, these are objective symptoms. Doctors, 
as a rule, prefer forming an opinion as to the nature of an illness on objective 
symptoms rather than on subjective. In many hospitals, naore particularly those 



THE SYMPTOMS OP DISEASE, XXVl! 



which are called the " special " hospitals, the patients are asked hardly any 
questions, but are examined straight off. For instance, a patient goes to 
a throat hospital, it is taken for granted he has a bad throat, and that organ 
is at once examined. In the same way, at a hospital for consumption the 
physician wastes no time in asking the patient if he has a cough, but at once 
proceeds to sound the chest. If there is nothing wrong with the heart or lungs, 
then comes the question, " What are you complaining of 1 " And so it is with 
skin diseases, the doctor looks at the rash, recognises its nature, perhaps asks one 
or two simple questions respecting its duration, and prescribes the appropriate 
remedy. In some instances the symptoms are purely subjective. A woman, for 
example, is» suffering from a bad attack of neuralgia or tic ; the agony may be intense, 
and she may be able to describe her symptoms most graphically, but there is 
nothing at all to be seen. Malingerers practically appreciate the difference between 
these two kinds of symptoms. A prisoner who shams ill with the view of getting 
off hard labour knows that if he says he has rheumatism, or lumbago, or sciatica, 
he is pretty safe, and that it is very difficult to prove that he has not, whilst if 
he were to pretend that he had a violent cough, an examination of his chest would 
at once demonstrate the absence of disease, and lead to his detection. 

As a general rule, then, objective are much more valuable than subjective 
symptoms, but the importance of the latter may sometimes far exceed anything 
that the doctor can learn by direct observation. In the early stages of some 
serious diseases of the heart or brain nothing wrong can be detected by the most 
practised ear or eye, and yet the patient speaks of a deep unrest or sudden 
horror, which, although it has no objective sign, may be the herald of a sudden or 
lingering illness. In medicine, as in everything else, there are fashions, and the 
prevailing tendency of the medicine of to-day is to underrate the importance of 
subjective symptoms, and to pay but little attention to the account given by the 
sufferer himself. 

For the detection of objective signs there are certain special modes of examination 
which are resorted to by the physician. In examining the chest, for instance, he 
sounds it, or, as he says, " percusses " it, that is, he strikes it lightly with the tips 
of his fingers, with the view of detecting any difference in the note on the two 
sides. Then he listens to it, or, as he says, " auscults " it, to see if the air enters 
freely and equally all over. He may listen to the chest by placing his ear on it, or 
b«3 may use his stethoscope. Every physician carries one of these instruments. 
They are cylindrical in shape, and are generally made of some light wood, such as 
cedar, and, being hollow, serve to convey and intensify the sound. 

The increased accuracy of late attained in the recognition of certain diseases has 
been greatly assisted by the use of special instruments. Without the microscope 
the existence of many forms of blood disease could not have been established, and to 
its aid is due the knowledge of the parasitic nature of ringworm and thrush. The 
detection of Bright's disease is materially aided by the information a microscopical 
examination of the urine conveys. The thermometer to the practical physician 
affords, as we shall presently see, information of the highest value, whether regard 
be had to the detection of disease or its treatment. The laryngoscope, an instrument 



for examining the throat, enables us to appreciate changes in the organ of speech, 
which, without its aid, could not hare been suspected, and to determine with 
certainty the presence of other diseases, which, without it, could only have been 
suspected. The ophthalmoscope, or instrument for examining the eyes, has afforded 
valuable information in the detection of disease not only of the organ to which it 
is more especially directed, but also of the brain. The weighing machine is of 
great importance in determining the progress, that is, the advance or otherwise of 
wasting diseases, and of the value of the treatment being pursued. At our hospitals 
it is customary to weigh the patient at certain stated intervals, say once a fortnight, 
and to record their weight on cards provided for that purpose. We need hardly 
point out the necessity in making observations on the weight, of always using the 
same instruments, and more especially of the patient always being weighed in the 
same clothes. 

Wasting or emaciation is sometimes the first observable symptom of disease. 
It is early seen in the countenance, partly because it is uncovered, partly because 
a slight diminution of the fat under the skin of the face produces a striking 
alteration in the features. It occurs in complaints that are not commonly 
dangerous, as in indigestion, and in hypochondriasis, which is often connected with 
indigestion. When it does appear it marks the reality of the disease. This 
wasting happens also in many serious maladies, for example, in consumption and 
dropsy, although the dropsical enlargement sometimes masks it. It accompanies 
many fevers, and is reckoned an unfavourable symptom, for it shows that the body 
is not properly nourished. 

There is another word frequently used in connection with the term symptoms 
which we cannot pass by without notice. We sometimes speak of a "patho- 
gnomonic " symptom, and by that we mean one that is characteristic of the disease. 
Thus the peculiar eruption is pathognomonic of small-pox, and chalk-stones are 
pathognomonic of gout. 

There is considerable difference in the mode of onset of different diseases, some 
coming on quite suddenly, and others vsry gradually. A man may be on his legs 
at a public meeting, when he suddenly has a stroke, and goes down just as if he had 
been shot ; or, on the other hand, a man's powers may fail aim so gradually that 
it is impossible for him to say really when he first noticed anything wrong. 
Frequently the illness is " acute," not only coming on rapidly, but being severe in 
character and brief in duration. The great majority of cases are " chronic," the 
symptoms setting in gradually, not being very severe, and the progress being slow 
and protracted. A chronic disease may, however, be the sequel of an acute attack, 
and an acute attack is not unfrequently the cause of a fatal complication in 
chronic cases. 

In many diseases, especially the acute diseases, the illness is divided into different 
stages. For instance, a person is brought in contact with a patient suffering from 
small-pox, but it is not till twelve days after that he feels ill, has shivering, and 
suffers from a pain in the back. This period is called the period of latency or 
incubatiun, and varies in duration in different diseases. Its existence is not limited 
to acui* diseases, for we find that it is present in many nervous affections. Far 



WILL HE RECOVER 1 Xxlx 



example, a child has a severe fright, and a week or so after suffers from St Vitus** 
dance or becomes epileptic. Here the disease is not dependent on the entrance oi 
any poison into the body, as is probably the case in most of the fevers, but neverthe- 
less there is a period of incubation. Then again, we often speak of the u stage 
of invasion " and " stage of decline " of a rash. We do not know that these 
terms have any particular value, but they are constantly employed, and are often 
convenient. Certain morbid conditions are often left behind after an illness, and 
these are usually spoken of as the " sequelae n — for instance, the occurrence of Bright's 
disease after scarlet^fever is regarded as a sequela, and not as a part of the original 
disease, because it is not of constant occurrence. Then again, by " complications * 
we mean such conditions as are liable to arise during the progress of an illness, but 
do not usually form a part of its course. For instance, a man has acute rheumatism. 
Has he any complications 1 you ask Yes, pericarditis, or inflammation of the sac in 
which tho heart is contained. 

When the doctor is called in to any case of illness, one of the first questions he it 
asked is, " Is it serious 1 Is there any danger V In some cases he is enabled to 
say at once that humanly speaking there is no danger, whilst in others he is bound 
to admit that it is impossible for him to give & positive opinion. Our power of 
foretelling the termination of any particular attack of illness is small. Medicine if 
not an exact science, and life is too subtle for us to know or measure all its possible 
contingencies. We know that certain maladies rarely endanger life, whilst from 
others perfect recovery is the exception. We know that the mortality in certain 
diseases is very much higher than in others, but this information will not enable 
us to foretell positively the termination in any individual case. We may describe 
the probabilities of any given disease, and may even express them numerically, and 
use them as a basis for accepting or rejecting lives at insurance offices, but we are, 
after all, dealing only with doubts, and not with certainties. Our knowledge of the 
results of disease, as applied to masses of people, is marvellously accurate, but as 
applied to individuals it is woefully small We know how many people will die of 
bronchitis, and how many of consumption next year, and we even know how many 
will be killed by being run over in the streets, and how many will commit suicide 
by throwing themselves in front of express trains, but if we are called in to two 
people of the same age on the same day, who are stricken down with typhoid fever, 
we cannot tell whether one, or both, or neither will die W© can fix the probable 
duration of certain diseases pretty accurately, but with regard to others our know- 
ledge is infinitely smalL We know approximately the duration of shingles, of 
small -pox, of typhoid and scarlet fevers, and also of such maladies as consumption 
and cancer of the stomach, but with regard to many chronic affections, such as rheu- 
matism and sciatica, our knowledge is much less accurate, and of less practical utility. 
An acute disease may prove fatal, or it may terminate in recovery, or it may become 
chronic, Rheumatic fever affords a good example of an acute disease which some- 
times becomes chronic. In certain cases the fever completely subsides in due course, 
but leaves the joints swollen and painful for weeks, or even months. Some acute 
diseases, such as scarlet fever and measles, never become chronic. 

Diseases have been divided into two groups — preventable aad nan- preventing 



XXX INTRODUCTION. 



and it should not be forgotten that many diseases that we are powerless to cure 
might be readily and completely stamped out A few years ago an attempt was 
made to estimate the undoubted preventible mortality from disease. A comparison 
was made between the death-rate of the healthiest registration districts of England 
and those the least healthy, and the diseases were then ascertained from which the 
excessive mortality arose. It was proved most conclusively that these diseases 
might be so reduced in frequency as to bring down the death-rate of the now 
unhealthy districts to the level of the healthy. First and foremost among 
preventible diseases is rickets, which, either directly or indirectly, is one of the 
most fatal maladies of infantile life. The causes of rickets are poorness of the 
mother's blood, errors in diet, and more especially overcrowding of the bed-rooms. 
Every doctor knows that not a single child ought ever to die from rickets or its 
consequences. If we could only provide the poor with light, airy, well-ventilated 
rooms, we could soon stamp out not only rickets, but many other diseases. The 
rich are directly interested in the welfare and sanitary condition of the poor, for the 
fever which carries off the millionaire in his palace has probably grown and gained 
strength in the wretched dens which, sad to say, are too often the only habitation 
of those who earn their daily bread by the sweat of the brow. 

Then again, syphilis is a preventible disease, and it is indirectly the cause of 
many deaths. Many a case of so-called liver disease, or Bright's disease, or brain 
disease, is in reality dependent on a syphilitic taint contracted perhaps years and years 
before, in the days of youth and passion. Delirium tremens is a preventible disease, 
and even gout is in a large proportion of cases dependent on preventible conditions. 
Of course, the diseases which are due to the injurious influences consequent on the 
exercise of certain trades are to a certain extent preventible. Many diseases are 
caused by ignorance of sanitary laws and neglect of the most simple rules relating to 
food, air, clothing, light, and exercise. One constantly meets people accomplished 
and highly educated, who would be ashamed to be ignorant of classical and 
mathematical knowledge, but who do not know even enough to maintain their 
bodies in a healthy condition This ignorance of sanitary laws is by no means 
confined to those who in other respects are uneducated. Over and over again, we 
find towns springing up under the fostering care of rich and influential proprietors, 
without any other mode of drainage than the collection of the filth of each house 
into its own cesspool, and with no other supply of water than that obtained from 
surface pumps. 

Now a word or two about treatment. Concerning medicinal treatment, it must 
be admitted that there is still in certain quarters considerable scepticism. Curiously 
enough, this want of faith is met with not so much in those who take medicine as 
in those who prescribe it. The greatest sceptics are the consulting physicians. 
Your family practitioner would laugh you to scorn if you were to say you did not 
believe in medicine — and serve you right, too. What, then, is the explanation of 
this scepticism among hospital physicians ? Fortunately, it is not far to seek. You 
must remember that the majority of people do not care to consult a physician unless 
they have something serious the matter with them. If they have only some trivial 
affection they go to the general practitioner, and regard a consultation as a dernier 



WHAT MEDICINE CAN DO FOR US. XXxi 

res8ort. The result is that the bulk of the hospital physician's patients are what 
are technically called " bad cases," and, as from their very nature they are unlikely 
to improve under treatment, he gradually becomes sceptical as to the action of 
medicines. The general practitioner, on the other hand, gets all kinds of cases, 
trivial and severe, and is much more likely to be able to form a correct estimate of 
the value of his remedies. At the same time, we are happy to say this scepticism 
on the part of the regular physicians is far from being universal One of the most 
accomplished and successful physicians, a man at the head of the profession, recently 
made the following " confession of faith." He said : " Now, for myself, I desire to 
repudiate, absolutely, scepticism in regard of medicine. I believe as confidently in 
the power of physicians to treat disease successfully as I did when clinical clerk to 
one of the first practical physicians of my youth. Extended knowledge and accu- 
mulated experience have only increased my confidence in the remedial powers of our 
art." We should say that a man who disbelieved in the curative powers of medicine 
must be blind to the evidence of his own senses. The man who could not perceive 
the beneficial action of quinine in ague, or of mercury in syphilis, would not see a 
hole in a ladder. You sometimes hear a man say he " doesn't believe in medicine." 
He might as well say that he does not believe in bread-and-butter. There are, of 
course, many diseases that are still beyond the power of our art, but this number is 
decreasing day by day. Every year serves to introduce new remedies and fresh 
preparations of old ones, and the number of diseases amenable to treatment is 
steadily, but surely, increasing. " How wonderful," says the physician whom we 
have just quoted, " is the influence of bromide of potassium over diseases for the 
treatment of which we were but a few years ago almost impotent. A dull, heavy- 
looking lad suffered for seven years from epileptic attacks, which steadily increased 
from the first in severity and frequency, till many occurred in twenty-four hours. 
For a year he was treated by a physician on general principles with little benefit. 
The case was in all particulars most unpromising; yet from the time the boy took 
the first dose of bromide of potassium to the present, nearly three years, he has not 
had a single fit." This is by no means an unusual case. We have seen many like 
it, and so must every one who has paid the slightest attention to the action of 
drugs. But it illustrates well the power of a comparatively new remedy over a 
class of cases which only a few years ago were regarded by practical men as almost 
as much beyond the curative influence of drugs as is a case of cancer of the stomach. 
Other illustrations of the strides made in treatment are afforded by the influence 
of cod-liver oil and the hypophosphites in consumption, of iron in anaemia, of 
digitalis in heart disease, of ipecacuanha in the cure of dysentery and some kinds of 
vomiting, of sulphide of calcium in boils and abscesses, and of electricity in many 
diseases of the nervous system. With reference to the power of our art to alleviate 
suffering, the difference between the medicine of to-day and that of five-and- 
twenty years ago is very great. No one who has suffered from a painful local 
affection can think of the immediate relief which followed the subcutaneous injection 
of a dose of morphia without feelings of overpowering gratitude. There is no one who 
has had to submit to the knife of the surgeon whose heart does not overflow with 
thankfulness to those who introduced anaesthetics. The electric telegraph, the 



sxiii nrntODUcmoH. 



second greatest marvel of our time, was a thing "which, in a rough way, scientific men 
had long thought possible, but to be cut for a stone and know nothing of the agony ; 
to have a leg removed, and smilingly ask, when the operation is over, " When are yon 
going to begin 1 " to have a nail torn away, and look on and laugh while that most 
painful operation is proceeding — these are marvels of which no one dreamed. No 
extravagance of fiction equals the living reality. The discovery of the value of the 
subcutaneous injection of morphia and other anodynes, oi local anaesthesia by 
freezing with ice or ether spray, and of general anaesthesia by ether, chloroform, and 
laughing-gas, may rank amongst the proudest triumphs of this or any other age. 



THE FAMILY PHYSICIAN. 



DISEASES OF CHILDREN. 

Special Susceptibility of Children to Disease — Old-fashioned Methods of Treatment— Indications of 
Disease— Temperature— Diseases of Children, in Alphabetical Order, with their Symptoms and 
Treatment. 

A reference to the returns of the Board of Health (which invariably show in 
definite numbers what we all know by common experience, viz., the great mor- 
tality among children under five years of age) will be sufficient to prove that 
the early years of life constitute a time at which we are more vulnerable to 
disease than at any other period of our existence. The reason for this is twofold. 
Firstly, because there are several diseases which are of so infectious a nature 
that we are sure to contract them the first time that we come in contact with their 
contagion. Such are whooping-cough and measles, which are in no sense properly 
peculiar to childhood, but are rather to be considered as peculiar to and inseparable 
from life in crowded communities. Secondly, the proneness to disease in early life 
is by reason of the highly impressionable nature of the body at that period. 
Influences which have no effect upon us in adult life may during our early years be 
productive of very grave results indeed. All the vital processes are very active — the 
body is growing rapidly. Great results spring from trifling causes, and disease once 
started is liable to spread with very great rapidity. The processes of dentition, and 
especially of the first dentition, produce a general irritation and disturbance of the 
body, which causes very often a slight febrile reaction, during which the child is 
peculiarly susceptible to all evil influences. 

Many of the diseases of childhood may be averted by a very small amount of 
care in the feeding and nursing of children, and it is not too much to say that the 
healthy child of a careful and discreet mother may pass through its infancy without 
ever taking a dose of medicine. 

It used to be the fashion to dose children enormously, and even now one may 
occasionally see in old-fashioned houses a horrible instrument of torture called a 
physic spoon, with which unhappy children are loaded, as it were, with " charges n 
of the most nauseous compounds it is possible to imagine. 

In the present day, however, we hope that wiser counsels prevail, and that 
unnecessary dosing has nearly died out. Every unnecessary dose of medicine given 
1 



DISEASES 01 CHILDREN. 



to a child is a positive injury to it; and, in fact, the giving of drugs at all to children 
is a harmful proceeding, and is only to be countenanced when it is necessary to avert 
or counteract some greater evil. The necessity for giving drugs to children would 
arise much less often than is usually the case if the rules which we shall lay down 
for the general management of children were more scrupulously attended to. 

The signs of disease in children are different from those we observe in grown-up 
persons ; and when they cannot talk or definitely complain we have to learn to 
interpret those numerous indications of disease which are afforded by the child's 
general demeanour. 

There is no more valuable indication of disease than the temperature of the body. 
We do not mean the apparent temperature as tested by the hand, but the actual 
temperature as measured with a thermometer. A child's pulse may be exceedingly 
quick, its face may look flushed, and its skin foel hot, and this may all be due to 
excitement, and after a night's rest the symptoms which caused alarm may have all 
disappeared. If, however, we find the temperature of the body raised, we know at 
least that the cldld requires careful watching until the temperature goes down 
again It is not often possible to say at once to what the rise of temperature is due. 
It may be caused by indigestion, or a passing cold, or inflammation of the lungs, 
or bronchitis ; or one of the children's fevers — as measles, scarlet fever, <fcc — may be 
coming on ; but as long as the temperature is raised we may expect anything. The 
great advantage of taking the temperature is that it gives us early information of 
disease, and we are often able to separate a child from its fellows before it has been 
able to infect the others. We should strongly advise the mothers of families and 
others who have the care of children to buy a " clinical thermometer," which may 
be got from any surgical instrument maker, and learn to take a temperature. The 
proper temperature of the body is 98*4 Fahrenheit, and anything over 99° Fahrenheit 
must be looked upon as fever. From 99° to 102° we should call slight fever; from 
102° to 105°, severe fever; and anything over 105° Fahrenheit very severe fever. 
A temperature is best taken by placing the thermometer in the armpit or the mouth 
(if the child is old enough), and allowing it to remain for two or three minutes. Let 
us suppose that a child is " out of sorts." We take its temperature, and find it 
natural ; we know that there is nothing serious the matter, and that it will probably 
be well in a few hours. If, however, we find the temperature raised, we must be 
prepared for the advent of something serious, and must not treat the case lightly. 
We have often seen the temperature raised by very slight things, such as an 
indigestible meal ; and, in fact, nothing shows the impressionability of childhood so 
much as the manner in which the temperature rises at slight causes; but nevertheless 
we have often been able to get four-and-twenty hours ahead of a disease, as it were, 
because the thermometer has forewarned us of the impending storm. 

Another important indication of disease in children is " fractiousness," or 
irritability of temper. Healthy children are generally good, and if we find a child 
become troublesome, we should always suspect some physical cause for its altered 
manner. 

Healthy children are, when awake, lively. They smile, and crow, and throw 
their limbs about in one never-ending round of delight When a child becomes 



CHILDREN IN HEALTH AKD DISEASE. 



listless, and dull, and fretful, we know that it cannot be well, and that it demands 
attention. 

Children when asleep should sleep quietly and tranquilly. If they become 
restless, and throw off their bed-clothes, and kick, and gnash the teeth, this may be 
taken as important evidence of impairment of health. 

Loss of appetite is, with children, as with grown-up persons, a very common sign 
of disease. 

A child's skin should be clean, clear, and rosy-coloured. If it is muddy-coloured, 
or blotchy, or if sore places form, or chafing occurs between the folds, or eruptions 
make their appearance round the mouth, round the bowels, or elsewhere, they may 
be taken as sure evidence that the child is seriously out of health. 

Vomiting is a very important symptom of disease in young children, and, when 
persistent, indicates disease of the brain almost as often as it does disease of the 
stomach. 

We will now proceed to discuss the more common diseases of childhood seriatim, 
and in order to facilitate reference we shall take them alphabetically. 

Bed-wetting. — This is one of the most annoying of the troubles of childhood, and 
frequently occurs in children who are in all other respects in perfect health. It 
is not only very unhealthy, both for the child and for those who live with it, but 
since it either imposes a barrier to education, or causes the school-life of the child 
to be unhappy instead of pleasant, no effort should be spared to alleviate it. The 
treatment is very largely guided by common sense. The general health should be 
attended to, and examination be made for the presence of intestinal worms, and the 
opinion of a surgeon should be sought, to be sure that no serious disease of the 
bladder or urinary organs is present, such as stone in the bladder and gravei. 
The trouble usually comes on when the child is seven or eight years old, and it 
appears to be more common in boys than girls. Great care should be observed 
that no undue amount of liquid is taken late at night. Children ought never to 
eat suppers, and those with this weakness should be particularly careful in such 
matters. When they go to bed, some one should go with them to the bedroom to 
make sure that the calls of nature are properly attended to before falling asleep, and 
as the father or mother go to bed they should pay another visit to the child's room, 
wake it up, and insist on its passing water a second time. These measures alone 
will often ward off the trouble. The bed-clothes should not be too heavy or too 
warm, and the child must of course have a bed to itself. It is a good plan to place 
a "draw-sheet" under the middle of the child — that is, a sheet lined with water- 
proof, about a yard square. If this be done, and if the upper clothes be raised off 
the child by a cradle, should an accident occur, it will cause a minimum amount 
of trouble. The mattress (such children should sleep on mattresses and not on 
feather beds) should in every case be protected by & sheet of mackintosh placed 
between it and the under blanket. The woven wire mattress is much to be 
recommended for such cases. We have in belladonna a drug which has beeu 
of undoubted service in such cases. It should be given in the form of pills, 
because it is unadvisable to give more liquid to these children than is absolutely 



DISEASES OF CHILDREN. 



necessary. The dose must be small to begin with, and then may be gradually and 
cautiously increased. A pill containing a quarter of a grain or less of the extract of 
belladonna (which should be purchased of some druggist of acknowledged reputation) 
should be administered every night at bedtime, and if this be found insufficient, the 
dose may at the end of a week be doubled. If the child complain of thirst, and the 
pupils of its eyes become dilated, the remedy must not be pushed too far; if delirium 
occur, the belladonna must be withheld. The general health of the child must be 
carefully looked to. 

Chafing. — In situations where the folds of skin in young children are in close 
contact and overlap, as in the folds of the groin and the root of the neck, they rub 
together and chafe, and cause an irritable and inflamed state to be engendered. This 
condition is technically known as intertrigo. It is rarely that it arises from chafing 
pure and simple, but the condition is predisposed to by a want of attention to 
cleanliness; and the collection of perspiration and other secretions in the moist folds 
of skin is often largely answerable for the mischief. The treatment of chafing is 
simple. The parts must be kept scrupulously clean, and be washed twice a day 
with warm soap and water. After washing, they must be thoroughly dried with a 
soft towel or a silk handkerchief. The part must then be thoroughly dusted with an 
absorbent powder, such as starch, or oxide of zinc, or fuller's earth. The health of 
the patient must at the same time receive attention, as chafing is far more likely to 
occur in sickly than in healthy children. 

Chicken Pox is a mild general disease, through which most children pass once. 
It is said to be very contagious, and the incubitive period is alleged to be a 
fortnight — the same, in fact, as small pox. As a rule, the sufferer is scarcely ill, but 
occasionally there is evidence of slight febrile disturbance, such as chilliness, quickness 
of pulse, loss of appetite, and some elevation of temperature. On the second or 
third day after the onset of febrile symptoms (supposing them to be noticeable), a few 
rose-coloured spots appear about the body, and these quickly become vesicles or little 
watery heads. They increase in number for two or three days, and we find the body 
covered with a variable quantity of these little watery bladders which may number 
as many as 150 in bad cases, and the child looks as if it had been exposed to a 
shower of scalding water. They come about equally on all parts of the body with a 
slight excess occasionally on the head. In extreme cases a succession of them may 
appear for eight or ten days. The individual vesicles last three or four days, and 
then begin to dry up, and as they dry they leave a little scab. They often itch 
badly, and the child often scratches itself — scratches off the scabs and produces sore 
places which may prove troublesome. This disease has to be distinguished from the 
far graver malady, which in some degree resembles it — viz., small pox. In small po\- 
the premonitory symptoms are far more severe, and the patient appears to be 
extremely ill with headache, vomiting, and violent pain in the back (see Small Pox). 
The eruption in small pox appears first on the face, and, before it becomes pustular. 
there is a stage during which it feels like a hard lump or " shot " beneath the skin 
This stage is absent as a rule in chicken pox. The eruption of small pox always 



CHICKEN POX — CHILBLAINS. 



becomes pustular (that is, mattwy), while in chicken pox it remains vesicular (that is, 
watery), except in a few very rare cases. The eruption of small pox is umbilicated, 
that is, it is "tucked in" in the centre like the navel or the top of a cottage loaf. 
This is, however, rarely Ihe case in chicken pox. 

Chicken pox hardly requires treatment of any kind, and happily the children 
get well in spite of anything which may or may not be done for them. Keep the 
child from catching cold, and take care that it does not pick the scabs, or trouble- 
some ulcerations may result. The vesicles should be protected from irritation of 
all kinds, and if they occur on parts of the body which are liable to be rubbed by 
the dress, or to come in contact with neighbouring folds of skin, they should be 
protected by a piece of soft rag which has been lightly covered with a thin layer of 
cold cream. 

Although the disease itself is trivial, it •_»ftvr leaves the child in a very weak 
condition, and we sometimes find that children who have been perfectly well 
previous to their attack of chicken pox fall off in health very much afterwards, 
and lose flesh, and become generally sickly. If there is any family tendency to 
tubercular disease, this is a period at which they are very liable to contract it. 
The vesicles occasionally leave scars about the body. 

Chilblains are a very common source of trouble to children. They consist of red 
and swollen patches, the result of mild inflammatory action, and they are caused by 
exposure of the part to cold or damp. They are most liable to occur at the extremi- 
ties, where the circulation is feeble, and are most common on the toes and fingers. 
They may occur also on the lobes of the ears, the tip of the nose, and elsewhere. 
Children who suffer from chilblains are often weak and sickly, of a sluggish and 
lymphatic habit, and indisposed for active pursuits. The tendency to chilblains is 
increased by any weakening and debilitating disease, or by bad feeding, or other 
causes which tend to depress the health. The mildest kind of chilblain consists 
merely of slight redness and swelling, accompanied by intolerable itching. In worse 
forms, the skin gets bluish over the swelling, and this is not unfrequently followed by 
the excoriation of the skin, and the " breaking " of the chilblain. Broken chilblains 
are far more serious than simple chilblains, and are often accompanied by a large 
amount of discharge, are liable to become exceedingly chronic in their course, and 
not unfrequently they cripple the patient for many months at a time. 

The treatment of chilblains is both general and local. The health must be most 
carefully attended to ; tonics may be freely administered — cod liver oil, iron, and 
quinine are all of use — combined with a liberal diet and a fair amount of stimulant. 
The parts which are the scat of chilblains must be kept thoroughly warm, and the 
child must be encouraged to take as much exercise as possible. The stockings must 
be woollen, and the boots or gloves warm and roomy, so as not to compress the 
hands or feet. The parts may be further stimulated by rubbing, and it is often 
advisable to use some mild stimulating liniment, such as soap liniment or ammonia 
liniment. Spirit of any kind, such as brandy or gin, may be employed for nibbing 
the part. When the chilblains become broken, the parts must be kept at rest, and 
it may be necessary to apply poultices or warm-water dressing for a time, until the 



DISEASES 07 CHILDTIEW. 



discharge has ceased. The best dressing for them after tliis period is any miJd 
stimulating ointment spread upon soft rag. Resin ointment, or ointment of t) # 
oxide of zinc, are both very useful. 

Child Crowing. — (See False Croup.) 

Children' } s Paralysis. — This disease is also called infantile or essential paralysis. 
The name "essential" is given because it often happens that no cause for it is detectable. 
It occurs generally during the period of teething, and cases are not so common after two 
years of age. The child may have been quite well previous to the attack, or, it may 
be, just recovering from measles or some other disease of childhood, or perhaps it 
has had a febrile attack accompanied by pain in the joints or limbs, which is spoken 
of as rheumatism. Yery often the onset is marked by slight feverishness accom- 
panied by indigestion. During the attack the mother or nurse notices that the child 
is unable to move some of its limbs. Perhaps one arm or one leg hangs helplessly, 
or both legs and one arm may be affected, and the child may be reduced to a condi- 
tion of almost complete helplessness. This extreme amount of paralysis generally 
passes off in a few days, but the limb never completely recovers, and there is 
always a residuum of paralysis left : this varies in amount. It may be that the 
whole of one limb is paralysed, or it may be that certain muscles only are affected. 
The child may be able to use the hand fairly well, but is unable to raise the shoulder ; 
or the leg may be useful to some extent, but there is a certain dragging of the toes, 
or swinging inwards or outwards of the foot, or a difficulty in bending the knee, 
or a clumsiness in the movement about the hip-joint. If this residual paralysis does 
not receive very prompt and very careful attention, it will remain permanent, and if 
the paralysis be not cured, we are apt to get a shortening and contraction of the non- 
paralysed muscles, and an unequal action of the muscles working round a joint, and 
as a consequence a permanent deformity of the joint. This form of paralysis is the 
great cause of club feet and similar deformities, and most of the children whom one 
sees walking about in irons, with their feet enclosed in various kinds of surgical 
boots, have suffered from infantile paralysis. 

The treatment of this paralysis must be prosecuted with the greatest perseverance, 
and with unremitting attention ; and although much patience is demanded of the 
friends and the medical man, there are few complaints in which patience is so well 
rewarded. 

In the first place, the general health of the child must be kept up, and it must 
be carefully dieted, and should be treated with cod liver oil and steel wine, or other 
tonic medicine. 

Next, as to the treatment of the affected limb. If a limb is completely paralysed, 
it is not used, and it wastes ; or if partially paralysed, it may be of so little use that 
practically the child does not use the limb at all, and consequently it wastes. 
If these cases have been neglected, we find that the limb which is the seat of the 
paralysis is often of less girth, and very often shorter than its fellow. It is blue, 
and invariably cold. The most essential thing is to keep up the temperature of the 
limb, which should be kept constantly enveloped in a stocking or a sleeve made 
of flannel, and quilted with cotton wool. A child should have a change of these— 



CONSTIPATION. 



one for niglit and one for day, and they should be always thoroughly aired and 
warmed before they are put on. When the child is in bed, it should have the limb 
kept warm by one or more india-rubber hot-water bottles laid alongside of it. 
In the next place, the limb should be kept thoroughly well rubbed ; and night and 
morning the whole limb, and especially the affected muscles, should be systematically 
shampooed. 

The child should be encouraged to use the limb as much as possible, and, if it 
can manage to do so, it should be made to run about, but, if this be not possible, 
passive movements must be made for it, so as to avoid the risk of joints becoming 
distorted and tendons stiffened. 

A valuable adjunct to the treatment of these cases is undoubtedly electricity, but 
to be of any service it must be applied with care and great discrimination, and, above 
all, with very great patience. The paralysed muscles require to be sedulously worked 
at often for many months before much result is obtained, but we believe that elec- 
tricity is the sheet anchor in this disease, and, in fact, the only remedy which is 
likely to be of much service for the cure of what we termed the residual paralysis. 
The electrical treatment must not be delayed too long, as is often the case. " A 
stitch in time saves nine," and the applicability of this proverb to disease is very 
general. To prevent contraction of muscles, and the consequent deformities, various 
iron supports, and shoes, and similar appliances have been invented. These are of 
undoubted service when used with judgment, and with the advice of a reliable 
surgeon. Their drawback is that they hamper the free movement of the child, and 
prevent its proper muscular development, and they are rarely justifiable except in 
cases where locomotion is scarcely possible without them. We would strongly 
caution the reader against a class of instrument makers who to the trade of a black- 
smith endeavour to add the profession of a surgeon. They are ignorant of anatomy 
and physiology, are incapable of taking other tlian a mechanical view of the case, are 
naturally anxious to sell their often costly wares, and by looking at patients solely 
from their point of view, often condemn them to be crippled for life. 

Chorea. — (See St. Vitus' s Dance.) 

Constipation in Children. — When a child is constipated, its nurse gives it a dose 
of purgative medicine as a matter of course, and if this does not have the desired 
effect, the remedy is repeated, and in the very great majority of cases no harm comes 
from this haphazard method of treating a common symptom. It is well, however, 
that people should bear in mind that constipation may arise from causes which are 
not only unremovable by purgative drugs, but which might be greatly aggravated 
by their administration. Take rupture, for instance, a complaint which is very 
common among children A piece of the bowel comes through a hole in the internal 
coats of the belly, and cannot get back again— becomes strangulated, as the term is. 
Now the administration of purgatives in such a case could do nothing but harm ; 
and an examination should always be made, in cases of constipation, of the patient's 
groins, to see whether or no a rupture exist, and if such be found, a surgeon must 
be called in without delay. 

Again, the bowels may get twisted inside the belly, and then we get a condition 



DISEASE8 OF CHILDREN. 



very like t rupture. In all cases of rupture or internal obstruction nothing is passed, 
not even wind, by the bowels. The child complains of great pain, and after a time 
vomiting occurs, which becomes very offensive. The combination of constipation, pain 
in the stomach, and vomiting, should always make one chary in giving purgatives, 
and it is wise in all such cases to lose no time in calling in the help of an expert. 

Children are liable to suffer from a trouble in the bowels which is almost peculiar 
to childhood. This is the intussusception of the bowel, as it is called, or the slipping 
of one part of the bowel into the part below, just as we may draw back the finger of 
a glove within itself. When this accident occurs, there is usually sudden and intense 
pain at the moment of its occurrence. The child is absolutely constipated, and there 
are generally eructations of flatus (belching of wind) and vomiting. So far these are 
the signs common to all cases of complete obstruction of the bowel. At the end of 
two or three days we are confronted with a very characteristic symptom, viz., the 
passing of blood and mucus by the bowel It is not a common thing for children 
to pass blood from the bowel, and if they do so in any quantity, we should always 
think of intus-susception as a possible cause of it. The part of the bowel which 
gets ensheathed in the part below passes gradually onwards, so that it may occa- 
sionally be felt, or even seen, at the lower opening of the bowel. Sometimes the 
mass of ensheathed bowel can be felt like a sausage through the wall of the belly. 
Peritonitis, or general inflammation of the bowels, is a common consequence of this 
condition, and is the usual cause of death in these cases. Intus-susception is not, of 
course, to be treated by giving purgatives, which would only increase the trouble. 
Our aim must rather be to restrain the action of the bowels by giving opiates. The 
condition has been " reduced " by injecting air into the bowels, and distending them 
until the ensheathed portion slips out of the part below. If it can be satisfactorily 
made out that the child is suffering from this condition (and attention to the 
symptoms we have mentioned will generally enable a physician or surgeon to come 
to a right conclusion), it may be advisable to open the child's belly by a slight 
incision, and hunt for the ensheathed bowel, and pull it out with the fingers. Many 
cases in which this has been successfully accomplished have been reported of late. If 
this be not done, the child has but a small chance of recovery, although a few cases 
have been reported in which a spontaneous cure took place. It is certain, however, 
that if relief be not afforded, either by natural or artificial means, death will result. 

As to the treatment of ordinary constipation, we would impress upon the reader 
that it is never justifiable to give a dose of medicine to a child if this can be avoided. 
The practice of indiscriminate dosing cannot be too strongly condemned, for it is 
certain that it has acted to the prejudice of very many children. A child should be 
taught as early as possible that the bowels ought to act at regular times, and it 
should never be allowed to neglect this important natural function. If a child 
becomes constipated, it is often sufficient to attend to its diet, and give a little fresh 
vegetable, fresh fruit, or stewed fruit, to excite a slight laxative action. If this be 
not sufficient, it is a good plan to give an injection of tepid water into the bowel 
occasionally : this, however, is a measure which should not be too often repeated. If 
drugs become necessary, the phosphate or sulphate of soda dissolved in hot broth or 
milk is very effectual. Rhubarb and soda powders, or a dose of Gregory's powder, 



CONVULSIONS. 



are time honoured remedies, and their /value is too well known to need any 
encomiums from us. A tea-spoonful of castor-oil is a good simple remedy. It 
now and then happens that children have unusually sluggish bowels, which refuse to 
respond to any of the ordinary purgatives. A systematic friction of the abdomen 
in a circular direction from right to left (following the direction of the large intestine) 
will often suffice to give tone to the bowel, and restore a healthy action. It is a gocd 
plan to use a little cod liver oil as a lubricating medium, and to rub the abdomen the 
last thing at night. A tea-spoonful of ordinary salad oil the first thing in the 
morning also helps to encourage a proper action. We have heard of cases in which 
this treatment succeeded after everything else had failed. It has the merit of sim- 
plicity, and is not likely to do any harm. On this ground alone it is a method of 
treatment to be strongly recommended. If stronger remedies become necessary, or 
if a child is more than two days without having its bowels relieved, in spite of 
medicine, a doctor should be sent for. 

Convulsions are very common in children, and few mothers of large families have 
been without some experience of fits. It is not too much to say that no healthy 
child has fits ; but on the other hand, a very slight cause indeed is sufficient to bring 
on an attack of convulsions in young children. Fits seem, it is said, to take the 
place of delirium in older persons, and a very eminent authority on children's 
diseases has remarked that some children are convulsed as easily as some people 
dream. Dreaming, however, is not always a healthy condition even in grown-up 
people ; and if dreaming in an adult sometimes calls for medical treatment, how much 
more is a young child who is subject to fits in need of careful supervision ! 

When a child is taken in a fit it becomes insensible, and often gives a little cry 
at the moment of seizure. The face is pale or dusky, and there intervene twitchings 
of the body and limbs. The face is " drawn " or distorted by contraction of the 
facial muscles ; there is squinting of the eyes, and the mouth is drawn to one side, 
while frothy fluid escapes from the mouth. The legs and arms are the seat of 
twitchings, and the thumbs are tightly bent over the palms of the hands. When a 
child is taken with fits, those about it should endeavour to take notice of certain 
facts which may assist the medical man on his arrival to come to a proper conclusion 
as to the cause of the trouble. Does it cry out and bite its tongue ? How do the 
fits begin — in the arm, or hand, or leg, or how? How often do the fits recur? 
Are the twitchings of the body limited in extent, and do they affect one side more 
than the other? As the medical man is not generally on the spot to observe all 
these points for himself, he is obliged to trust to the accounts given him by others. 

The individual fits do not last long, but they may succeed each other with such 
rapidity that it is not possible to say where one tit ends and the next begins. A 
child does not often die in a fit, but this accident does occasionally happen. When 
death takes place in a fit, it is brought about by suffocation. Children occasionally 
also die of exhaustion if the fits have been prolonged. 

When a child has fits, the fact may be taken to indicate with certainty one or both 
of two things — (1) That the child is of a weak constitution, and (2) that there is some 
source of irritation in the child's body which is setting up the convulsions. As to 



10 DISEASES OF CHILDREN. 



the constitutional condition of the child, this, in the vast majority of cases, is found 
to be rickety. Search must accordingly be made for every indication of the rickety 
constitution, (See Rickets.) Although rickets is the condition of all others in which 
convulsions are likely to occur, we meet with them also in other weakly states of 
the constitution, as the tubercular or scrofulous. Sometimes convulsions indicate a 
family tendency to nervous diseases, and it may be found that other members of the 
family have suffered in the same way, or are liable to neuralgia, or hysteria, or 
epilepsy, or some other form of nervous disturbance. If this be the case, and if the 
fits are repeated, they may, perhaps, be taken to indicate that the child is going to 
become subject to epilepsy. 

Having examined into the constitutional condition of the child, we next look for 
any local source of irritation which may be the cause of its trouble. Fits are most 
common during the trying period of the first dentition, and some difficulty in cutting 
the teeth will in a great number of cases account for the symptoms. Do not, how- 
ever, rush to the conclusion that the gums want lancing. Doubtless this is very 
often necessary, but, on the other hand, we have no doubt that gums have very fre- 
quently been lanced when there was not the least occasion for it. Be sure, therefore, 
before lancing the gums that they are swollen and tender. This caution is parti- 
cularly necessary, because children who are liable to fits are very sensitive to any 
loss of blood, however slight, and even the slight bleeding which follows the lancing 
of the gums is a matter to be avoided. 

If the local irritation be not found in the gums, we must look elsewhere, and, 
perhaps, the next most common cause of fits is the irritation set up by intestinal 
worms. The motions must be carefully examined for worms, and if they are detected, 
the proper remedies be administered. (See article on Worms.) Any irritation of 
the intestinal canal Ls particularly liable to set up fits, and the diet must be strictly 
inquired into. We well remember the deep impression made upon us many years 
ago by seeing a healthy child six years old suddenly seized with very violent con- 
vulsions. As no cause could be discovered for the attack, except the fact that the 
child had been indulging in a quantity of " pastry," an emetic was at once given, 
and the child vomited up, among much food of a not very digestible character, a piece 
of slate-pencil about half an inch long. This was the cause of the mischief, and the 
child being relieved of it, the fits ceased, and did not return. 

Fits are occasionally the first warning of the onset of serious diseases, and the 
child should accordingly be stripped, so that it may undergo a thorough examination. 
The signs of scarlet fever and measles should be sought as well as other fevers. The 
lungs also should be carefully examined with a stethoscope, so that diseases of the 
lungs, such as inflammation or pleurisy, may be detected and treated without delay. 
Again, convulsions may indicate disease of the brain, but happily this is not often 
the case. Asa rough test, we may examine the fontanel, and if this is depressed, 
the convulsions are certainly not due to brain disease. If it is prominent, however, 
one must not conclude that the fits are caused by cerebral disturbance. 

Disease of the kidneys is a common cause of convulsions, even in young children, 
and when convulsions occur during convalescence from scarlet fever, they always 
cause one to suspect that the kidneys have suffered. A careful examination of the 



CfcOCF. 11 

mine will suffice to determine this question. Chemical and microscopical observa- 
tions will not fail to give evidence, should any disease be present. 

The treatment of fits is generally very simple. During the fit we must loosen the 
child's dress, and see that it has a plentiful supply of air. We must also take care 
that while the convulsions are in progress it takes no harm, and it is advisable to 
stand by it, and exercise some slight control over the movements of its limbs. If 
the cause can be detected, every effort must be used to remove it. The bowels 
must be emptied by a purgative, or the stomach relieved by an emetic, or, if there 
be real necessity, the gums may be lanced. A hot bath is often of great service, and 
the application of mustard plasters to the calves of the legs is a method of treatment 
of such respectable antiquity that we cannot but believe in its utility. 

It is important not to employ too strong measures. Fits are no indication 
of inflammatory action, and it is not necessary to apply leeches, nor to use strong 
purgatives, nor apply blisters. These weaken the child, and increase its danger. 

Fits prove fatal by the exhaustion that they cause, and it is therefore highly 
necessary to keep up the child's strength. In the intervals between the fits it must 
have some nourishing food — milk, beef tea, or meat jelly ; and if the fits are of long 
continuance, we may add a small quantity of wine, or even brandy. If it is found 
impossible to feed the child by the mouth, owing to the close setting of the jaws, it 
may be necessary to give nutritive injections by the bowels, but such strong measures 
are only admissible by and with the advice of a medical man. 

Next to feeding, the most important indication in treatment is to calm the excita- 
bility of the nervous system, and if possible get the child to sleep. The bromide of 
potassium or ammonium, in doses of five grains every three or four hours, may be 
given either dissolved in water or in food, and this will generally be found to 
have the desired effect of producing calmness, if not sleep. If the convulsions 
are very frequent indeed, the medical man may think it necessary to administer 
a little chloroform, but we need hardly say that the friends will not think of 
dealing with this potent medicine on their own authority. The greatest caution, 
too, is necessary in dealing with the stronger narcotic medicines, as opium 
or chloral. 

Consumption. — (See Tuberculosis. ) 
Cow Pox. — (See Vaccination, p. 63.) 

Croup. — This disease, which is one of the most terrible and fatal to which 
children are liable, is characterised by inflammation of the upper part of the wind- 
pipe (larynx), accompanied by the growth of membrane. The membrane which 
grows in the windpipe makes it narrower, and consequently the ingress and egress 
of air from the lungs is very greatly impeded. In addition to this mechanical 
obstruction, however, there is superadded a spasm, caused by the irritation of the 
inflammatory action, for during the continuance of croup there is always more or 
less difficulty of breathing, and this permanent difficulty, aggravated by spasm, 
renders respiration at times an absolute impossibility, and if this impossibility lasts 
for more than a few minutes, the child is necessarily killed by suffocation. The 



ft DISEASES OF CHILDREN. 



windpipe of children is narrower than that of adults, and hence it is that any 
tendency towards inflammation of it is so much to be dreaded. It has been thought 
by many that croup is the same disease as diphtheria — the only difference between 
them being, that in croup the larynx alone is affected by the false membrane, while 
in diphtheria the membrane grows on other parts as well — as the soft palate and 
uvula, and also on the "swallow," or pharynx. If a child has croup — i.e., if the 
membranous inflammation is limited to the larynx — it is not usual for the disease to 
spread to other members of the family ; but in diphtheria the case is far otherwise, 
and nothing is more common than for it to attack the members of a family by 
turn. This is the chief difference between the two, and although tins difference is 
an important one, and one which alone would be sufficient to place them in different 
categories, still, the points of resemblance are so many that for all practical purposes 
croup may be considered as diphtheria of the windpipe. Croup seems to be favoured 
by hereditary tendencies, and it is one of those diseases which are apt to fall with 
undue severity on certain families through many generations. Exposure to cold, 
too, seems to be a great exciting cause, and the spring and winter are the seasons in 
which the disease is most prevalent. Unhealthy domestic arrangements, such as 
imperfect drainage, exposure to emanations from sewers, and low-lying, situations, 
seem also in some degree to predispose towards croup. It must be said, however, 
that it is not a very common disease, and the experience even of medical men of 
large practice among children does not include very many cases of this fatal malady. 
The child usually goes to bed tolerably well, or perhaps it has complained or its 
friends have noticed that it has a slight cold, or speaks a little hoarsely. There is also 
some heat of skin, and perhaps a little thirst and headache. Having gone to bed with 
no symptom that could cause alarm, it may wake in the night with all the torments 
of fully-developed croup. The windpipe may be tender to the touch, but this is not 
usually the case. The child struggles for breath, and clutches at its throat in an 
agony of terror. There is a loud, clanging, peculiar cough, and the noise of the 
breath passing and re-passing through the obstructed air-tube is high-pitched and 
hissing. The expression is anxious, the eyes suffused, the face purple, the whole 
body bathed in perspiration, and the voice whispering and hoarse. The child seems 
on the very point of suffocation, when the paroxysm subsides, and it becomes quiet 
again and tolerably comfortable. It must be borne in mind that these paroxysmal 
increases of suffocation are due to spasmodic narrowing of the windpipe excited by 
the inflammation. The remission of the symptoms is due to the subsidence of the 
spasm, and not to the removal of the membrane, which is the ferns et origo of the 
trouble. These paroxysms last variable times — from ' half a minute to half an hour. 
The liability to their occurrence is much greater during the night than during the 
day; and the parents, who see their child lying tranquilly throughout the day, or 
without any great evidence of suffering, are apt to be buoyed up with the delusive 
hope that the disease is subsiding; but when with the return of night the spasm 
returns, and returns probably with increased severity, this hopefulness is cruelly 
dissipated. The urgent difficulty of breathing is usually attributable to the spasm, 
but occasionally the growth of membrane may be so great as absolutely to obstruct 
the opening of the windpipe. The amount of obstruction present is judged of 



CBOUP. IS 



by the degree to which the chest sinks in during the attempts to draw the breath. 
In health, the chest walls bulge out during the act of inspiration j but if the entrance 
to the windpipe (the glottis) be obstructed, they fall in, and the degree to which 
they do so is a measure of the amount of obstruction. The sinking in of the chest is 
always considerable during the attacks of spasm, but in the intermediate periods it 
may not be noticeable, and the inference we draw is that the amount of membrane 
present is not great; but if in the intervals between the spasms the chest walls 
recede, we conclude that the obstruction is considerable, and our apprehensions are 
consequently serious. It is not usually feasible to see the membrane in the throat. 
This is only possible by means of the laryngoscope, an optical instrument for 
illuminating and reflecting an image of the windpipe ; but it is not advisable to use 
it on children suffering from croup, lest the excitement may bring on a spasm. 
On simply looking into the throat, we may see that it is red and perhaps swollen, 
and if we can catch a sight of the tip of the epiglottis — the lid covering the top of the 
windpipe — we may see that it too is in the same condition. If any false membrane 
is seen on the palate or the back of the mouth, the case would be spoken of as one 
of diphtheria, and not croup. Occasionally children cough up great pieces of the 
membrane, which resemble tough pieces of moistened wash-leather. This is usually 
followed by relief; but the membrane often grows again, and in a few hours the 
child's condition is as bad as ever. The disease, if it terminates fatally, usually does 
so by the end of two or four days ; but if the child survive, and live into the second 
week, the chance of its recovery is greater. Occasionally we may find the glands 
along the side of the neck enlarged. 

The complications of croup are all referable to the lungs. It is very usual to 
have some bronchitis, and if this bronchitis be caused by the growing downwards 
into the lung of the false membrane, it is necessarily of a very serious kind, and very 
often results in collapse of great portions of the lung, i.e., the lung emptying of air 
and not being able to get filled again. Pneumonia, or inflammation of the lung 
itself, is a very serious complication, and one which is very generally fatal. 

It is not easy to foretell the result of an attack of croup, but the disease when 
once established is but too often fatal. Very young children recover less often than 
older ones, so that the older the child the better is his chance of recovery. It is 
said that croup is especially fatal when it follows measles. The presence of any of 
the complications, especially pneumonia, is very serious. It should be borne in 
mind that children occasionally die quite suddenly in croup, apparently from the 
shock caused by sudden closure of the windpipe. A second attack is said to be less 
likely to be fatal than a first; but it is somewhat doubtful if true croup ever recurs, 
and whether these so-called second attacks are not merely attacks of ordinary (not 
membranous) inflammation of the larynx to which spasm is superadded. 

Croup has to be distinguished from the above-mentioned simple inflammation of 
the larynx, with which it is not unfrequently confounded. The disease of all others, 
however, which is most often mistaken for croup, is the so-called false croup, or 
laryngismus stridulus, which is quite a different disease, and which consists of 
spasm of the windpipe alone, without any inflammation of any kind. The noises 
in the throat in laryngismus very closely resemble those of true croup, but th* 



14 DISEASES OF CHILDREN. 



paroxysms are of less duration, and it is generally accompanied by peculiar con- 
tractions of the fingers and toes, which are not observed in true croup. Laryngismus 
is almost limited to those of rickety constitution, while true croup attacks con- 
stitutions of all kinds, and respects none. 

The treatment of croup must be rational, and we must be careful not to do too 
much and so weaken the child who requires all its strength to battle with its disease. 
It used formerly to be the fashion to apply leeches to the neck over the windpipe, 
and to dose the sufferer pretty freely with calomel and tartar emetic, "or antimonial 
wine ; but this is seldom considered necessary nowadays, and any attempt to cut 
short the disease by strong measures is, we think, to be deprecated. It is very 
useful to begin with an emetic, and a tea-spoonful of ipecacuanha wine may be 
administered with advantage. The act of violent coughing which usually accom- 
panies vomiting may have the effect of dislodging some of the membrane in" the 
larynx. The parts should be kept warm and moist. Poultices may be applied to 
the throat, and the child may with advantage inhale the steam of hot water. The 
bed should be provided with curtains, and the steam from a kettle provided with a 
long tube from the spout may be conducted between them. The bed should be 
of a large size, and the curtains not too thick, so as to avoid overheating the 
patient, and producing weakness. Some physicians are accustomed to repeat the 
emetic, and always keep one at the bedside to administer when a dangerous 
paroxysm supervenes. It is necessary to give a sufficiency of the most nourishing 
food. The strongest soups, milk and wine, or brandy and water, may be given with 
no stinting hand, but great care must be taken not to overload the stomach, nor to 
give anything which shall make too great a demand on the digestive power. 

If the child is in urgent danger of dying of suffocation, it is necessary to open the 
windpipe by the operation of tracheotomy. This is always a very serious proceeding, 
but serious as it is there should be no hesitation in consenting to its performance, 
for it assuredly gives the child a chance of life. It must be remembered that the 
windpipe of the child is blocked with a membranous exudation which it has failed 
to remove by the act of coughing ; that it is not only impossible but inadvisable 
even to attempt to remove the membrane through the mouth by inserting forceps 
into the windpipe ; but it is certain that if some plan be not devised for getting 
air past the obstruction into the lungs, death must inevitably result. The operation 
of tracheotomy consists in making a small cut into the windpipe below the 
obstruction, and inserting a tube through which the child is enabled to draw air 
into its lungs. The operation is one which to the uninitiated seems terrible, and 
during its performance the child had better be left entirely to the care of the 
medical attendants and nurse, who are accustomed to perform and witness operations 
of all kinds. In many cases it is quite safe to give a little chloroform to lessen 
the sufferings, but even if this be not thought advisable, the Mends will find some 
consolation in the fact that the sensibility of the little patient has been so deadened 
by the suffocative process to which it has been subjected that it will feel but little, 
and being quite unconscious of what is going to be done to it, it is saved all the 
terror of apprehension which so increases the sufferings of adult patients. If the 
operation be successful, the relief afforded by it is one of the most gratifying 



FiiSE CROU*. 15 



testimonies to the value of the surgical art which it is possible to witness. The 
child, who a few moments previously had been struggling for breath in an agony 
of terror, with a face purple from suffocation, suddenly finds that air can be drawn 
without difficulty into its lungs. The agony vanishes, the natural complexion 
returns, the child is able probably to take nourishment, and after some expressions 
of satisfaction it commonly falls into the caresses of " Nature's soft nurse." 

Unhappily, the relief afforded by tracheotomy does not always secure the recovery 
of the child. There are still rocks ahead of which the friends should be well aware. 
The most common cause of death after tracheotomy is bronchitis or inflammation 
of the lungs, and the best method of guarding against this is to exercise great care 
that the air of the room in which the child lives is kept properly warm and 
moist. Ordinarily, the air which we breathe is warmed by passing through the 
hot cavities of the mouth or nose, which is not the case when the air is admitted 
to the lungs through a tube in the throat, and it often happens that bronchitis 
is set up or kept going by the irritation of cold air striking on the lungs. 

Sometimes the child dies of exhaustion after tracheotomy. This is often the 
case when the operation has been too long delayed, which is a common result of 
the reluctance of the friends to give the necessary permission for its performance. 
The child has been so weakened by disease that its power of recovery is too 
slight to allow of its receiving any advantage from the operation ; but even in 
such cases the sufferings are very much lessened, and the friends are spared the 
spectacle of a helpless child dying in the greatest agony. If tracheotomy has 
been performed, great care must be taken that while the child is wearing the 
tube in its throat it be kept scrupulously clean. The tube should be washed or 
changed every day, and the edges of the wound should be carefully cleansed of 
all discharge which may accumulate round them. If the operation be successful, it 
will be found that as recovery advances the obstruction in the windpipe diminishes ; 
and if the patient be taught to close the orifice of the tube with the finger, or 
if the tube be closed for it, it may be able to cough up the portions of false 
membrane as they loosen and separate. When the child is able to breathe when 
the orifice of the tube is stopped, i.e. t when the child is able to draw air through 
the top of the windpipe and past the tube, the tube may be removed, and in a 
very few days the opening which was made for its insertion will heal and close. 

During convalescence from croup, great care must be taken that the child is 
not exposed to cold, for the exposure of the scarcely-healed windpipe to the cold 
air may bring about spasm, and perhaps a return of the trouble. 

During an attack of croup, the child should be kept se[>arated from its fellows, 
so that no risk of contagion may be run ; and it should not be allowed to mix again 
with its companions till every croupy symptom has disappeared. Sea air is of great 
service in restoring the strength after croup, as after other exhausting diseases, but 
our south coast with its moist balmy breezes should be selected in preference to the 
more cold and bracing climate of the east. 

False Croup is of two kinds. Many children, especially between the ages of 
about four and twelve, when they catch cold are liable to suffer in their throats. 



16 DISEASES OF CHILDREN. 



The cold, instead of settling in the nose or the head, " flies to the throat," as it is 
termed", and a trifling catarrh, i.e., the slightest possible inflammation, is liable to 
affect the upper part of the windpipe. To this symptom not unfrequently is super- 
added spasm of the glottis (the opening of the windpipe), and the child wakes in 
the night with a loud crowing inspiration and also with a difficulty of breathing. 
This crowing sound as a rule subsides after a little time, and the sound 
of the respiration, although it may be slightly loud and hissing, has not the 
clanging crow which only supervenes during the attacks of spasm. This cold in 
the windpipe lasts about as long as a cold in the nose — a variable period from 
forty-eight hours to a week — and then subsides, and with it subside all the 
alarming croupy symptoms. This condition of things is very liable to recur, and 
when we hear of a child being liable to croup, we know that this mild catarrhal form 
is meant, and not the severe kind, which is characterised by the growth of false 
membrane, and which (if the child escape unscathed from its attack) we believe never 
returns. The treatment of catarrhal false croup is simple. The state of the bowels 
should be attended to, and, if necessary, a mild purgative should be given. A 
powder composed of rhubarb and carbonate of soda, to which a very small quantity 
of grey powder is added, will be found of service. To the outside of the throat a 
mustard plaster, or even a blister, should be apnlied, and the child should be made to 
inhale the steam of hot water either from a common jug or from one of the patent 
inhalers which form part of the stock-in-trade of every druggist. Many parents whose 
children are liable to this form of croup are accustomed to carry always with them a 
bottle of emetic (generally ipecacuanha wine), which they administer directly the 
familiar symptoms make their appearance. This does good very often by emptying 
the stomach ; and since the determining cause of these attacks is frequently some 
error in digestion, the emetic is often sufficient of itself to effect a cure. 

Spasmodic False Croup. — Child crowing, or Laryngismus stridulus, as it is 
technically called, is a totally different disease, and although resembling true croup 
and catarrhal false croup in its prominent symptom, it is on no account to be con- 
founded with either. It occurs generally during infancy, while the child is cutting 
its first teeth. The children who suffer are of delicate constitution, never robust, 
and the constitution which seems most liable to this disease is the rickety (see 
Rickets). The period of first dentition is always a time during which the nervous 
system manifests an undue activity, and while some children suffer from attacks of 
general convulsions (see Convulsions), others show a tendency more to a convulsion 
or spasm of the windpipe. There is generally some irritation present which is recog- 
nisable as the cause of the spasm. This may be found in the stomach in the form of 
indigestible or improper food, or in the intestines in the form of worms, and often, 
no doubt, the irritation of teething is sufficient to produce it These patients are 
generally backward with their teeth, but one must not on that account rush to the 
conclusion that the backwardness or difficulty of cutting the teeth is the cause of 
the spasm, but we must remember that the spasm of the glottis or windpipe and 
the delayed dentition are generally dependent on the same cause, viz., the rickety 
Ymsttefe^ These children have often the big head of rickets, and the trouble 



FAlftE CROtTP. 17 



may be supposed to be due to disease of the brain, but such is very rarely the 



The symptoms of laryngismus stridulus are — a sudden suspension of respiration. 
The child wakes suddenly from its sleep, starts up and struggles for breath, then 
often becomes unconscious, and lastly, as the spasm of the windpipe relaxes, it draws 
in its breath with a loud crowing noise, which is highly characteristic. The suspen- 
sion of respiration may endure so long as to cause the child's face to become pale and 
livid, but directly the breath has been drawn, this symptom disappears, and the child 
becomes well again. The attacks are generally renewed again and again at uncertain 
intervals. During the attacks there are usually observable curious contractions of 
the fingers and toes which are technically known as the carpo-pedal contractions, and 
which are almost absolutely characteristic of this disease. The toes are bent down 
and are rigid, and the thumbs are tightly bent across the hands. The disease may 
be looked upon as indicative of an impaired constitutional state rather than as 
dangerous in itself, but it must also be borne in mind that children do occasionally, 
though happily very rarely, die during a spasm. This is an accident which, in point 
of fact, is liable to occur whenever the upper part of the windpipe is diseased, and 
especially when the patient is of tender years. Recovery, however, is the rule, and 
death is the exception. 

This disease has to be distinguished from the catarrhal false croup and true croup, 
and the distinction is generally not difficult, for not only are we guided very often 
to a right conclusion by the spasms of the hands and feet, but the fact that the child 
is absolutely well between the attacks of crowing is sufficient to prevent any mistake. 
In catarrhal croup, the voice is hoarse, even between the attacks of spasm, and in 
true croup the voice is either hoarse or reduced to a whisper, and the noise of the 
respiration is high-pitched and hissing. 

The treatment of spasmodic false croup must be directed to the prevention of 
the spasm, and the curing of the constitutional condition which is the cause of it. 
The spasm is liable to be brought on by any excitement, any quick movement 
of the child, or anything which may be likely to rouse its emotions or passions. 
Children, therefore, who are liable to this disorder must be kept very quiet, and 
should be separa ted from any of their little companions who are likely to be too noisy 
or rough. 

The diet must be most strictly attended to, and a careful surveillance must be 
kept lest the child get hold of any of the edible trash which is such a potent 
cause of sickness in children. Until a child has cut its first teeth it ought to be 
kept like a baby, and ought not to be allowed to be nursed at meals with the rest 
of the family, and be fed upon a variety of things which its young stomach is 
not able to digest. As soon as a child is weaned, its diet should consist almost 
entirely of milk and meat broths, and the less starchy matter it has the better. 
There is no gpesier misis»V* tban to cram a child with patent foods, which are so 
much in vogue at present If the child v omits curdled milk or passes 'white curC 
matter from the bowels, a little lime water should be mixed with the milk to 
counteract the undue acidity of the intestinal secretions. About three table- 
spoonfuls of lime water to every pint of milk is generally sufficient. If the bowels 
3 



18 DISEASES 07 CHILDREN. 



are confined, a mild alterative purgative (rhubarb, soda, and grey powder) may 
be given, and the motions should be carefully watched for any signs of worms or 
other cause of irritation. 

Next look to the teeth, It used to be almost a matter of routine to lance the 
gums in every case of laryngismus, but some discrimination is necessary before this 
measure is taken. Look to the mouth, and ascertain if the child has the proper 
number of teeth for its age (see Dentition), and if it has not, proceed to ascertain 
whether the gums are being pressed upon and irritated by the teeth coming up 
beneath. If this is the case the gums are generally reddened and swollen, and so 
tender that the child will cry out when they are touched. It is not uncommon 
to find the glands under the jaw enlarged and tender. If these signs be present, 
then there need be no hesitation about lancing the gums; but if they are not 
present, such a proceeding is unnecessary, and is merely a useless infliction of 
pain. 

Examine carefully into the child's constitutional state, and examine its head, 
bones, joints, and back, for any sign of rickets, and in nine cases out of ten we have 
no hesitation in saying that such signs will be present. This being the case, we 
must look to the diet, which should be as nourishing as possible, and great benefit 
will be derived from the administration of cod liver oil and steel wine (a tea- 
spoonful of each twice daily after meals). It is important, too, that these children 
should get as much as possible into the open air. It is a mistake to suppose that 
their throats are delicate and that they need coddling : such is not the case. They 
should be warmly wrapped up with a thick veil over the face to keep off the cold 
wind, and they should be taken out regularly, and, if old enough, encouraged to 
run about. Sometimes the child, instead of being rickety, is scrofulous, and in 
such cases the administration of iodine (half a tea-spoonful of the syrup of the 
iodide of iron once or twice a day) is advisable. Sea air in scrofulous cases is 
a most valuable adjunct to treatment, and the child should, if possible, have the 
benefit of it 

Dentition. — The cutting of the teeth is a natural process, and we have no right to 
class it among the diseases of childhood; but, nevertheless, the process is often a cause 
of so much difficulty and trouble to delicate children, and the period during which 
the process is going on is one which is often so critical, that we may be excused for 
offering a few remarks on the subject. The " first set " of teeth, or the milk teeth, 
as they are more properly called, are twenty in number. The first to appear are the 
central incisors, or the thin cutting teeth, in the middle of the jaws, in the very 
front of the mouth. These should be cut by the seventh month of life, so that at the 
end of the seventh month a child should have four teeth — two in each jaw. The 
lateral incisors are the next to appear. These are two in number in each jaw, and 
immediately adjoin the central incisors. They should be cut by the end of the ninth 
month, so that a child of nine months old ought to have eight teeth. At the end of 
the first year the anterior molars, or front grinding teeth, ought to have appeared ; 
and at a year and a half the canines, or dog teeth, should be cut. Lastly, by the 
completion of the second year, the posterior molars, or back grinding teeth, make up 



DENTITIOW. 



II 



the full set of twenty milk teeth. The following scheme shows at a glance the order 
of cutting and the number of teeth which a child should possess at different ages : — 




A««. 



7th month . 
9th month . 
12th month 
18th month 
24th month 



Teeth < 



Central incisors (a) 
Lateral incisors \b' 
Anterior molars (c 
Canine teeth ( 
Posterior molars (e 



Total No. 
of Teeth. 



12 
16 
20 



Even in healthy children there is some variation in the time of cutting the teeth, 
and if the dates above given be taken as the average, we must allow a month or two 
of latitude in either direction. Some children are very precocious with their teeth, 
beginning to cut them at three or four months old, and finish by eighteen months. 
Occasionally we hear tell of children being born with teeth, like Shakespeare's 
Richard ILL :— 

** The midwife wondered, and the women cried — 
■ 0, Jetu bleu «#, he it born with teeth/' " 

When children begin to cut the teeth, the gum swells up and becomes tender, and 
is painful. This makes the child fretful and peevish, and one that was good before 
becomes troublesome. This is often the cause of much injudicious feeding, and 
unwholesome things are given to the baby to keep it quiet, or else it is over-fed, and 
is allowed its bottle or is nursed whenever it cries. This, we believe, is the cause oi 
many of the troubles of teething, although we do not mean to deny that the period of 
tooth-cutting is really critical and trying to weak constitutions. It is, and it has for 
centuries been the custom to give a child something to suck or bite, with the idea, 
doubtless, of exercising pressure on the gums and so helping the tooth through its 
tough casing. A coral at least helps to keep a child quiet, and it is of use in this 
way certainly, and possibly in other ways. Rubbing the gums gently with a knob 
of sugar until a speck of blood appears will sometimes help the tooth to pierce 
the gum. 

Before the teeth are actually cut, a white centre can be seen pressing on the 
swollen gum, and if this point be evidently very tender, and if the child's condition 
calls for any interference, it is sometimes advisable to lance the gums ; but this is a 
proceeding which should not be resorted to without good cause. 

Whenever dentition is greatly delayed, the mother should suspect that her child, 
from some cause or another, is debilitated. Any weakening constitutional condition 
will cause delay in cutting the teeth, but the most common of all causes is rickets 
(see Rickets); and it is perhaps not too much to say that nine out of every ten 
children in whom dentition is greatly delayed are rickety. Tubercular or scrofulous 
children, or children who have been weakened by diarrhoea or lung disease, also fail 
to cut their teeth at the proper time. In very rare cases the condition of the 
{pirns or jaws is the cause of the delay in the appearance of the teeth ; but such 



20 



DISEASES OF CHILDREN. 



conditions are wholly exceptional and are very rarely met with. The diseases most 
common to the first dentition are the constitutional diseases : rickets, scrofula, and 
tuberculosis, which often make themselves manifest at this time. Convulsions and 
false croup of the spasmodic kind are also liable to occur. It is a period when 
children require a large amount of attention. 

About the age of six, children begin to prepare for the second set of teeth by 
shedding the first, and children of this age are generally noticeable for their ragged 
mouths. There are twelve more teeth in the second than in the first set, or thirty- 
two in all. The extra teeth, six in each jaw, are inserted at the sides, so that the 
form of the arch of the teeth is different in the young child and in the adult, being 
exactly semi-circular in the first instance, and somewhat like a donkey's shoe in 
the second. These extra teeth consist of two " bicuspids " on each side, which are 
inserted between the dog teeth and the front grinders, and one wisdom tooth on 
each side, four in all, which are inserted at the extreme end of the dental arch. 
The permanent teeth are cut in the following order : — The anterior molars at six 
years, the central permanent incisors at seven years, the lateral incisors at eight 
years, the anterior bicuspids at nine, and the posterior bicuspids at ten years, the 
canine at eleven, and the second molars at twelve years. The wisdom teeth, which 
are the last to appear, are very uncertain in the time of their appearance, and 
may come at any time between the seventeenth and twenty-fifth year, or even 
later. The following scheme shows the times of cutting the permanent teeth :— 



Agt. 



6 years • 

7 years 

8 years • 

9 years . 

10 years • 

11 years • 

12 years 
17-25 years 



Teeth cut. 



Anterior molars . 
Central incisors . 
Lateral incisors . 
Anterior bicuspids 
Posterior bicuspids 
Canines 

Second molars . 
Posterior molars (wisdom) 



Total No. 
of Teeth, 



4 

8 
12 
16 
20 
24 
28 
82 



The second dentition is scarcely so critical a time with children as the first, 
although certain diseases of the nervous system, such as St. Yitus's dance and 
epilepsy, are very apt to declare themselves at this time. As to the act of cutting 
the second teeth, it is very rarely that it causes any annoyance or trouble. 

Diarrhoea and Dysentery in Young Children. — It must be borne in mind that the 
bowels of very young children act three or four times in the twenty-four hours, and 
that the motions are generally loose; one must not, therefore, rashly conclude that a 
child is suffering from diarrhoea ; but if a child of less than three months of age has 
an action of the bowels more than thrice, or one over that age more than twice, in the 
day and night, we shall not be wrong in concluding that the actions, provided they 
be not hard, are excessive, and need checking. It too often happens that the first 
acquaintance which many children make with this world is marked by diarrhoMfc, 



DIARBH(EA — DYSENTEBY. SI 



produced by ill-advised measures. Many ignorant midwives have a notion that th« 
first and best thing to do with a newly-born baby is to give it a mixture of melted 
butter and sugar, in order, as they term it, to " cleanse its bowels," but in reality to 
give it indigestion, to cause it to be early acquainted with the colicky pains of wind, 
and to trouble its nurse and friends with an early-developed attack of diarrhoea. 
This first false step leads to ignorant and injudicious tinkering with drugs, and the 
unhappy innocent is hurried on by its ignorant and foolish protectors from trifling 
maladies to those which lead to a permanent injury of the health. 

The main causes of diarrhoea in children are to be found in the food — its quality 
or its quantity. Children are doubtless the victims of much wrong feeding, the case 
usually being that the food given to young children is of too complex a nature, and 
such as they are unable to digest. The proper food for -children prior to the cutting 
of the first teeth is the mother's milk, which they should receive at regular inter- 
vals. A child of three months old and under should be fed regularly about every 
two hours, and less often during the night. It should be kept at the breast until it 
shows signs of having had enough, when it should be taken away and not fed again 
until after its regular and proper interval It rarely happens that children who are 
fed carefully in this way cause any trouble whatever. If the mother has plenty of 
milk, it should be fed on nothing else for the first six or seven months at least. It 
should have no other milk, and no starchy or farinaceous food is on any account to 
be given until the teeth begin to appear. Milk is the proper food of children before 
they cut their teeth, and it has been conclusively proved that they are unable to 
digest starch in any form — bread, baked flour, biscuits, patent foods, or corn flour. If 
the latter be given they are very likely to do harm, and they cannot nourish the child. 
If the mother have no milk, the child must be fed on cow's milk diluted with one- 
third part of warm water. The meal for very young children must not be too large ; 
and if under three months, about four ounces (eight table-spoonfuls) of milk diluted 
as recommended, and sweetened with a knob of sugar, may be given at a time. 

When children begin to cut their teeth, and weaning has commenced, a little 
farinaceous food may be given ; and when the child is a year old a small quantity of 
beef tea may be added to the diet ; but until a child is two years old (until, that is, 
all its teeth are cut), it should be fed entirely on milk, beef tea, or broth, and bread 
or biscuit. When children about two years old and upwards are brought to the doctor 
with diarrhoea, and in answer to the doctor's question, " What are you feeding him 
on ? " the mother replies, u The same that we have ourselves," one may be certain 
that the cause of the diarrhoea is want of judgment or ignorance. 

Great care must be taken that the milk is neither sour nor putrid. Milk is a 
very sensitive fluid, and requires to be kept most carefully in a cool, clean place \ for 
if it be kept in a dirty pantry or a hot stuffy room, the milk is far more likely to 
become unwholesome than otherwise would be the case. If the milk is sour the 
child is sure to have diarrhoea. In hot weather, it is a good plan to boil the milk 
before giving it, and it may be diluted with lime water instead of simple water. 
Whenever a child passes white curds from the bowel, or vomits them, we may be 
sure that the addition of lime water to the milk is one of the remedies needed. 

Feeding-bottles require more attention than generally is supposed. Directly a 



$3 DISEASES of cniLDiftt. 



bottle has been used it should be put into hot water (tube as well as U*Ue), -where it 
should be allowed to soak for some time, and should be then rinsed and put to drain 
in a clean, airy place until it is wanted again. The smallest particle of sour milk 
sticking to the cork or to the tube of the bottle is sufficient to cause the whole of 
the milk put into the bottle to turn sour. Always smell both the bottle and the 
stopper before filling it, and on no account put fresh milk into a bottle which has 
the least odour of sourness about it 

After a child has been fed, its mouth should be immediately washed, and on no 
account is the child to be allowed to go to sleep with the drops of milk unwiped from 
its mouth or soaking into its bib or dress. Care must be taken, too, that the nipple 
of the breast of the nurse (in cases of suckling children) is not only free from disease 
but scrupulously clean. 

If these simple dietetic measures are insufficient to arrest the diarrhoea, it may 
be advisable to give a tea-spoonful of ordinary chalk mixture (the mistura cretw of 
the Pharmacopoeia) every three or four hours. This is almost the only remedy 
which may be safely administered to a young child without . medical advice. No 
form of opium and no patent .soothing medicine can be administered without danger. 

Sometimes the cause of the diarrhoea is to be found in the state of health of the 
mother or the nurse, and a change of nurse is often sufficient to arrest the troubles of 
the child. The condition of the teeth must be looked to, and, if necessary, the gums 
may be lanced. If the child have thrush, the suitable remedies must be used. (See 
Thrush.) The mother must always bear in mind that an obstinate diarrhoea may 
be caused by typhoid fever or by tubercles in the bowels. Diarrhoea is one of 
those troubles which should never be allowed to go on unchecked or without giving 
the child the benefit of skilled attention, if possible. 

There is one variety of diarrhoea to which young children are liable, and that is the 
mild dysentery, with which they are often attacked in the autumn. The difference 
between simple diarrhoea and dysentery is this, that in the latter disease there is 
an inflammatory condition of the lining membrane of the large bowel which requires 
special treatment. This form of dysentery (which, although bearing the same name, 
is hardly to be compared with the terrible forms of dysentery met with in the tropics) 
is accompanied usually by slight pain and some tenderness of the bowels. The belly 
is sometimes distended and sometimes sunken in, and the child passes from its bowels 
not only the ordinary motion, but slimy mucus, and even blood as well. It is the 
passing of blood and mucus from the bowel which points out the real nature of the 
affection. 

The cause of this dysentery is, in the first place, improper feeding of all kinds, and 
the remarks which we have made apropos of diarrhoea are equally applicable to the 
treatment of dysentery. It seems to be most common in low-lying districts, and it is 
probable that a malarious condition of the atmosphere is occasionally to be regarded 
as one of the causes. The administration of decomposing vegetable matter and 
unwholesome fruit to children, which is particularly liable to happen in the autumnal 
season, is undoubtedly a potent cause of this affection. 

The best treatment for' this condition is the' repeated administration of small doses 
c£ castor oil. Five drops of castor oil with an equal quantity of gum water, given is 



•UfGRENOUB ULCERATION 38 



a tea-8poonfal of cinnamon water every three or four hours, acts very often like a 
charm. If there be much pain, or if the discharge from the bowels be very copious, 
it may be necessary to give a small quantity of laudanum ; but the administration of 
laudanum to young children requires so much judgment, and is a matter which, in un- 
professional hands, is fraught with so much danger, that we forbear to name the dose 
which is requisite. "We rather feel it our duty to repeat that neither laudanum or 
opium in any form, nor indeed any narcotic drug, whether in the form of a patent 
medicine or otherwise, ought ever to be administered to a young child unless by 
the advice and with the consent of a medical man. 

Bad water is also a cause of dysentery, and the source of the water supply 
should be looked to in every case, so as to find whether or not the water has been 
contaminated by sewage, or by any other decomposing matter, whether animal or 
vegetable. 

Falling Down of the Bowel — or prolapsus cmi—h an accident which is liable 
to happen occasionally to weakly, and especially rickety, children. When the child 
goes to stool the bowel protrudes, and does not go back again. This condition of 
things is brought about — first, by the state of the child's health, which occasions a 
relaxed condition of the bowel ; secondly, by any undue irritation of the bowel, as by 
worms ; and thirdly, by constipation, which by causing the child to strain excessively 
at stool, produces the mischie£ The condition need cause no alarm, for, although 
it is a strong indication of impaired health, it is not in itself dangerous. 

The treatment consists, first, in the careful regulation of the child's health, and 
the administration of astringent tonics ; cod liver oil and steel wine (a tea-spoonful of 
each) twice a day, after meals, is productive of great benefit, and is often sufficient in 
itself to effect a cure. The bowel should be carefully replaced after eveiy motion, 
and, if necessary, it may be retained in its place by a conical pad fastened on by a 
bandage. The parts in the neighbourhood of the bowel must be kept carefully 
cleaned, and should there be any indication of the presence of worms, suitable 
measures must be instituted for the removal of them. The diet must be regulated with 
great care, and all indigestible food be most rigidly avoided, and constipation must 
be carefully guarded against ; at the same time, care must be taken not to administer 
purgatives of too violent a kind. If we can ensure a perfectly free action once a day, 
that is all that is necessary. It is often easy to effect this by adding something to the 
diet that has a slightly laxative effect, as fresh fruit, tamarinds, stewed prunes, or 
figs. A tea-spoonful of phosphate of soda, dissolved in beef tea or milk, is a very 
agreeable purgative for children, and if administered hot it is usually very effectual. 

False Croup. — (See article Croup.) 
Fits. — (See Convulsions.) 

Gangrenous Ulceration of the Cheek. — This is a very serious condition indeed, and 
is one that occasionally attacks children when they are recovering from the infantile 
fevers, and especially after measles. It is most common between the ages of two and 
thirteen, but happily it is a rare condition. The first symptom consists in a swelling 
of the cheek, which of ten has a tense shining appearance, and on touching it we find a 



24 DISEASES OF CHILDREN. 



hardened spot, which is perhaps better felt if one finger be applied to the inside and 
the other to the outside of the cheek. The skin over it is generally red, and the 
condition is not unlike an angry carbuncle growing in the thickness of the cheek. 
This swollen patch mortifies or sloughs, and then we get extensive ulceration, with 
discharge of matter and shreds of core. This ulceration may spread enormously, so 
that the teeth fall out, and pieces of the jaw-bones loosen and come away. The 
glands of the neck and under the jaw get very much enlarged. The child but too 
often dies, the mortality from this alarming complaint equalling seventy-five per cent. 
of the total cases. Death is brought about either by exhaustion or by blood-poisoning 
secondary to the local condition. This disease is not due, as has been asserted, to 
the administration of mercury. 

The treatment must be local and general. For the local treatment very strong 
measures are necessary, and it is always advisable to have the opinion and assistance 
of a surgeon. The gangrenous surface of the wound must be destroyed, so as to stop 
the gangrenous action, and for the effecting of this, strong aquafortis is probably the 
best application. It must be applied thoroughly and to every spot of the wound, or 
it may have to be repeated. Disinfectants must be used to cleanse the mouth, and the 
strength of the child must be supported by every possible means. The strongest soups, 
beef tea, port wine, arrowroot, and other nourishing and wholesome food, must be 
given liberally. In a condition like this there need be no hesitation about giving wine 
even to very young children, as they take it well, and it will certainly do them good. 

German Measles. — This may be looked upon as a new disease, and although it 
has long been recognised by German physicians, it is only of late years that it has 
been noticed in this country. It is also known by its German name of " Rotheln," 
and has occasionally been spoken of as hybrid measles or hybrid scarlatina. Such 
names are' not good, because they are liable to lead to the false impression that the 
disease in question is a mixture of measles and scarlatina. The premonitory fever 
in Rotheln very closely resembles that of measles. There is malaise, headache, loss 
of appetite, ninning at the nose, and occasionally a painful condition about the eyes. 
It is of much less duration than in measles, and lasts generally only twenty-four 
hours instead of four days. 

The eruption very closely resembles that of measles, but is often more copious, and 
is liable to coalesce, so that the skin appears uniformly red. The rash, indeed, begins 
like measles, and ends often like scarlet fever. The eruption lasts a longer time 
than that of measles, and its duration varies from five to ten days. After its 
disappearance there is a general peeling of the skin. This is more marked than ever 
is the case in measles, but is not nearly so pronounced as in scarlet fever. 

The sore throat is always a prominent feature. It is never so severe as the throat 
affection of scarlet fever, but it is, nevertheless, more severe than that met with in 
measles, and often endures until the disease has completely run its coursa 

The disease is contagious and infectious, but it invariably gives rise to true 
Rotheln, and not to measles or scarlet fever, as one might suppose from the name 
hybrid which has been given to it. Neither does Rotheln protect from measles or 
■carlatina, nor do either of these diseases protect from Rotheln. 



KZJLBLML 



2fl 



For treatment, see article on Measles. 

Hooping Cough. — (See Whooping Cough, p. 70.) 

Gum Boil. — (See Domestic Surgery.) 

Hydrocephalus. — (See Water on the Brain.) 

Intussusception of Bowels. — (See article on Constipation,) 

Incontinence of Urine. — (See Bedrioetting.) 

Infantile Paralysis. — (See Children's Paralysis.) 

Intertrigo. — (See Chafing.) 

Laryngismus Stridulus. — (See False Croup.) 

Measles. — This is certainly the most common of all the diseases of childhood, and 
very few children indeed escape their attack of measles, which is almost looked upon 
as one of the early and necessary consequences of existence. It is not, properly 
speaking, a disease peculiar to early age, but being one of the most infectious of 
the infectious diseases, human beings seem invariably to contract it when they 
are first brought in contact with its influence. When measles attacks a u virgin 
population," as it is called, i.e., a population which has not previously suffered from 
the disease in question, it is found to attack all ages alike, and the elderly are found 
to suffer quite as severely as the young. Thus, in 1845, the measles invaded the 
Faroe Islands for the first time, and it was found that scarcely one of the inhabitants 
escaped being attacked by the disease; and one of the consequences of the annexation 
of the Fiji Islands has been the importation of measles there, and we need not do 
more than recall to the mind of the reader the severity of the epidemic and the large 
number of fatal cases. The disease is far more severe and far more fatal when it 
invades a country for the first time ; and it seems as though we inherited from our 
measles-infected ancestors and transmitted to our offspring some power of resisting 
the attack, which is not found among those whose history records no epidemic of this 
commonest of maladies. Even in this country we find that measles is capable of 
attacking old persons as well as young, and no one can be considered as freed from 
all liability until he has once suffered. It is rare for a person to suffer more than 
once, and, as a rule, one attack is found an effectual protection ; but this is not 
always the case ; and every one who has had an average experience of life can recall 
cases of persons who have suffered a second time from undoubted measles. 

Measles is so infectious that it is often impossible to say how the child contracted 
it, and if one child in a house suffers, it is almost the invariable rule that all the 
denizens of the nursery suffer by turns. The infection of measles is probably 
conveyed by the air, and consists, it is not unlikely, of fine particles given off with 
the breath, or rubbed off the skin, which, floating in the atmosphere, are swallowed 
or inhaled, and give rise to measles in the person by whom they are taken in. 

" Measles being so infectious," the question may be asked, " is it any use to try 
and prevent them 1 " To this we should say, decidedly, yes, and especially if the 
ohild be very young. We think no mother would be justified in i-unning any risk 



26 DISEASES OF CHILDREN. 



by allowing her babies to have any intercourse with houses or families where this 
complaint is known to exist. Very young children have necessarily less resisting 
power for disease than older ones ; and if the attack of measles can be warded off 
until the child is a couple of years old, and has passed through the period of 
cutting teeth, the chance of its passing successfully through the measles, and 
making a complete recovery from them, is very greatly increased. 

Symptoms. — Measles may be likened to a very bad influenza cold, with a rash. 
The child appears " out of sorts ; " is peevish, perhaps ; does not take its food with a 
relish ; and instead of participating in the amusements of its fellows, is more inclined 
to keep quiet, to lie down on the sofa, or even to remain in bed. Then comes a 
little sniffing at the nose, a running at the eyes, and perhaps a trifling sore throat. 
These symptoms are very characteristic, and any nurse who has had the ordinary 
experience of the nursery would, on seeing these, suspect the onset of measles. Any 
child presenting the appearances we have mentioned should at once be separated from 
its fellows until the disease has either passed away or declared itself In these early 
stages the child is feverish, and the temperature of the body (as measured by a 
thermometer) will be found increased. It is probable also that a child is infectious 
even in this very early stage, and its being placed in quarantine may be now too late 
to prevent the spread of the disease, but we nevertheless strongly advise separation 
as a precautionary and proper measure. 

After the child has suffered for two or three days (generally three) from this 
feverish cold the rash appears, and when the rash appears the other symptoms 
generally increase somewhat in severity. The rash appears first on the forehead, at 
ike roots of the hair; next it goes to the cheeks ; then the chest and surface of the 
stomach are attacked ; and lastly the arms and legs. The rash consists of rose- 
coloured spots, varying in tint very much, as the tints of red blotting-paper vary, 
from a pale pink to a decided red. The spots are of an average size of a small split- 
pea, and may be scattered in separate spots or so close together as to make the skin 
look uniformly red They are sometimes collected together into crescentic patches, 
but the crescents as a rule are not easily recognised. Each spot is said to last about 
twenty-four hours, and then fades, and the eruption ought to have subsided entirely 
by the end of the fourth day after its appearance. As the eruption subsides the other 
symptoms subside also : the feverishness abates ; and at the end of a week, in favourable 
and average cases, the child will have passed through its measles with very little 
trouble to itself or its friends. 

We have described an average attack, but it not unfrequently happens that the 
special symptoms which we have enumerated are so severe as to give real annoyance, 
if not to cause alarm. Thus the eyes are not unfrequently much reddened and 
inflamed. The child feels as if there were sand beneath the lids, it is unable to bear 
the daylight, and the discharge from them may be considerable in amount. The 
discharge from the nose may be copious, accompanied by incessant sneezing, and at 
times bleeding from the nose may take place. The sore throat, too, may be trouble- 
some, and the glands under the jaw and round the neck may become enlarged and 
tender. The rash, as we have said, varies in amount, and in rare cases the whole 
becomes red and swollen, and the poor child is a pitiable object, with its eyes 



ItfeASLltt. V 



swollen np and intolerant of light, its throat too sore to swallow, its nose tender and 
discharging, almost deaf from the spreading of the trouble from the throat and face to 
the ears, and harassed by incessant coughing and sneezing. 

When measles runs an uncomplicated course, it is not a disease which generally 
causes much alarm. When measles is fatal, it is so by its complications ; and it is 
for these complications which the friends and the doctor should ever be on the look- 
out, and for the prevention of which much of the treatment is directed. 

These complications often occur in the windpipe or lungs. We may have inflam- 
mation of the windpipe established, or inflammation of the lung-tubes (^bronchitis), 
or inflammation of the lung substance itself (pneumonia). These complications are 
all serious, and are indicated by noisy breathing, great increase of cough, very rapid 
respiration, and sometimes by signs of impeded respiration and commencing suffoca- 
tion. When any of these complications occur, the child cannot be considered to be 
free from danger. 

Complications referable to the bowels are not uncommon, and obstinate diarrhoea 
often proves a great trouble. It should be considered a rule that diring measles all 
purgative medicine should be given with a most sparing hand, lest by setting up 
diarrhoea the life of the patient be jeopardised. Measles is liable to be confounded 
with certain other diseases, or other diseases which resemble measles may be mis- 
taken for it. Children are not unfrequently troubled with a rash closely resembling 
measles, which is called roseola, but which differs from measles (1) in coming out 
all over the body at once ; (2) by not running a definite course ; (3) in not being 
accompanied by the running at the eyes and nose which are characteristic of measles ; 
and (4) by often being directly attributable to some error in diet. 

Smallpox and scarlet fever have both been mistaken for measles — an error which 
may be fraught with serious consequences. The mode of outset of small pox is more 
severe than that of measles, and the eruption differs in several ways : thus, the 
small-pox eruption begins in the centre of the face, while that of measles is at the 
roots of the hair; the small-pox eruption is raised and hard and soon becomes 
mattery (pustular), while that of measles is scarcely perceptibly raised, and never 
suppurates. The commencement of scarlet fever is usually marked by the severity of 
the throat symptoms, while in measles these are generally of a subordinate character. 
The eruption of scarlet fever is a bright scarlet, composed of fine dots, and commences 
at the root of the neck and top of the chest. 

When the disease has subsided, and convalescence sets in, the child requires the 
greatest care, for patients who are recovering from any febrile disorder, but more 
especially measles, are very prone to fall into constitutional weaknesses, which may 
prove rapidly fatal, or cause a " delicacy " of constitution which may last for a life- 
time. Tuberculosis in one of its forms may be, and very often is, established; and 
it is no unusual thing to see a child become consumptive, or succumb to meningitis, 
or tuberculosis of the intestines (marasmus). Discharges from the ear, which 
are often very troublesome and difficult to cure, are not unfrequently caused by 
measles. Gangrene of the cheek is a somewhat rare occurrence, and happily so, for 
when it happens it is almost ^variably fatal. During convalescence from measles, 
children are peculiarly liable to contract whooping cough, and, strangely enough, the 



28 DISEASES 07 CHTLDUJT. 



reverse seems also to hold good, for children suffering from whooping cough are 
peculiarly liable to contract measles. 

The treatment of uncomplicated measles is a very simple matter. The disease 
itself requires no treatment. There is no antidote for measles ; and in spite of drugs 
and medicines it will run its coursa The chief thing to be aimed at is to take care 
that while the child is suffering from measles it takes no harm. The patient should 
be kept in a warm, well -ventilated room, and is probably safer in bed than running 
about Happily, the patient often prefers being in bed, so that there is no difficulty 
in keeping him there. The light should be partially excluded from the room if there 
is much soreness of the eyes, and these, as well as the nose and mouth, should be 
kept scrupulously clean by occasional washing with warm water. If thirst is com- 
plained of, toast and water or lemonade, made without or with very little sugar, may 
be given to drink. The skin should be sponged once a day with warm water to which 
a little vinegar has been added This should be done with the greatest care, since 
any undue exposure to the risk of catching cold is above all things to be avoided. 
The food should be bland, nourishing, and simple, and should vary according to the 
age of the patient Milk, barley-water, soft puddings of custard and farinaceous 
articles, beef tea, mutton or chicken broth, bread-erumbs and gravy ; and for older 
children, a dinner of boiled mutton or chicken may be given. Food should be given 
at regular intervals, and, as a rule, no departure need be made from the regulated 
times for meals. If drugs become necessary, they should be given only by the sanc- 
tion and under the supervision of a medical man. 

Not only is it necessary to insure that the little sufferer passes safely through the 
attack, but it is of the greatest importance also to guard against the invalid becoming 
a centre of infection to others. No child who has had measles should be allowed to 
mix with other children until the temperature has fallen to the normal amount 
(98°4 Fahrenheit), and all the other symptoms have entirely subsided. After the 
rash has disappeared, a little roughness, scaliness, or scurfiness of the skin is liable 
to prevail in those places where the eruption has been most severe ; and, although 
this scaling of the skin is far less marked than it is in scarlet fever, no child can be 
said to be free from infection until it has disappeared. 

When all the symptoms have completely subsided, the child should be thoroughly 
bathed and washed with soap, and all its clothing, bedding, bed and window curtains, 
and the clothing of those who have been in attendance upon it, should be thoroughly 
washed. The carpets, furniture, eta, of the room should likewise be cleaned, and, 
if possible, thoroughly exposed to fresh air and sunlight It should always be borne 
in mind that during convalescence from even a slight attack of measles, children are 
in a delicate state of health, and require more than an ordinary amount of care and 
attention, and a watchful eye should be kept upon them for a month at least, to take 
early notice of any signs of constitutional weakness. 

Meningitis.— {See article Tuberculosis.) 

Mothers' Marks. — (See Domestic Surgery.) 

Mumps, otherwise known as parotitis, is a disease which is characterised by a 



MTOfPS. 29 

painful and inflammatory swelling of the salivary glands. It is generally limited to 
the parotid gland — the one just below and in front of the ear on either side — but it 
may affect the glands which are under the jaw and tongue as welL It is a genera* 1 
disease, and not a local one. It is, in fact, a specific fever, and must be placed in the 
same class as measles, small pox, <fcc. The affection of the salivary glands is what is 
known as the local manifestation of a general disease, and is distinctly analogous to 
the eruption of small pox, the ulceration of the bowels in typhoid, and the sore throat 
and rash of scarlet fever. It is distinctly infectious, and once being introduced into 
a house it usually runs through the household. Although most common in childhood, 
it is by no means limited to the first years of life, but is tolerably common at any 
age up to thirty ; but beyond this period it is said not to occur. The period of 
the commencement of the second dentition is perhaps the most common time. The 
period of incubation, i.e., the time which elapses between the exposure to the con- 
tagion and the first manifestation of the disease, is said to vary from one to three 
weeks. The disease usually begins by a feeling of pain in the neighbourhood of one 
ear, which is greatly increased during any exercise of the jaw, as in eating. The 
characteristic swelling then appears, and this is often sufficient to cause a considerable 
deformity of the face. The swelling is just below the ear, behind the angle of the jaw, 
and extends also a little forward over the angle of the jaw to the front of the ear. It 
is uniformly smooth, and is more or less tender all over the surface. The swelling 
begins first on one side, and then, as this subsides, the other side is usually 
attacked. When the swelling on both sides occurs in this way, we may almost 
certainly assert that the disease we have to deal with is mumps and nothing else. At 
this period there is considerable general disturbance, and, besides the local trouble, 
the patient complains of headache, thirst, loss of appetite, and general malaise. The 
temperature in the earliest stage is considerably raised, and a thermometer placed in 
the mouth will usually register 100° Fahrenheit, and may rise much higher, to 103°, 
and even over. The patient feels miserable, and prefers to be left alone. Even if 
the appetite remains fairly good, the act of taking food is often so painful as to render 
it impossible. When the glands under the jaw are affected as well as the parotids, 
the patient's condition is really pitiable. It often happens that the pain is far less 
in children than it is in adults. Associated with the swelling of the salivary glands 
there is often a good deal of enlargement and tenderness of the lymphatic glands at 
the side of the neck. Although the swelling is often very great, and the skin over 
it may become reddened, matter hardly ever forms in the gland, and the swelling 
usually subsides again completely. 

The disease usually reaches its height before the end of the first week — sometimes, 
in mild attacks, after a couple of days. It then begins to decline, and is fairly over 
at the end of eight or ten days, and the child is quite well again. One attack 
protects from another. 

Although the disease happily, as a rule, runs a mild course, it does not always do 
so, and there is a great liability in mumps for metastasis to occur — i.e., for the 
inflammation to shift its ground and attack other parts. The parts most liable to 
suffer are the pudenda, but this is especially the case with boys, and & watchful eye 
must be kept over them for the first appearance of any trouble of this kind. 



90 DISEASES OF CHILDREN. 



Occasionally, too, the brain may suffer, and it not unfrequently happens thai 
during an attack of mumps the first signs of tubercular meningitis become manifest. 
It is because of these possible serious complications that mumps must be considered 
as one of those diseases during which, no matter how mildly they may suffer, 
children require unremitting attention. 

The only disease for which mumps is likely to be mistaken is an inflammatory 
swelling of the glands over and in the neighbourhood of the parotid — the so-called 
parotid bubo — which sometimes forms during or after scarlet fever, and, less fre- 
quently, after other of the febrile attacks of children. 

The treatrnent of mumps is very simple. Those affected should be separated from 
those non-affected, and it must be borne in mind that a child is supposed to be 
infectious for at least three weeks after it is first attacked. Many thoughtless 
persons might be inclined to say, u Such precautions are nonsense : mumps is a mild 
disease, and the sooner the children have it the better." Such an argument cannot 
be too strongly condemned, and we think that those who do not use every reasonable 
precaution to protect their children from disease of all kinds, no matter how slight 
and trivial it may appear, incur a very grave responsibility. If mumps is a trifling 
matter, we have shown that its complications are often serious, and we would further 
insist that during convalescence from these little diseases children are often left in a 
very vulnerable state, and are liable to be attacked by constitutional maladies of a 
very grave natura Children need not be kept in bed, but they must be kept in an 
equable temperature, and not exposed to draughts. The bowels must be regulated 
by a little phosphate of soda given in broth, and the diet must be nourishing and 
soft — soups, beef tea, eggs, arrowroot, and so forth. If there is much thirst, some 
lemonade to which some bicarbonate of potash has been added will be found grateful. 
Iced seltzer water (the true, not the artificial) is often appreciated. Unless the local 
swelling is very bad, no treatment need be resorted to ; but if there be much 
pain or tension, warm-water fomentations constantly renewed will be found to give 
relief. If fomentations or warm applications are used, it must be constantly borne in 
mind that after their removal the parts are very liable to suffer from the effects of 
cold, so that they must be constantly and carefully wrapped up in flannel. If the 
testicles become inflamed, the boy must immediately be sent to bed, and kept there 
till the inflammation subsides. 

When the disease subsides, which is best judged of by employing the thermometer, 
it may be advisable to give some tonic medicine, such as quinine, bark, iron, or the 
mineral acids, and the remarks we have made about the convalescence from thin 
disorder must not be forgotten. 



Nanus, or Mothers' Mark — (See Domestic Surgery.) 

Night Terror 8. — This is one of the minor troubles of childhood which often prore 
alarming to the friends. A child is put to bed in good health and spirits. After it 
has been asleep some two or three hours, shrieks and cries are heard coming from its 
bedroom, and when the mother has run in to see what is amiss, the child is found 
sitting up in bed in an agony of fright crying at the top of its voice, and with the 



RICKETS. 31 

tears streaming down its face. " Take it away, take it away ! That thing ! There 
it is ! there it is ! " are probably the terrified expressions to which the child givea 
utterance, and perhaps it points to some gown or curtain which, hanging on a peg, 
and half illumined by the moonlight, has been mistaken for one of the ogres or bogies 
with tales of which its nurse has filled its infant mind. The child at first refuses 
to be comforted, and in spite of the presence of light and of friends, it is still 
apprehensive that something is wrong. The mother should sit by its bed, hold its 
hand, and talk to it, and its mind being diverted from that which caused it alarm, it 
will not be long before it falls asleep again. These troubles do not occur more than 
once during the night, but they are very apt to recur at the same hour every night. 
They need not, as a rule, cause alarm. They are seldom the precursors of fits, or 
epilepsy, or of any serious trouble, and they are usually to be attributed to some 
difficulty in digestion, or to some error in feeding. The child has probably made 
its first acquaintance with nightmare, and has seen in its dreams some weird face, 
with many varieties of which we become acquainted as we grow older. Nightmare 
will cause an adult to wake with a start, and with a feeling of devout thankfulness 
that " it was only a dream," and it is not to be wondered at that children should fail 
to put the proper interpretation upon these alarming apparitions of our sleeping 
hours. Children who suffer thus often require a dose of mild aperient medicine, 
such as Gregory's powder, or rhubarb and soda, and if this be given, and care be taken 
that its last meal is of a light and digestible nature, these night terrors will cease to 
be a trouble to the child or its parents. 

Red Gum. — This is a very common disease among children from birth until the 
completion of the first dentition. It is technically known as strophulus, and consists 
of a sprinkling of pimples or papules irregularly scattered over the body. The 
pimples are usually small, about the size of a pin's head, and are occasionally the 
seat of troublesome itching. The eruption is of small importance. It sometimes 
depends upon slight derangement of the stomach, and occasionally is attributable to 
the irritation of dentition. 

The treatment is almost nil. The child's diet must be supervised, and, if 
necessary, a dose of carbonate of soda is to be given, or a little lime water may be 
added to the milk. 

Rickets. — This is a disease which every one who is much brought in contact with 
children should endeavour to understand. It is very common in London and other 
large English towns, and has been called on the Continent the " English disease." 
Its main features are a softness of the bones, and a general muscular and constitu- 
tional weakness. The softness of the bones leads to deformities of the limbs, chest, 
and back, and most of the crooked-limbed cripples and dwarfs that we see in this 
country have been the victims of rickets. There is another disease occurring in adult 
life which is characterised by softness of the bones, but that is quite different from 
rickets, which is a disease limited to childhood. Children are not born rickety, but 
the symptoms appear during the completion of the first dentition (between the 
seventh and twenty-fourth month). The child appears not to be well; it is irritable 
and languid, and does not care for its food. The motions from the bowels are 



32 DISEASES OF CHILDREN. 



particularly offensive, and often have a rotten odour, from the decomposition of undi- 
gested food in the intestines. The child is pale, sallow, and muddy-looking : it is 
restless at night, kicks the bed-clothes off persistently, and when it sleeps it perspires 
freely, so that its night-dress becomes quite wet, and the perspiration stands in beads 
upon its forehead, and soaks the hair and the pillow. When these symptoms appear 
before the completion of the second year, the rickety constitution may be suspected, 
and it is important to detect it before any deformity has occurred. 

The growing ends and margins of the bones are bigger and thicker in rickets than 
they should be, and to these points we accordingly look for confirmatory evidence. 
The joints are big and clumsy, as an inspection of the wrists and ankles shows. The 
ends of the ribs, where the bone joins the breast-plate of gristle which closes the 
front of the chest, are enlarged, and by passing the hand over this line of junctions 
we may feel them to be big and nobby. The anterior fontanel (the owning between 
the bones on the crown of the head) remains unduly open, and keeps so until after the 
twenty-fourth month, at which date it is closed in healthy children, and the edge* 
of the bones forming the side and top of the skull may (by a practised hand) be felt 
to be enlarged. The general lassitude of the child is a very marked feature; and, 
indeed, the muscular weakness is as strongly characteristic as is the softness of the 
bones. The child no longer delights in being played with, and neglects the game* 
which lately were its greatest source of joy. It does not, as most healthy children 
do, draw its feet up towards its mouth ; and when it is lifted from its cot or dandled by 
its nurse it cries with pain instead of crowing with delight. In some rare cases, the 
muscular weakness is so great, and the general helplessness of the child is so marked, 
that it has been compared to a lay-figure made of wet brown paper. Soon the 
deformities make their appearance. They are due to the softness of the bones. The 
pigeon-breast is perhaps the most common and characteristic of these. The sidee 
of the chest fall in, and the breast-bone projects forward not unlike the breast of a 
bird. The back gets bowed outwards, and it is characteristic of the crooked back 
caused by rickets that it sometimes will straighten out if the child be held up by the 
arm-pits. The arms and forearms are bent outwards. The thigh-bones bend forwards, 
and the bones of the legs bend out, so as to produce the extremest degree of bandy- 
legs. The head gets big, and the forehead is high and square, and this, coupled with 
the dislike for the sports of infancy which the child acquires, generally causes it to 
be looked upon by its friends as a prodigy of cleverness. This is far from being 
the fact, however, and the intellectual power is not unfrequently as much below 
par as the physical ; but since these children often sit with their elders instead of 
playing with their fellows, they are apt to pick up a few quaint and old-fashioned 
expressions, which give the false notion that they are clever beyond their years. 
The teeth are late in being cut, and, indeed, rickets is the commonest of all cause* 
of delayed dentition. 

Rickets is not in itself a very common cause of death, but the rickety condition 
very largely increases the danger of other diseases, and notably of all diseases tliat 
affect the lungs. Whooping cough is a very fatal disease to rickety children, and 
so is bronchitis. The reason of this is that, owing to the softness of the walls of the 
chest, the child if unable to distend its lungs with air properly, and oonsequectlj 



RICKETS. S3 

it has a great difficulty in coughing. If, therefore, bronchitis should set in, and 
secretion is poured into the lung tubes, the child is not able to cough it out as a 
healthy child does, but dies suffocated. These weak, rickety children are peculiarly 
liable to be attacked with bronchitis during measles and whooping cough, and when 
so attacked they very generally die ; and, although the death is generally ascribed 
to bronchitis, it ought really to be ascribed to the rickety condition. Laryngismus 
stridulus, or false croup (see False Croup), is another disease which is very common 
in rickety subjects, and so, too, are general convulsions. 

The subjects of rickets are very thin, and they are often spoken of as suffering 
from atrophy. The liver is occasionally enlarged, as is also the spleen, and this, 
together with weakness of the abdominal muscles, causes a prominence of the belly. 

The bones of rickety children have been found to contain scarcely one -third the 
proper amount of earthy matter. 

Rickets is probably one of those diseases which is absolutely preventible, and 
hence a knowledge of the causes which are said to produce it is of the utmost 
importance. First, then, it is not hereditary. Parents of healthy constitutions may 
have rickety children, and parents who have been rickety do not seem liable to 
transmit the disease from which they have suffered. The health of the mother at 
the time she is pregnant with and nursing her child seems to have considerable 
influence on the development of rickets. The first children in a family are seldom 
rickety. The disease usually shows itself after the birth of one or two children, 
and after rickets has once shown itself the subsequent children seem also to be liable 
to the disease. The explanation offered of this fact is as follows : — A poor man 
marries, and his wages are, perhaps, adequate for his position in life. In a year, 
probably, their firstborn arrives, but if they have been prudent people, and have 
been properly thrifty, something has been saved to meet the slight extra expense 
entailed, and their one child is a scarcely appreciable burden on their exchequer. 
The mother, being well-fed, is able to nurse her offspring without difficulty, and the 
child passes satisfactorily through its infancy. The family continues to increase, 
but not so the wages of the father, and when the second child arrives, and still more 
when the third makes its appearance, the parents begin to find that what was enough 
for two is not enough for five. The mother, probably, has to live upon a scantier 
diet than heretofore ; and, in addition to the call upon her system entailed by 
suckling a baby, she finds that the performance of her household duties is no slight 
tax upon her strength. Dreading the periodic increase of her family, she suckles 
her baby much longer than she ought, and instead of nursing it for nine months, she 
probably keeps it at the breast for twice that period, hoping thereby to escape 
becoming pregnant. As a consequence, she becomes terribly anaemic ; she looks pale, 
bloodless, thin, and weak. Her strength is not sufficient for her household work, 
her head aches, her heart palpitates, and the slightest extra exertion makes her pant 
for breath. In this weakened state of health she becomes pregnant again, and this 
fourth child, born of parents in straitened circumstances, and nursed by a mother 
whose blood has been impoverished by want of proper food and over-nursing, is 
almost certain to become rickety. One rickety child having been born, and the 
circumstances which have produced it not being removed, subsequent children are 

a 



34 DISEASES OP CHILDREN. 



sure to be rickety also, and generally they show an ascending scale of the rickety 
constitution as we descend from the elder to the younger members of a family. 
Over-suckling has perhaps more to do with the production of rickets than any 
other of the single causes mentioned ; and it cannot be too strongly impressed upon 
young mothers in every station of life, but especially amongst the poor, that such a 
proceeding is in the highest degree immoral, and far from lightening their labours 
or helping to keep their families within convenient limits, it will assuredly increase 
the one a hundredfold (for in the place of a healthy mother presiding over a family 
of healthy children, we see a weak, sickly woman struggling with a family of 
cripples) ; and as for the other object sought to be obtained, there is no evidence 
whatever as to the possibility of gaining such an end, and, even if there were, the 
immorality of the proceeding is such that any woman practising it ought to be 
ashamed to confess it. Any woman suckling her children after the ninth month, 
except under wholly exceptional circumstances, is doing a thoroughly wicked thing ; 
and what is more to the purpose, perhaps, a wicked thing which will bring a 
terrible punishment upon her and hers in the shape of sickness, which will multiply 
the trials of life enormously. 

Rickets is certainly most common among the poor, but it is not altogether limited 
to the poorer strata of society. Occasionally we encounter rickets in a mild form 
among the well-to-do, and even the wealthy; and when such is the case, we shall 
find that the mother has been having her family very rapidly, or that something has 
occurred to depress her health during pregnancy, or that she, too, has made the 
fatal mistake of nursing her children for too long periods. 

Although rickets is certainly attributable to the causes mentioned, there must 
be other causes at work which are less understood, and while the pathological 
changes which take place in rachitis have been thoroughly studied, the immediate 
cause of these changes is undetermined. The statement made by most writers, 
that it is a condition of disturbed nutrition, affecting chiefly the bony system, is 
the simple announcement of a fact, but affords no satisfactory explanation of its 
cause. It has been suggested that the calcareous elements undergo solution from 
an excess of lactic acid ; but the most popular and perhaps the most plausible theory 
at present entertained by pathologists is, that the disease is in some way allied 
to inflammation. ~ Although rachitis never terminates in suppuration, the doctrine 
of inflammation approaches more nearly to a solution of all the phenomena usually 
present than any other yet suggested. 

The treatment of rickets is happily tolerably satisfactory, and there are few 
diseases in which we are able to effect so much and such permanent benefit. 

^ First, we must remove the cause, and point out to the parents of the children the 
evil influences which are at work for the production of disease in their children. We 
must see and try to ensure that the mother as well as her children are properly fed 
in accordance with the recognised rules of hygiene (see chapter on Hygiene). The 
ignorance existing among the poor as to the proper feeding of children is something 
truly lamentable, and it is no uncommon thing to see a child drawing part of its 
nourishment from Nature's fount, and alternating this with bread, red-herrings, 
underdone potatoes, or whatever else is to be found on the badly-furnished 



RICKETS. 8i 

dinner-tables of the poor. A child that shows symptoms of rickets wants a 
nourishing food that will make blood; milk and strong beef tea should be the 
staples of its diet, and if it have any teeth it may be allowed to chew meat for 
itself. It is better to give a child a good-sized piece of meat and let it chew it, 
than to feed it on meat minced to such a size that it is able to " bolt " the pieces 
without masticating them. The child should be fed at regular intervals, and 
should not be allowed to eat trash between its meals, and so destroy its appetite 
for really nourishing and valuable food. Farinaceous food should be given sparingly 
until the child has got sufficient teeth to be able to champ it in its mouth; for 
farinaceous articles are very difficult of digestion unless they are properly and 
thoroughly mixed with the saliva in the mouth. Oatmeal porridge is a form of 
farinaceous diet which is too little given to children. As a general thing, tea 
should never be given to infants, and alcoholic drinks (except in the case of acute 
illness) should be entirely withheld. Next to good and wholesome food, fresh air 
is of the greatest importance, and a rickety child should be taken for its daily 
airing without fail. It should be well wrapped up, and its face and chest should 
be thoroughly protected, for a cold which would be a trifling ailment for other 
children might prove fatal to one who has a weak, rickety chest. 

With regard to drugs, there are several which may be given with advantage. 
The state of the child's bowels should be very carefully attended to. If the 
motions are offensive, a powder consisting of two grains of rhubarb, mixed with 
an equal quantity of carbonate of soda, may be given once or twice a week at 
bedtime to a child a year old, or five grains of Gregory's powder may be given 
with advantage. If there is much tendency to acidity, or if the child vomits or 
passes from its bowels white lumps of curdled milk, it is advisable to mix lime water 
with the milk. Even when the child is suckling, it may be given milk and lime 
water (in the proportion of half a pint of the former to two table-spoonfuls of the 
latter) as well. 

The above-mentioned drugs may be given to improve the digestion,, but, in addition 
to these, remedies for the general health are of great service. Happily we have in 
cod liver oil a drug which may be given with the greatest benefit to rickety children, 
and which in most cases they take very readily. There may be a little difficulty at 
first, but very soon they learn to like it, and we have even known children for whom 
this invaluable medicine has been prescribed go to the cupboard where it is kept, and 
help themselves from the spout of the bottle. The mistake is often made of giving 
cod Liver oil in too large doses, and then it often makes the child sick, and creates a 
disgust which is above all things to be avoided. A tea-spoonful is quite enough for 
a dose, and this, repeated twice a day, will often work wonders. The cod liver oil 
may be given with a small quantity of milk or orange wine, or, still better, it may be 
mixed with an equal part of steel wine, and then we have the advantage of giving two 
valuable drugs at the same time. The steel wine, if it be not mixed with the oil, 
may be given separately, and a tea-spoonful twice a day, given after meals, is of the 
greatest service, and is scarcely looked upon by the child in the light of a dose of 
medicine. 

When the deformities of rickets make their appearance, the question arises, What 



36 DISEASES OF CHILDREN. 

is to be done for them t The deformities are due to the softness of the bones, which 
are unable to bear the weight of the body, or perform the work required of them. If 
the legs are bent, the child must not be allowed to walk, for if it do so, the deformity 
will assuredly increase ; and it needs no great knowledge of mechanics to see that, if 
the bones of the legs have become bowed, any pressure exerted on the top of those 
bones must increase the amount of the bowing. Splints have been used to straighten 
the legs, and assuredly, if the bowed legs be properly and scientifically bandaged to 
the splints, the deformity may be very much reduced, if not cured ; but while the 
splints are being used for the legs, the child must on no account be allowed to walk, 
for it must be borne in mind that all the bones in the body are as soft as those of 
the legs, and that although the splints may prevent the leg-bones from bending, yet 
the weight of the trunk will cause a curvature of the spine, and probably a deformity 
of the hip-bones, which (if the child be a girl) may seriously interfere with child- 
bearing hereafter, and even, should she ever become pregnant, endanger life. A 
child that is the subject of rickets should be "taken oif its legs " for a time, and 
encouraged to keep the horizontal position, and when it takes the air, it should 
do so in a long-bodied perambulator, in which it can lie at full length. 

In concluding this account of rickets, we think it right to state that most of our 
knowledge of the disease and its causes is attributable to the quick perception and 
diligent research of Sir William Jenner, K.C.B. 

Ringworm. — This is a most troublesome and infectious disease, and although it 
is not dangerous to life, it often interferes for many weeks, or even months, with 
the child's education, since it is never safe for a child with ringworm to mix with 
other children. There are two varieties of ringworm : ringworm of the scalp, and 
ringworm of the body. They resemble each other in this, that, beginning from a 
centre, they spread from that centre, and gradually enlarge, forming circular patches 
on the head and red scaly rings upon the body. They are both caused by the growth 
of a vegetable parasite— a fungus, in fact — in the roots of the hair, and in the 
superficial scales of the skin (the cells of the epidermis). If we may compare small 
things with great, we may say that the rings of ringworm are exactly comparable to 
the " Fairy rings " seen upon the Downs in the South of England, which grow 
centrifugally, enlarging day by day, and having their outer limits marked by a crop 
of fungi, or toadstools, as they are popularly designated. So when the hairs from a 
patch of ringworm are examined with a microscope, we see the spawn and the fruit 
of the fungus, which are far too small to be visible to the naked eye. The fungus has 
received the name of the Trico-phyton tonsurans (Anglice, "the shaving hair plant"), 
to the growth of whose " mycelium " and " spores " the phenomena of ringworm are 
attributable. 

Ringworm of the Scalp occurs in patches which vary in size from a threepenny-piece, 
or even smaller (although they seldom attract attention before they have attained 
this), to a penny. All the hairs on a patch of ringworm look as if they had been 
broken off, for they are all short and all choked as it were by the excessive scurfiness 
which has arisen among them ; for the growth of the fungus seems to cause an 
excessive development of the superficial cells of the skin, which are rapidly thrown 



RINGWORM. 37 



oft. The patches feel thickened, and may be hotter than the rest of the head, and 
the child usually complains of itching of the part. 

Ringworm of the scalp is generally more difficult to cure than ringworm of the 
body, the reason being that the fungus is more difficult to reach when remedies are 
applied to hairy parts. The hair must be cut as close as possible all over and round 
the patch. It often goes to a mother's heart to have to rob a pretty child of its 
flowing locks; but if she be a wise woman she will steel her heart for the 
trial, for we are sure that the long duration of many cases of ringworm is 
entirely due to the unwillingness of friends to permit the only proper and rational 
treatment. The hair having been removed, and the part having been moistened 
by the application of hot-water dressing for a time, the best remedy is to apply 
very carefully and thoroughly with a brush a freshly-prepared solution of sulphurous 
acid, which (if good) should possess the characteristic and penetrating odour of a 
burning sulphur match. Carbolic acid and glycerine, creosote ointment, and sulphur 
ointment, are also favourite remedies. During the treatment, the part should be 
kept perfectly clean, and the local remedies should be applied at least twice a day. 
The treatment of these two varieties of ringworm must not, however, be entirely 
local in all cases. Vegetable fungi do not grow on all soils, and the healthy skin 
of a child is probably quite incapable of nourishing them. Ringworm probably 
always shows one of two things, either that the child is out of health, or that the 
skin, either from dirt, neglect, or accident, has become irritable and slightly inflamed. 
It is necessary to attend to these points, and to give constitutional and other remedies 
if the child be in need of them, and to give the most scrupulous and unremitting 
attention to cleanliness. It is a foolish, a dangerous, and always a troublesome, 
practice to allow the hair of children to grow long. In this state it requires an 
enormous amount of attention, it is kept clean only with difficulty, and affords 
a dangerous lurking-place for vermin, or the seeds of fungi, which, for aught we know 
to the contrary, are always floating in the air ready to take root directly a fitting 
soil is afforded them. It is the fashion on the Continent to crop the hair 
of children as closely as possible, and it would be well if the custom were more 
general in this country. " Long hair," says Sir Garnet Wolseley in his " Soldier's 
Pocket Book," "is the glory of a woman, and the shame of a man." We wish 
it were considered a shame in little children also. In treating ringworm, we must 
warn the reader that after the application of the remedies, and after the death 
possibly of the fungus, the patch may remain red and scurfy. We must not be in 
too great a hurry to make fresh applications of the parasiticide unless we are sure 
that the patch is actually extending at the edge. The application of glycerine 
of borax is generally sufficient in these cases to restore the head or skin to its natural 
condition. 

There is a pseudo ringworm of the head which is happily not very common in 
this country. It is due, like ordinary ringworm, to the growth of a fungus. It 
seldom occurs on the body, and it is very liable to cause permanent baldness of 
the spot which has been affected, which ordinary ringworm never does. This 
disease is called favus, and in it the head is covered with yellow crusts, which have 
a disagreeable foetid odour which reminds one of mice. It is a disease very difficult 



38 DISEASES OP CHILDREN. 



to cure, and requires the same remedies as ordinary ringworm ; but, being a more 
serious disease, its treatment ought in all cases to be controlled by a medical man. 

Ringworm of the Body may occur on any part of the face, limbs, or trunk. It is 
said to affect mainly the roots of the hair, like the allied disease of the head, but the 
hairs on the body being finer and more scantily placed, we are enabled to get a better 
and different view, as it were, of the phenomena of the disease. The broken hairs 
in ringworm of the body require to be very carefully looked for with a powerful 
magnifying glass. The extreme scurfiness seen in the head is replaced by a trifling 
roughness and scaliness of the skin, and the advancing edge of the ring, not being 
hidden by long hairs, becomes the most prominent feature of the disease. The 
red ring is usually of a dull red colour, and if it be carefully examined, it will 
be seen to be marked by very fine clear watery heads or vesicles, and tiny 
branny scales. 

Those who possess a microscope may be interested to see these minute vegetable 
parasites which occasion so much trouble in our nurseries. It is a simple matter 
to do so, provided the microscope has a quarter-inch object glass. Pluck out one 
or two hairs from the patch, and scrape off a few of the scales with the point of a 
penknife. Place them on a glass slide, and add a few drops of strong solution of 
potash ; then cover with a covering glass, and examine. The threads of the fungus 
and the little round spores will then be seen within and between the scales of the 
skin, and within and around the roots and shafts of the hairs. 

The cure of ringworm is simple in theoiy, but often very difficult and tedious in 
practice. The only thing to be done is to kill the fungus, and prevent its further 
growth. For ringworm of the body, the popular method of painting the patch with 
ink is often sufficient to effect a cure. It seems to be the salts of iron in the ink 
which do the good, and we may apply a concentrated solution of sulphate of iron 
instead of ink, which will often answer the purpose equally welL Strong acetic acid 
is another favourite remedy ; so also is a strong solution of borax or boracic acid. 
Nitrate of silver may be used, or a solution of corrosive sublimate, but the latter 
remedy had better not be applied except by a medical man. Carbolic acid is also a 
favourite and effectual remedy for these cases. 

St. Vitus 1 Dance, or Chorea, is a disease which is trying alike for the patient and 
the friends. Its onset is generally gradual, but may be sudden. The starting- 
point of the disease is very often some sudden fright to which the patient has been 
exposed — and the remembrance of this fact, if nothing else, ought to make one 
veiy careful about playing practical jokes on young children. It is not a disease 
of very early infancy, but usually comes on between the ages of six and fifteen, 
during the second dentition, and while children are approaching the threshold of 
manhood or womanhood. The disease is characterised by a general unsteadiness of 
the muscles of the body, and this is generally well marked in the face. The face 
has an appearance as if a constantly-recurring wave of motion were passing over 
it. The eyes are unsteady, and are jerked about; the corners of the mouth are 
drawn this way and that; the cheeks and nose are constantly wrinkled; and 



ST. VITUS' DANCB. 39 



the chin is alternately protruded and retracted ; while the tongue can very often be 
seen moving unsteadily and in a jerking manner within the mouth. The limbs, as 
well as the face, generally suffer, and neither arms nor legs are quiet for an instant, 
but the child's body is in one constant state of fidget The degree of movement in 
this disease varies immensely. It may be so slight as only to be observable occa- 
sionally, and then only in a very small degree ; or it may be so excessive that the 
child requires to be constantly held in its bed to prevent its being jerked out 
upon the floor. These extreme cases are very terrible to see, and a child attacked 
in this way not unfrequently dies from the exhaustion caused by the excessive 
movement. Sometimes the choreic movement is limited to one side of the body. In 
average cases the child is unable to walk steadily, to sit steadily at table, and feeds 
itself with great difficulty. They are not to be trusted to carry any breakable 
articles, since their grasp is necessarily very uncertain. The movements cease during 
sleep, but in extreme cases the excessive amount of movement may prevent the child 
from getting to sleep. 

There exists a curious relationship between this disease and rheumatism, and it 
has been very frequently observed that chorea often follows or is followed by an 
attack of rheumatism, or else that the families of children who suffer from chorea 
are very subject to rheumatic affections. 

This disease is infectious ! Such a statement may seem startling, but is never- 
theless true ; and it has been found again and again that if a child suffering from St. 
Vitus' dance be allowed to associate with its fellows, other children are very apt 
to become affected, and to acquire the trick of movement, as it were, by unconscious 
imitation. There have been genuine epidemics of this disease. The most notable, 
perhaps, is one which is recorded to have broken out at Strasburg in 1418, and a3 
the sufferers made pilgrimages to the shrine of St. Vitus to obtain relief, the name of 
this saint has been given to the disorder. Although most common in childhood, 
it does occasionally make its appearance (especially in women) at more advanced 
periods of life, and we occasionally meet with cases of it at twenty years of age, 
or even at more advanced ages. It occasionally happens that disease of the heart 
accompanies the disorder of movement, and diligent search should be made by the 
medical man in charge for the detection of the heart trouble, which can only be 
done by means of the stethoscope. 

The treatment of this disease is simple, and happily it subsides, as a rule, 
without being obliged to have recourse to any strong measures ; but occasionally it 
proves very obstinate, resisting every attempt to alleviate it, and in some very few 
instances it proves fatal by the exhaustion which it causes. The child's health must 
be very carefully attended to, and search must be made for any source of irritation 
which may help to keep up the trouble. The teeth must be looked to, the digestion 
must receive attention, any errors in diet must be corrected, the bowels must be 
regulated, and diligent search be made for any evidence of the presence of intestinal 
worms, which are not unfrequently a cause of this disorder. The child should have a 
bed to itself, and the bedroom should be airy ; but, and especially if the trouble have 
arisen from fright, an elder person should sleep in the same room, and a light should 
be burnt. The lessons need not, except in the more severe cases, be abandoned, but 



40 DISEASES OF CHILDREN. 



they should be light and easy, and not such as will tax the child's physical or mental 
strength in any way. A considerable time should be spent every day in the open 
air, and much benefit may be derived from the daily use of a cold douche bath. 
This should be taken before a fire if the weather be chilly, and it is often a good plan 
to let the child stand in warm water and pour the cold over it. The douche should 
be followed by gentle frictions with a rough towel. 

For the movements themselves, the best cure is some form of drilling, and such 
children ar© particularly benefited by "deportment lessons." They should be made to 
practise rhythmical exercises with their limbs, and if these exercises be done, as they 
ought to be, to the sound of well-timed music, the good results will be more marked 
and quicker in appearing. In the Middle Ages in Italy the bite of a certain spider — 
the tarantula — was supposed to give rise to a disease, doubtless of the same type as 
the chorea of our times, and this disease was said to be cured by the execution of a 
certain dance, which derived its name from the tarantula itself. We fully believe 
the accounts we have heard of this disorder, and we believe also that well-timed 
rhythmical movements are powerful in the alleviation of St. Vitus' dance. 

If medicines be given, it is with one or two objects, either to improve the general 
health, or to calm the movement. For the former purposes, cod liver oil, iron, 
sulphate of zinc, quinine, arsenic, nux vomica, and strychnine have been used. Some 
physicians, having regard to the close and curious relationship which this disease 
has to rheumatism, have advised the administration of alkaline medicines, such as 
carbonate of potash, but such treatment is of doubtful efficacy. If the child cannot 
sleep, we must help it to do so by artificial means. The inhalation of a little 
chloroform, or the giving of a little hydrate of chloral at bedtime is of great service, 
as is also the bromide of potassium, or even opium or morphia in small quantities. 
Such dangerous remedies, however, must only be given when prescribed by a medical 
man. Strong narcotic drugs ought to have no place in the domestic medicine chest. 
Bromide of potassium and belladonna may help to subdue the movement during the 
daytime, and these medicines may be combined with the tonics. 

Scald Head. — This is a vulgar name which is applied to two or three distinct 
diseases of the scalp which resemble each other superficially. It is most common 
among scrofulous children. It not unfrequently commences as a slight redness 
with little watery heads which weep. This occurs in patches, and a very favourite 
situation is behind the ears, whence it creeps upwards towards the scalp, and 
sometimes completely covers it. The proper name for this form of the complaint is 
eczema of the scalp. The watery heads, which discharge a clear sticky fluid, are the 
characteristic features, and the discharge running amongst the hairs glues them 
together, and converts the child's head into a most revolting and loathsome mass. 

If the child's head be irritated by the presence of lice, we get, instead of the clear 
discharge from the watery heads of eczema, a yellow mattery discharge from pustules, 
and the matter discharging and drying cakes the hair into masses, and covers the 
scalp with a hard yellow skull-cap. This disease is known as impetigo of the scalp. 
It is particularly liable to occur in children of weak constitution, and, the children 
being usually scrofulous, the irritation of the inflamed scalp is sufficient to cause 



■CABLET FEVER, 41 



considerable enlargement of the glands of the neck- This enlargement of the glands 
of the neck is said to be distinctive of this form of the disease, but such an assertion 
is scarcely warrantable. Impetigo — at least some forms of it — is contagious, and has 
been conveyed from one child to another by exchange of head-dresses. Care should 
therefore be taken to keep a child with this malady away from school, and separated 
from its fellows for a tima 

The treatment of these two conditions consists, first, in removing the cause, if any 
such exist in a tangible form. A careful search must be made in every case for the 
presence of lice or nits in the head, and if such exist they must be destroyed by 
the application of carbolic acid and oil (one part to ten), or of white precipitate 
ointment The next point in the treatment is cleanliness. The hair should be cut 
off, and the scalp should be thoroughly cleansed of all crusts and scabs by prolonged 
bathing and soaking with warm water. This being done, the head is in a fit state 
for the application of remedies, but it is of no use to apply remedies to heads which 
have not been previously cleaned. The best application for eczema is zinc ointment, 
which should be very gently applied to the part with the point of the finger, the head 
being then covered with a skull-cap made of rag or linen. For impetigo, the best 
application is probably the nitrate of mercury ointment, which should be applied in 
the same way. The head must be thoroughly and completely cleansed night and 
morning — and even though it take hours, it will be time well spent. It is well not to 
be afraid of cutting off the hair, and it is advisable to cut very wide of the disease. 
In cases of eczema of the scalp, it is recommended that the head should be washed 
with oatmeal and water instead of soap, as being less irritating. 

Internal remedies and constitutional treatment must not be neglected, for it will 
be found that these diseases do not get well without them. In cases of impetigo, 
the administration of quinine often acts like a charm, and under its influence the 
trouble ceases at once. It is often necessary to precede the tonic treatment by a 
brisk purgative, and a dose of grey powder and jalap is often administered with 
benefit. The various remedies mentioned for the treatment of scrofula are of service 
in these diseases. The diet must be carefully supervised, and every precaution taken 
to prevent the children stuffing themselves with trash. 

Scarlet Fever. — This is one of the most fatal of the diseases to which we are 
liable, especially in childhood, and when the disease becomes epidemic the mortality 
which it causes is often really terrible. It is the dreaded scourge of some families, 
and it is one of the well-recognised peculiarities of the disease that it falls upon som« 
constitutions far more heavily than upon others. 

The great cause of scarlet fever is contagion, and one person suffering from the 
disease becomes a centre of infection to others. There seem to be states of atmo- 
sphere, epidemic conditions in which the disease is more easily spread than at other 
times ; but whenever a case of scarlet fever occurs it is generally not difficult, 
if diligent search be made, to point with certainty to the source* from which the 
poison has emanated. The healthy should hold no communication with scarlet- fever 
patients unless they themselves have already had the disease, and have thus earned 
an immunity from further attacks. Those in attendance upon scarlet-fever patients 



42 DISEASES OF CHILDREH. 



should also remember that, though they may be incapable of suffering themselves, 
they may readily carry the disease to others. We shall reserve further remarks on 
the contagion until after our discussion of the disease itself, when we shall be better 
able to explain whence the contagious matter comes. A person having been 
exposed to contagion, a contagious particle having, as it were, been sown in his body, 
a certain period elapses before the disease becomes manifest This is called the 
period of incubation, and in scarlet fever it is a very variable period, its length 
seeming to depend not only upon the recipient but on the giver of the poison also. 
We often observe that, in the same soil and under the same condition, some seeds 
germinate sooner than others ; and it is a very common observation that variations 
of soil, temperature, etc., are capable of causing great variation in the time which 
elapses between the sowing of the seed and the first appearance of the shoots. This 
incubative period in scarlet fever seems to vary between twenty-four hours and 
a week, and some say that as much as a fortnight sometimes elapses between 
the exposure to the fever poison, and the development of the disease. 

The symptoms and severity of scarlet fever vary immensely. They may be 
so mild as scarcely to be perceptible, and may be so severe that death ensues within 
twenty-four hours of their first appearance. We shall first of all describe an attack 
of ordinary severity. 

The child complains of " feeling out of sorts ; " the appetite fails, and symptoms 
of feverishness make their appearance. There are chills alternating with flushings 
and a sense of heat Headache is complained of, and very often vomiting is one of 
the first symptoms to attract attention. The pulse is quick, and if the temperature 
be taken it will be found considerably elevated. It may rise as high as 104 degrees 
on the first day, or nearly six degrees above the normal temperature of health. The 
next symptom to attract attention is the sore throat ; and if the throat be looked at, 
the tonsils will be seen to be enlarged, and there is a general redness and swelling of 
the whole of the back of the throat. The tongue also presents a characteristic 
appearance. It is generally somewhat furred, and at its tip a number of fine red 
points will be seen showing through the white fur, giving the end of the tongue 
an appearance very like that of a strawberry, so that the " strawberry tongue " 
of scarlet fever has become one of the recognised terms of medicine. The reader 
must be warned, however, that this condition of tongue is common in other 
states besides scarlet fever, and it is impossible to distinguish scarlet fever by 
the appearance of the tongue alone, unless the other symptoms be present also. 
With these symptoms there is often some sensation of heat about the skin, and 
if the patient be asked to clench the hand, it will often occasion feeling of 
tension. Sometimes within twelve hours, and always before the lapse of forty-eight 
hours, after the first symptoms, the characteristic rash of scarlet fever appears. It 
appears first at the root of the neck and upper part of the chest. It consists 
of a number of fine scarlet points, and the skin looks sometimes as if it had been 
covered with a bright scarlet powder. These points may coalesce in places, and then 
we get scarlet patches. The colour varies, and may be of any shade of red ; or occa- 
sionally the eruption is dusky in appearance. When the skin is pressed upon with the 
point of the finger, or put upon the stretch, the colour of the points fades. The rash 



SCARLET FEVEB. 43 



spreads from the chest over the face and trunk, and over the arms and legs also. It 
reaches its maximum degree of intensity in three or four days, and then begins 
to fade, and usually by the eighth or ninth day it has completely disappeared. In 
favourable cases the other symptoms subside with the eruption; the temperature 
falls, the pulse sinks to its normal rate, the tongue cleans, and the patient begins to 
feel tolerably well again. 

At this period the skin begins to scale, or, in other words, the desquamation of 
the cuticle commences, and this may be looked upon as quite as characteristic of the 
disease as any of the other phenomena we have enumerated. The amount of scaling 
is proportional to the amount of eruption, and varies from a slight scurfiness of the 
skin to the downright peeling off of solid flakes, which are most pronounced usually 
on the soles of the feet and the palms of the hands. ' These are the spots where 
evidence of scarlet fever lingers longest, and whenever a child is seen with its 
palms or soles in a peeling condition, that child is to be regarded with suspicion, as 
it is probably infectious. The duration of the peeling period is very variable. 
Occasionally several weeks elapse before the skin is perfectly free from any sign 
of it. 

About the time that the skin begins to peel, the patient is very liable to have an 
attack of so-called rheumatism, accompanied by swelling of the joints. The knees, 
elbows, and hips are usually affected. The temperature rises again, and it occa- 
sionally happens that a genuine relapse takes place, and all the phenomena of the 
fever are repeated. In a favourable case the peeling will have ceased and the 
patient will be convalescent at the end of three weeks. 

All these symptoms, as we have said, vary very much in severity. There may be 
but little eruption, and no sore throat worth speaking of, and then the case is spoken 
of as one of simple scarlatina, or scarlatina simplex. When the throat symptoms 
are very bad it is called scarlatina anginosa, and when all the symptoms except 
the eruption are present it is spoken of as scarlatina without eruption ; and it is 
important to remember that such cases are recognised as occurring. It is supposed 
by some that there is a difference between scarlet fever and scarlatina, and we not 
unfrequently hear people say that " So and so has not got scarlet fever, but only 
scarlatina." It is right that people should thoroughly understand that the two 
diseases are actually the same, although the word " scarlatina " is usually applied to 
the milder cases. We would impress very strongly on the reader, however, that the 
mildest possible cases are capable of producing by their contagion the severest cases 
in others, and that no matter how mild the actual fever may be, the sequelae or conse- 
quences of that fever may be of the most serious and dangerous nature possible. This 
leads us on to speak of the complications and sequelae of scarlet fever. The condition 
of the throat may be so bad from the first as almost completely to overshadow the 
other symptoms of the disease. The throat may be immensely swollen internally, 
and the tonsils may be so much enlarged as completely to block the passage of the 
throat, and to threaten the patient with suffocation. The throat condition may persist 
long after the other symptoms have subsided. There may be deep-seated inflamma- 
tion all round the throat, so that the skin feels hard, tender, and puffy, like one large 
carbuncle surrounding the neck. Matter may be formed beneath the skin, and in bad 



44 DISEASES OP CHILDREN. 



cases this matter may be discharged by a series of openings either inside the throat 
or outside. The condition of the throat may be so severe as to kill a patient, either 
by exhaustion or by blood-poisoning. It is not at all uncommon to have the glands 
of the neck inflamed and suppurating during the sore throat of scarlet fever. 
Sometimes the nose is attacked as well as the throat, and the patient is troubled 
with a discharge therefrom which may be very offensive. The ear also may be 
attacked, and we sometimes get a discharge from the ear followed by a destruction 
of the tympanum, or drum, and permanent deafness. The bones of the ear may be 
damaged, and then there is occasionally a risk to the brain. 

The most serious and the most common consequence of scarlet fever u 
undoubtedly disease of tlie kidneys, which usually comes on during the decline of the 
fever, and while the desquamation of the cuticle is in progress. The early symptoms 
of this trouble are only to be detected by means of a chemical examination of the 
urine, which should be performed by the medical man at frequent intervals, in order 
that no time may be lost in checking the symptoms should they appear. If the urine 
becomes thick, smoky-looking, or bloody, the kidneys are certainly diseased ; or if the 
legs swell, or the eyelids are puffed up in the morning, we shall generally be right in 
coming to the same conclusion. The slightest appearance of disease of the kidneys 
should not be treated lightly; for if this trouble be not skilfully subdued, it may go on 
till it causes permanent dropsy and disease of the heart, and condemns the patient to 
be a valetudinarian for the rest of his life. 

Lung disease is occasionally set up during scarlet fever, and patients may be 
attacked with bronchitis, pneumonia, pleurisy, or consumption. 

Sometimes also, and especially during the persistence of the rheumatic symptoms, 
disease of the covering membrane of the heart {pericarditis) is established. Thus it 
will be seen that scarlet fever is not only a dangerous disease in itself, but that it is 
beset with subsidiary dangers, into any of which the patient may fall if he be not 
nursed and guarded with the greatest care. 

In the treatment of a case of scarlet fever we have not only to consider the safety 
of the patient himself, but we have, as far as possible, to guard against his being a 
source of danger to others. Directly the disease is detected, or, indeed, directly it is 
suspected, the patient should be isolated. Except in the very mildest cases, he must 
keep to his bed, and, no matter how mild the attack may be, it is absolutely neces- 
sary that he keep to his room, from whence he must not think of stirring for three 
weeks; for up to that time he cannot be considered as a safe companion for others, 
nor can he himself be considered free from the risk of kidney disease or some other 
consequence. Everything should be moved out of the room that is not absolutely neces- 
sary for decent comfort. The carpet should be taken up, and window curtains be 
taken down, and everything in the shape of a wardrobe or chest of drawers should be 
removed ; for these articles can well be dispensed with, and if allowed to remain in 
the room, they may one and all become lurking-places for contagious particles. It 
must be borne in mind that every excretion of a scarlet-fever patient is probably 
infectious. The breath expired through the ulcerating throat and nose is probably 
loaded with germs of the disease. The urine and the evacuations from the bowels are 
certainly contagious in the highest degree; and above all things it is to be remembered 



SCARLET FEVER. 45 



fchat every particle which flies from the roughened surface of the peeling skin is a 
particle with an unlimited potentiality for mischief, and being carried by the air, or 
in the folds of a garment, or even in a letter, may spread scarlet fever literally 
throughout the world No patient suffering from scarlet fever can be considered- free 
from infection until the process of peeling has absolutely ceased. While the disease is 
in progress, every effort should be made to reduce the dangers to a minimum. The 
patient should be moved to the top of the house, and the whole of the top floor, or 
the whole of one division of the house, should be given up to the invalid and his 
attendants, who should not be too numerous (the fewer the better), and who should 
hold no communication (or as little as possible) with the other inmates of the house. 
Over the door of the sick-room a curtain should be hung, and this curtain should be 
kept constantly moistened with carbolic acid dissolved in water (half a pint of the 
common acid to two gallons of water). The bedroom should be kept thoroughly 
aired, and in summer the windows must be liberally op^sned. The patient must be 
kept clean, and the bed and body-linen be frequently changed. The change of linen 
should be effected quietly, and the soiled linen, both of the nurses and the patient, 
should be placed in earthenware pans filled with a strong solution of carbolic acid, 
and provided with a cover. All excretions should be at once disinfected with 
carbolic acid, and thrown away immediately. All plates, dishes, and other utensils 
used by the patient should, when done with, be immersed in a disinfecting bath; and 
the walls of the room, as well as the floor and furniture, should be cleansed every day 
with a damp cloth. As to the patient himself, he must be kept perfectly clean. The 
mouth and nose must be scrupulously cleaned by means of a camel's-hair brush, or a 
syringe, with a weak solution of Condy's Fluid, or salt, or a strong solution of chlorate 
of potash. It is a good plan also, and one highly recommended, to keep the surface 
of the skin constantly greased with ordinary olive oil, to which a little carbolic acid 
has been added. The hair should be cut short, and that which is cut off should be 
burnt. If the patient be old enough or well enough to enjoy reading, or being read 
to, it must be remembered that all his books, and, in fact, everything that cannot be 
washed, must be burnt, and on no account be brought out of the sick-room. When 
the patient is sufficiently recovered to leave his room, he should only go out 
wrapped in a blanket, and be put at once into a warm bath, where the whole of the 
body should be most carefully washed. He should then be dressed in a complete set 
of clean clothes, and, presumably, he may then mingle with his friends without being 
an object of terror to them. 

The room lately occupied by the patient must next receive especial attention ; 
and first it should be disinfected by means of sulphur fumigation. This is done 
in the following manner : Take an ordinary slop-pail, and half fill it with water : 
then across the top of it place the fire-tongs. On the tongs lay the lid of an 
old saucepan, and in this put half a pound or a pound of common brimstone 
broken into lumps. Then shut all the windows closely, place a red-hot coal in the 
middle of the sulphur, and immediately leave the room. Shut and lock the door, 
and block up any chinks which may be left in it. This manoeuvre causes the escape 
of immense quantities of sulphurous acid gas (the gas which causes the choking 
sensation when we light a sulphur match, and which is probably fatal to every living 



46 DISEASES OF CHILDREN. 



thing, both animal and vegetable, inclusive of the germs of disease). After a lapse of 
twenty-four hours, it will be possible to enter the room, when the windows may be 
opened. The room should then be thoroughly scrubbed, including the articles of 
furniture remaining in it. The woodwork should be re-painted, the ceiling white- 
washed, and the walls either papered or coloured. The bedding should be sent to an 
upholsterer's to be thoroughly disinfected and re-made. 

If the precautions we have enumerated were attended to more scrupulously and 
carefully than usually is the case, we believe that we should hear less frequently of 
houses being infected with scarlet fever for years at a time, and remaining often 
tenantless because of the general belief that " it is impossible to get the scarlet fever 
out of it." If the attack of scarlet fever be mild, the friends are apt to forget how 
terrible the disease may be, and are unwilling to submit to the irksomeness of 
separation for a time from their friends and children. 

We may mention here, that if a scarlet-fever patient be moved while the infection 
still be on him, and if others, not having been forewarned, suffer harm in consequence, 
a civil action for damages may be brought against those who have been instrumental 
in importing this disease into a house. Such actions have been brought, and damages 
have been recovered. 

As regards the administration of medicines in scarlet fever, we may say at once 
that in favourable cases no drugs are necessary, and a child will pass successfully 
through a mild attack of the disease without taking a single dose of medicine. 
The patient must be kept quiet and cool. The diet must be exceedingly simple, 
and the bowels must be carefully regulated. If the throat is badly ulcerated, the 
ulcers may be touched, once and for all, with a stick of lunar caustic or a little 
strong muriatic acid. These are measures which, however, if resorted to, must be 
performed by the medical man. The mouth, as before mentioned, must be kept clean, 
and a strong solution of chlorate of potash may be used as a wash. 

If the rheumatic pains in the joints supervene, there is nothing more efficacious 
than quinine, which may be given in tolerably strong doses (three or four grains) 
every three or four hours. 

We have heard much of late years of the efficacy of belladonna in this disease, 
both for the cure, or as a prophylactic or preventive against contagion. The 
evidence in its favour, however, is not reliable, and although it has been very largely 
given at fever hospitals and elsewhere, the results have not been such as to 
warrant us in concluding that it has any specific action. Dr. Balfour, of the Royal 
Military Asylum, Chelsea, tried, during an epidemic of scarlatina, the preventive 
powers of belladonna. He selected 151 children, who had never had scarlet fever, and 
gave belladonna to every alternate one. The result was that two in each section 
were attacked with the fever. The number attacked was singularly small, and he 
very justly remarks, " Had I given the remedy to all the boys, I should probably 
have attributed to it the cessation of the epidemic." 

Scrofula. — This is a constitutional condition which is often confounded with, but 
should be kept distinct from, tuberculosis. The children who manifest a tendency 
towards scrofula are sometimes called " strumous," and the old name of the " king's 



SCEOFULA. 47 



evil " is still occasionally applied in country districts to some of the manifestations of 
the disease. 

The children who are the victims of scrofulosis differ widely in appearance from 
the tubercular children. Instead of being lithe, active, and elegant, they are heavy- 
looking and lymphatic, with muddy complexions, thick skins, coarse straggling hair, 
and clumsy limbs. The tubercular children are pretty, the scrofulous children are 
ugly, and the rickety children are deformed. The tendencies of the scrofulous 
constitution are of a peculiar kind, and are quite distinct from those of the other two 
constitutional conditions with which it may be confounded. 

There is a liability to enlargement of the lymphatic glands at slight causes, 
or from no obvious cause. The glands under the jaw and at the side of the neck 
are very liable to enlarge, and the irritation of cutting teeth or a slight cold in 
the throat are quite sufficient to cause great enlargement of the glands. The 
enlargement may only be slight, and the gland may feel like an almond or 
olive beneath the skin, but it may be so great as to cause the most terrible 
deformities, and completely obliterate the proper lines of the face, and cause the 
unhappy child to look terribly ugly and ghoulish. The mere enlargement of the 
glands is very trying both to the patient and the friends ; but when the glands 
suppurate, as they often do, and leave scars which last a lifetime, the annoyance is 
increased. 

Besides the enlargement of the glands, the patients are liable to inflammation of 
the eyes, which is often very difficult to cure. The edges of the eyelids get reddened 
and much inflamed, and little ulcers form on the eyes themselves. This causes 
a copious discharge from the eyes and lids, with a gluing together of the eyelids 
after sleep, a matting together of the eyelashes, and also a great intolerance of 
light. 

Diseases of the shin are likewise very common among scrofulous children, and 
they are liable to get chafed in places where folds of skin come in contact, 
to suffer from watery discharges behind the ears and on other parts of the body 
(eczema), and there is a tendency also to the different varieties of scald head. (See 
Scald Head.) 

They are often troubled also with discharges from the nose and ears, and 
the digestion is often bad from a chronic inflammatory condition of the stomach. 
The joints are often the seat of chronic inflammations, which not unfrequently 
endure for years, and ultimately wear the patient out with exhaustion. " White 
swellings " of the knee are most common in the scrofulous constitution. Diseases of 
the hip and ankle joints are also of frequent occurrence. 

Occasionally these children die with symptoms not unlike those of acute 
tuberculosis (see Tuberculosis), and we get diarrhoea, general inflammation of the 
bowels accompanied by tenderness (peritonitis), and in some instances a deposit 
of tubercles may take place in the lungs or on the membranes of the brain. This, 
however, is rare, and when it does occur it must be regarded as a grafting of 
tuberculosis on the scrofulous constitution. 

The treatment of scrofula has undergone great changes in modern times. This 
was the disease over which the sovereigns of England were supposed to exercise 



48 DISEASES OF CHILDREN. 



a supernatural power, and which is thus treated of in the "Surgical Treatises" 
of Richard Wiseman, who was Serjeant Chyrurgeon to Xing Charles II., and 
on*e of the foremost surgeons of his day. After stating that the king's evil 
often baffles the skill of the young surgeon, Wiseman goes on to say : — 

" But when upon trial he shall find the contumaciousness of the disease which 
frequently deludeth his best care and industry, he will find reason for acknowledging 
the goodness of God, who hath dealt so bountifully with this nation in giving the 
kings of it, at least from Edward the Confessor downwards (if not for a longer time), 
an extraordinary power in the miraculous cure thereof This our chronicles have all 
along testified, and the personal experience of many thousands now living can 
witness for his Majesty that now reigneth, and his Royal father and grandfather. 
His Majesty that now is having exercised that faculty with wonderful success, not 
only here but beyond the seas in Flanders, Holland, and France itself The King of 
this last pretends to a gift of the same kind, and hath often the good hap to be alone 
mentioned in chirurgical books as the sole possessor of it, when the French them- 
selves are the authors, yet even they, when they are a little free, will not stick 
to own the Kings of England as partakers with him in that faculty. Witness the 
learned Tagaultius, who in his institutions takes notice of King Edward's faculty of 
doing the same cure, and the continuance of it in his successors. Italy as 
well as France hath made the like acknowledgments in the books of Polydore Virgil, 
who, reciting the gift given to St. Edward the Confessor, doth subjoin these words, 
'Which immortal gift hath been derived as it were by an hereditary right to 
the latter kings; for the Kings of England even now do cure the struma by 
touch, etc.' " 

After alluding to and controverting the assertion that had been made by certain 
Roman Catholic divines that this miraculous power departed from the sovereigns of 
England at the Reformation, Wiseman goes on to say, " But it is not my business to 
enter into divinity controversies : all that I pretend to is — first, the attestation of 
the miracles ; and, secondly, a direction for such as have not the opportunity of 
receiving the benefit of that stupendious power. The former of these, one would 
think, should need no other proof than the great concourse of strumous persons 
to Whitehall, and the success that they find in it I myself have been a frequent 
eye-witness of many hundreds of cures performed by his Majesty's touch alone, 
without any assistance of chirurgery; and those many of them such as had tired 
out the endeavours of able chirurgeons before they came thither. It were endless to 
recite what I myself have seen, and what I have received acknowledgments 
of by letter, not only from the several parts of this nation, but also from Ireland, 
Scotland, Jersey, and Guernsey. It is needless also to remember what miracles of 
this nature were performed by the very blood of his late Majesty of blessed memory, 
after whose decollation by the inhumane barbarity of the regicides, the reliques of 
that were gathered on chips, and in handkerchiefs, by the pious devotees, who could 
not but think so great a suffering in so honourable and pious a cause would 
be attended by an extraordinary assistance of God, and some more than ordinary 
miracles ; nor did their faith deceive them in this point, there being so many 
hundred that found the benefit of it. If this dead blood were accompanied by 



SCROFULA. 49 

so much vertue, what shall we say of his living image, the inheritor of his cause and 
kingdom? whom though it hath pleased God to deliver out of those dangers 
that overwhelmed his royal father, yet it was with so long an exercise of afflictions, 
that though (God be thanked !) he be not now like to encrease the catalogue of 
martyrs, yet he may well be added to the number of confessors. This we are sure, 
the miracle is not ceased." 

On reading this, it is hard to acquit Wiseman of being as skilful in the arts of a 
courtier as he undoubtedly was in those of a surgeon, and one cannot but smile at the 
many excuses to his majesty (" who cureth more in one year than all the chirurgeons 
of London have done in an age ") which he feels it incumbent upon him to make 
before entering on the details of treatment which ar© recommended in those cases 
which cannot receive the benefit of the royal touch, 

But the reader will have had enough of Wiseman, and will be glad to hear some 
more modern views on the treatment of scrofula. The great point is to guard 
against the several consequences of the constitutional condition. The child must be 
kept from all irritations, and especially it must be properly fed, and must spend a 
great part of its time in the open. The skin must be kept very scrupulously clean, 
for any impurity of it may cause, not only troublesome sores and eruptions, but 
glandular enlargements also. The inflamed joints must be carefully attended to by 
a surgeon, as neglect of them may lead to stiffening of the limbs, or distortion, or 
permanent lameness. Glandular enlargements, until they suppurate, are best treated 
by hot fomentations, but when suppuration has taken place, it is impossible to lay 
down any rules for treatment, which must depend on the varying conditions 
which a practised eye can alone recognise. The eyes, if they become inflamed, 
must be kept scrupulously clean, and every particle of discharge must be removed 
night and morning by careful and prolonged fomentation. The eyelids may be 
prevented from adhering by anointing them with some simple ointment, such as cold 
cream. The strong mercurial ointments are not to be used, except by medical 
advice. There is great intolerance of light in these cases, and it is sometimes 
customary to keep children indoors, and in darkened rooms. This is rarely necessary, 
however, and we should advise the child being provided with a shade, and a good 
thick veil, and being taken out of doors whenever it w possible to do so. The 
application of blisters behind the ears, and still more the employment of a seton, is a 
measure which is necessary only in the very rarest cases, and would only be warrant- 
able on the recommendation of a skilled oculist. When ulceration of the eyes takes 
place, there is always some risk of permanent impairment of vision, so that the child, 
in these cases, ought to have the advantage of early advice. , 

There are several drugs which may be given to scrofulous children with 
advantage. They are, perhaps, the patients who are most benefited by cod-liver 
oil, and they often take it with avidity, and thrive wonderfully upon it. Iodine 
in all its forms is of great benefit, and may be given combined with potash or iron, 
in the form of iodide of potassium, or syrup of the iodide of iror*. Sulphur, too, is 
often of signal service, and should be given in the form of sulphide of potassium, 
otnerwise known as the Hepar sulphuris, or liver of sulphur.* This salt has an 
offensive odour of rotten eggs, and is suggestive of the famous sulphur waters of 
4 



50 DISEASES OF CHILDREN. 



Harrogate. A grain, or even two, of the salt may be dissolved in a small quantity of 
"water, and given twice or thrice a day. Great care must be taken that the odour of 
the salt has not evaporated. The taste is not so nauseous as the smell, and if the 
nose be held, children will take it without difficulty. Glandular swellings often 
disappear rapidly under this treatment. 

Change of air is often indispensable, and the diet should be nutritious, 
digestible, and abundant. The clothing should be warm, especially for the 
extremities, so as to keep up the cutaneous circulation, and prevent congestion 
in the chest or abdomen, 

Sore TJiroat antf Cold. — These conditions are often combined, and it may be said 
that those forms of sore throat which accompany an ordinary cold, are seldom of a 
severe character. Added to the running at the eyes and nose, there is often huski- 
ness and dryness of the throat, and some difficulty of swallowing ; and if the throat 
be inspected, it will be seen to be somewhat swollen and reddened. This condition 
generally subsides with the cold, and proves to be only a passing trouble, and the 
treatment for the cold is sufficient to cure the throat. If, after the subsidence of the 
cold the throat remains sore, and especially if the child spits up or coughs up any 
streaks of blood, it may be a question whether the throat has not drifted into a con- 
dition of chronic inflammation, and it may be laid down as a rule, that any persis- 
tent condition of sore throat, hoarseness, or huskiness, is one which should receive 
careful professional attention. Although sore throat and cold are sometimes com- 
bined, they more often occur separately, so that it will be well to discuss the two 
questions seriatim. 

Sore Throat is a symptom of many and various conditions. Thus we have the sore 
throat due to cold ; acute enlargement of the tonsils with or without the formation 
of abscesses, constituting the condition known as tonsillitis, or quinsy ; and chronic 
enlargement of the tonsils without inflammation, which is a common occurrence in 
weakly or scrofulous children. Sore throat is also often the first symptom of many 
dangerous conditions, such as croup, diphtheria, and scarlet fever, and it is generally 
a prominent symptom in measles, German measles, small-pox, and other fevers. 

It becomes necessary, therefore, to be able to distinguish between these various 
conditions, and in order to do so one must know what is to be seen and what is to 
be looked for in the throat itself. When the mouth is opened we usually see the 
arches of the teeth, the roof of the mouth, and the tongue, the two latter meeting 
and obstructing any further view. If the tongue be depressed by means of a tongue- 
depresser or the handle of a spoon, and if, as we depress the tongue, we ask the 
patient to take a full breath we are enabled to see the throat itself. Stretching across 
the back of the throat is the curtain of the soft palate, from the middle of which 
there hangs the uvula, a fleshy pendulous body, about a quarter of an inch long. On 
either side the soft palate is seen to split, as it were, into two parts, by which it is 
attached to the sides of the mouth. These two parts, called the anterior and posterior 
" pillars of the fauces," include between them the tonsil, a body the size of a hazel- 
nut, with a slightly dimpled surface. The arrangement of the parts may be compared 



■ORE THROAT. 51 



to that seen in the roof of a Gothic church, where the groinings from the windows 
on either side meet in a central boss or pendant. The central boss is the uvula, the 
windows are the tonsils, and the groinings are the pillars of the fauces uniting to 
form the lower edge of the soft palate. The normal colour of these parts is a pink, 
like that seen in the lips. In a really bad case of sore throat the amount of swelling 
of the parts may be enormous. The tonsils may be as big as Tangerine oranges, the 
soft palate swollen and thickened, and the uvula enlarged to the size of the little finger, 
and dropsical. The colour of the parts is either livid or bright scarlet, and the 
amount of tenacious secretion may be considerable. In cases of extreme swelling of 
the throat, swallowing is impossible, or is a matter of great pain and difficulty, and 
occasionally the respiration is very seriously interfered with. This condition of throat 
is most commonly seen in ordinary quinsy, but it occurs also in scarlet fever and 
some other forms of blood poisoning. A patient in this condition can never be con- 
sidered as free from danger, and skilled and constant assistance should be at hand. 
The best treatment is, in the first place, to clear out the bowels by a brisk purgative 
(two or three grains of calomel, followed in four hours by a " black draught"), to 
allow the patient to inhale the steam of boiling water almost constantly, and to 
apply hot poultices and fomentations to the outside of the neck, which must be 
changed at frequent intervals. Nourishing soups and hot milk must be given, and the 
patient should remain in bed. Some practitioners order small doses of aconite (a 
drop of the tincture every hour), but the present writer cannot say that he has ever 
seen any reason to suspect that any benefit has resulted from the practice, although 
he has made use of it very many times. If an abscess form in the tonsils, it is 
better to allow it to burst spontaneously than to cut into it. There are exceptions 
to this rule, however, which the practitioner in attendance would recognise. The 
sore throat of scarlet fever cannot be accurately recognised, but its sudden occurrence 
and bright scarlet appearance are the facts which generally arouse suspicion. The 
appearance of the scarlet fever rash soon decides the question. 

Diphtheria is known by the growth of a false membrane, closely resembling a 
piece of wet wash-leather, which begins at one point and spreads, usually equally in 
all directions. It is important not to mistake the natural secretion of the tonsils 
for the diphtheritic membrane. The tonsillar secretion appears on the tonsil itself, 
and is usually scattered over its surface in a series of points. 

The facts which show a sore throat to be serious, if not dangerous, are — (1) great 
swelling of the throat itself, with obstruction to swallowing and breathing ; (2) a 
scarlet appearance of the throat ; (3) the growth of false membrane ; and (4) grave 
constitutional symptoms : great weakness and prostration ; a weak, feeble, and quick 
pulse ; headache, shivering, and any undue elevation of temperature, or the appear- 
ance of any of the fever-rashes. Any of these symptoms would tend to show that the 
sore throat has passed the bounds of the trifling ailment which we include under that 
name. Enlargement of the glands of the neck is an indication of severity. If the 
breath be horribly offensive, or the patient expectorate blood or matter, this would show 
that the discharges are becoming decomposed. For the description of the various forma 
of sore throat, we must refer the reader to the articles on diphtheria, scarlet fever, 
and enlargement of tonsils, measles, &c. Sore throat is one of those diseases which is 



52 DISEASES OP CHILDREN. 



very apt to recur, and it is all important that the throats of persons liable to them 
should not be rendered delicate by any undue coddling. The throat should be washed 
with cold water, which should also be used as a gargle. Some good is also got by 
painting the throat with the glycerine of tannin, or some other astringent. When 
a sore throat, of the quinsy type, runs through a family, there is always reason to 
suspect that the patients have been exposed to some foul emanation, usually from 
the sewers, and the house should undergo a very thorough examination, with a view 
to the determination oT this point. Sore throat is very common among those who 
work in hospitals, and especially those who are called upon to dress foul wounds, and 
whenever similar throats occur in private life, it should always arouse the suspicion 
that miasms of a similar kind have found their way into the dwelling. 

Cold. — A cold, or catarrh, is, in our climate, one of the commonest of human 
ailments, and young and old seem almost equally susceptible to this mild form of 
disease. The parts affected are the mucous membranes, or soft linings of the air- 
passages, the mouth, throat, stomach, intestines, and eyes. Sometimes one and some- 
times another of these mucous membranes is the part seized upon, and we hear of 
people having a cold in their eyes, nose, throat, windpipe, or bowels. A " cold in 
the head " is the name given to a catarrh affecting the " frontal sinuses " — two air- 
chambers lined with mucous membrane, which are situated in the thickness of the 
skull just above the eyebrows, and communicate with the nose. The symptoms of 
a cold are too well known to need any description. There is often a slight feeling 
of " creepiness" or chilliness, and a feeling of dislike for cold. There follows a sensa- 
tion of dryness and fulness of the part affected. The nose gets " stopped up ; " the 
voice gets husky ; the eyes feel tense ; and the frontal sinuses are the seat of oppres- 
sion, which often takes the form of headache. With this there is often a feeling of 
general malaises, and sometimes a rise of temperature, and a slight increase in the 
frequency of the pulse. The urine also becomes scanty and high coloured, and the 
patient, in fact, is thrown into a state of mild fever. To this stage, the actual con- 
dition of catarrh (Anglice, " a flowing down ") quickly succeeds. The mucous mem- 
branes, which previously were dry and swollen, begin to run with moisture, which 
at first is clear and limpid, and then becomes thicker and more tenacious, and of a 
yellow colour. At this time evidence is got as to which way the cold is going to 
travel. If it is limited to the nose, constant violent sneezing, and an unceasing 
necessity for the pocket-handkerchief is the chief symptom. Any increase of hoarse- 
ness, or any tendency to cough, may indicate that the catarrh has reached the wind- 
pipe and bronchial tubes, while a loss of appetite, a furred tongue, and possibly 
diarrhoea, may show that the digestive mucous membrane of the stomach and bowels 
has been attacked. These symptoms subside usually in a few days, and the patient 
is in his usual health. 

Among the causes of "cold," the chief is exposure. A sudden chill or a pro- 
longed exposure to a draught of cold air is usually sufficient. The most potent cause, 
perhaps, is a sudden transition from a hot and foul atmosphere to a cold one ; and 
probably more colds are caught by coming from an over-crowded church or theatre 
into the chilly night air than in any other way. People in robust health do not 



colb. iS 

catch cold, and any derangement of the health (even a passing fit of mild indigestion) 
seems to lay one open to the evil effects of chills. A tendency to catch cold indicates 
a " weakness," and diligent search should be made for any indication of a tubercular 
constitution in such cases. It has been very much debated, as to whether or no a 
common cold is contagious or infectious. When we hear people say that " a cold has 
been running through the family," or that one child has caught it from another, the 
usual explanation is that the family has been exposed to a common cause. Never- 
theless, there can be no doubt that there are colds and colds, and while we have no 
belief in the contagiousness of the ordinary cold in the head, we do not feel 
inclined to speak so positively about the more severe forms of feverish cold which are 
accompanied by high temperature and herpetic eruption round the mouth. It is 
a good rule, we think, not to allow a child with a cold to sleep in the same bed with 
'another child. 

If a child has not had measles, the symptoms of a cold, especially if the eyes be 
unduly attacked, are, it must be remembered, the commonest first symptoms of that 
disease. The appearance of the eruption will soon decide the question. The treat- 
ment of a cold consists mainly in the protection of the patient from any further 
chill, and so preventing the untoward accident of "catching a cold upon a cold," 
which often leads to severe and prolonged disease of the lungs or other organs. 
Keep the child warm. If the weather be cold, it should be confined to the house, or 
even, if the attack be severe, to its own room or its own bed. Take care that the 
functions of the body are all properly performed, and that the diet is light and 
digestible. For the rest, encourage perspiration. This is the cardinal point in the 
treatment of a cold. Let the patient wear flannel in bed, and have some extra 
clothing and a hot- water bottle if necessary. A warm drink at night of hot gruel, or 
white- wine whey, or treacle posset with the addition of from ten drops to half a tea- 
spoonful of sweet spirits of nitre, will very much increase the action of the skin, and 
very soon after falling asleep, the patient will burst into a profuse perspiration. 
When this is attained, the cure is half wrought ; but it not unfrequently happens 
that, owing to want of thought, the patient is allowed to relapse again. It hardly 
need be said that after such violent action of the skin the susceptibility to chill is 
enormously increased, and great care is required that when the patient leaves his 
bed he should be kept thoroughly warm. A fire must be lighted in the bed-room, 
and the toilet be performed directly in front of it, a screen being drawn round as a 
further protection. It is advisable also that some food should be given before 
" getting up " and going through the process of dressing. These latter points are all 
important, and if they be not attended to it would be wiser not to give the hot 
drinks, <fec, which encourage the profuse action of the skin. The " specifics " and 
" certain cures " for colds are without number. Spirit of camphor is habitually used 
by many, and we see no harm in giving a few drops on a knob of sugar. 
" Alkaram " is a patent medicine, and is said by many to be effectual in stopping 
the flow from the nostrils. A snuff composed of bismuth, gum acacia, and a little 
morphia, will also check the secretion from the nose ; but no preparation containing 
morphia or opium is to be thought of for young children. Take care that the bed- 
room is well ventilated, for we are convinced that many children as well as adulti 



54 DISEASES OF CHILDREN. 



owe their susceptibility to cold to sleeping in stuffy rooms. The occurrence of 
diarrhoea, cough, great hoarseness, or other untoward symptom, should be a signal 
for professional advice, for it must be borne in mind that many severe illnesses of 
children " begin with a cold." The best preventives for colds are fresh air, exercise, 
warm flannel clothing, and well-ventilated rooms. The practice of cold bathing is 
also highly advantageous, but it is on no account to be pushed too far. The bath 
must generally " have the chill off," and it should always be given before the fire. If 
the child fail to get its "reaction" and warm glow after it, it should be discontinued. 
A child who is liable to cold often requires tonics, and cod-liver oil and steel wine, 
those never-failing friends of sickly children, should be administered. 

Spinal Disease. — This is one of the occasional ailments of childhood against which 
eyery parent should be on his guard. When attacked, the child attempts by every 
means in its power to save the spine from the weight of the head. It walks slowly 
and with fear, and seeks all the aid it can get from furniture, &c, and may be seen 
creeping from one part of a room to another, clinging to the rim of a table, or 
nervously shifting from one chair to the next. There is often pain in the stomach and 
a catching of the respiration, and this, if combined with any tenderness of the spine 
or any prominence of the bones, should at once arouse suspicion, and cause the calling 
of professional advice. Spinal disease occurs chiefly in sickly children of a tuberculous 
or scrofulous constitution. It ends, if not properly attended to, in ulceration of the 
bones of the spine, hopeless deformity, exhausting abscesses, and death. It is one of 
those diseases which is entirely beyond the range of domestic medicine, and we 
merely mention it that those who have the care of children may have a knowledge 
of its existence. It is sometimes caused by accident, such as a fall or blow, but 
depends usually more upon constitutional than accidental conditions. The only 
treatment is to call in a surgeon, and if one be not readily accessible, to keep the 
child in bed until the necessary advice is forthcoming. 

Hip Disease is a disease of early childhood to which the scrofulous and the sickly 
are peculiarly liable. It is very necessary to be on one's guard against it. The 
child limps and goes tenderly on one leg. The leg of which the hip-joint is diseased 
has usually the thigh slightly bent forward, the knee bent a little, and the toe 
turned inward. There is often pain in the hip, but quite as often or more often, 
perhaps, the child complains of pain in the knee, and it is very important to 
remember that pain in tlie knee may be the most prominent sign of commencing 
disease of tlie hip. In the early stages the disease can be successfully cured, but if 
allowed to go without treatment, it ends in destruction of the hip-joint, abscesses 
which may burrow both internally and around the joint, and the death of the child 
after a painful and lingering illness. The treatment of this disease is 'beyond the 
scope of non-professional persons. The advice of a surgeon (not a spinal or bone 
specialist, nor an orthopaedic blacksmith) should be sought, and the case be left 
entirely to his skilled treatment. 

Stammering. — There is nothing more likely to interfere with the worldly 
advancement of a child than stammering, and consequently no effort should be 
spared to check it directly a child shows any tendency towards unsteady utteranoet 



STAMMERING. 55 



It is one of those disorders which is engendered by imitation and example, and it is 
therefore of the greatest consequence to remove children away from any chance of 
their picking up so dangerous a habit (for it is more a habit than a disease), and one 
which it is so difficult to shake off when acquired. Stammering is rarely congenital, 
it is almost always acquired, and very often comes on while the child's general 
health is weakened by some of the common diseases of childhood. It is not necessary 
to describe so common a complaint. It is due to unsteady action — a sort of chorea — 
of some of the muscles used in vocalisation or articulation (more often the latter, 
however), and it is generally found that while mere sound is produced without 
difficulty, articulate speech is impeded to a greater or less extent. Careful examina- 
tion may enable one to determine where the failing exists, and by making the child 
repeat slowly the letters of the alphabet, we may find that some letters occasion a 
greater difficulty than others. These are generally the labial sounds, such as P and 
B, but occasionally the fault is greatest with other sounds. Stammering in many 
cases is a mere passing trouble, and exists only during some temporary impairment 
of health, and when the child gets strong, its stammering disappears. These children 
are sometimes nervous and shy, and their trouble is often much aggravated if general 
attention be directed to them. To cure stammering, the first thing is to gain the 
child's confidence. One must appear not to notice the trouble, treat the child with 
great kindness, descend to its intellectual level, and encourage it in a friendly way to 
talk. Yery much may be done by exercising the voice, and if the child can sing, or 
has any taste for music, it should be encouraged in every way, for stammerers can 
always sing without hesitation, and if this fact becomes plain to the child, the moral 
effect of such a discovery cannot be over-estimated. Not only can stammerers sing, 
but they can invariably talk if they alter the pitch or the rhythm of the voice, and 
they should be encouraged to learn by heart pieces of poetry, which they should recite 
rtrith great care. Never allow a child to " haggle " over a word. If its utterance is 
checked, bid it stop at once, give up all effort, and begin again at the beginning. 
Recitation ought to be part of the education of every child. A proper command of 
the voice is only acquired by practice, even by those who have great natural aptitude 
for oratory, and the systematic rhythmical exercise of the voice of stammerers must 
be regularly persevered in for months. Perseverance will be rewarded by success in 
a veiy large number of cases. If the child fail with some sounds more than others, it 
should practise those sounds with diligence. If, for example, P be its stumbling- 
block, it should be encouraged, by a small reward, to repeat, very slowly, very 
distinctly, and without faltering, some lines in which this letter recurs often, as 
in the well-known nursery adage — 

" Peter Piper picked a peek of pepper,** && 

Strophulus, (See Bed Gum.) 

Teeth. (See Dentition.) 

Thrush. — This is a very common disease, especially among the poor, with whom 
•very child is expected to pass through its attack of thrush almost as a matter of 
course. The disease is due to inflammation of the lining membrane of the mouth, 



56 DISEASES OF CHILDREN. 



which, generally goes on to the production of ulcers, and on the inflamed ulcers there 
come white patches, which are due to the growth of a fungus, a white mould, in 
fact, known as the Oidium albicans. It is highly probable that the inflamed and 
ulcerated condition of the mouth is prior to the growth of the fungus ; but it also 
seems probable that this fungus, directly it has begun to grow, helps to keep up the 
inflamed condition, so that the two elements of this disease lean upon each other, as 
it were, for mutual support. If a little of the white patch be placed under the 
microscope, the fungus may be clearly seen, and those who possess a microscope may 
be interested in looking at it Place a little particle of the white substance on a 
glass slide, place upon it a drop of solution of potash, and then cover with a covering 
glass. The fungus, when magnified by a quarter-inch object-glass, looks like a 
number of branching threads. The ulceration and fungous growth sometimes travel 
through the intestines, and the child is often, in fact, usually, troubled with diarrhoea, 
and sometimes inflammation round the lower opening of the bowel. "When this 
occurs, the thrush is said to have "passed through." During an attack of thrush, 
the health*of the child usually deteriorates very much, and occasionally even children 
die of the exhaustion caused by the diarrhoea. Strong children ought not to have 
thrush, and whenever the disease breaks out it is a sign of something wrong, either 
in the child itself, or else in its management. If children were kept as scrupulously 
clean as they ought to be, we should undoubtedly hear less of this disease. In the 
majority of cases it arises from injudicious feeding. A child with thrush should be 
fed entirely on milk, and if it be a year old, or upwards, a little beef tea may be 
added. If it is being fed on any of the numerous patent farinaceous foods, they 
should be discontinued for a time. If fed by hand, care must be taken that the 
feeding-bottle is clean, and that no particles of sour milk are clinging about the lips 
and stopper or the tube, as is too frequently the case. If the child is being suckled, 
the mother's breast should receive attention, to be sure that it is in a fit state for such 
a purposa A little lime water should be added to the child's milk if the diarrhoea is 
very severe — in the proportion of two table-spoonfuls to half a pint of milk. If this 
should fail to arrest the diarrhoea, it is often advisable to give a little chalk mixture 
— a tea-spoonful three or four times a day. The child must be kept scrupulously 
clean, and its mouth must be washed after every meal, and all particles of milk must 
be removed by means of a camel's hair brush. The best application for the destruc- 
tion of the fungus is a solution of sulphite of soda, or a very weak solution of carbolio 
acid — one part of acid to sixty of water. The fungus being destroyed, the ulcerations 
will heal, and the inflammation subside; but the application of glycerine of borax, 
or borax and honey, is often of very great service. It occasionally happens that 
older people have thrush, and we sometimes see, during the course of severe fevers, 
when patients are too weak to cleanse their mouths properly, a growth of the 
oidium albicans on the mucous membrane of the mouth. The same thing occurs, too, 
towards the termination of chronic complaints of long standing; but whenever it 
occurs, it may always be taken to indicate that the patient is in a state of very great 
weakness. 



Tonsils, Enlargement of-. — Sickly children, especially if they be scrofulous, and 



TUBERCULOSIS. 57 



many children also who are not otherwise out of health, suffer from great enlargement 
of the tonsils — the two almond-like lumps which are seen at the back of the mouth. 
Children who have large tonsils usually snore; and if a child snores, its mouth should 
always be examined. The tonsils may swell up to five or six times their natural size, 
and may, in fact, become so large as to seriously interfere with respiration. The 
tonsils may become acutely enlarged in many conditions, as, for example, inflam- 
mation of the tonsils themselves (or quinsy), scarlet fever, and diphtheria. Having 
been enlarged from any of these causes, they are slow to return to their natural size. 
The treatment of enlarged tonsils must be both constitutional and local, and in 
many cases the constitutional treatment alone (consisting of the administration of 
good wholesome food, tonic medicines, cod liver oil, and syrup of the iodide of iron) 
will be found sufficient to effect a cure. If, however, they remain obstinately 
enlarged, and seriously interfere with the child's comfort, they had better be removed, 
a question which will have to be decided by a surgeon. 

Tuberculosis. — The tendency to this constitutional disease must be looked upon as 
the weakness, par excellence, of the whole of the inhabitants of Northern Europe. It 
is the form of constitution in which we find phthisis, or consumption of the lungs, 
occurring ; in which children are liable to be attacked with inflammation of the 
membranes of their brains ; and in which, if the disease fly to the glands of the 
abdomen, we get marasmus or wasting from mesenteric diseasa It is distinctly 
hereditary, and we find the disease " cropping up " in its various forms in the 
different generations of a family, and among the different members of the same 
generation. Thus, when we hear of two or three members of a family dying of 
consumption, we shall very often, on inquiry, learn that others have died in infancy 
of diarrhoea (which may have been due to tubercles in the intestine), or marasmus, or 
atrophy (tubercle of mesenteric glands), or symptoms referable to the brain (tubercle 
of the membranes of the brain). There is no fact more clearly established than that 
tuberculosis is hereditary ; a fact which has been proved with regard po the lower 
animals as well as man. Those, therefore, who, having shown symptoms of this 
disease, persist in marrying, do so at the risk of having children who may inherit 
from them disease instead of health. 

With regard to the causes which seem to help in the production of tuberculosis, 
eertainly in those who are, and probably also in those who are not, predisposed to it 
by inheritance, we may mention, first, overcrowding, for certainly this disease is most 
common among those who work in crowded, ill-ventilated workshops, and who sleep 
in overcrowded apartments — as is too often the case among the poor. Secondly, we 
may mention that a damp, ill-drained soil seems to predispose to tuberculosis, or at 
least to that form of it which attacks the lungs ; for Dr. George Buchanan, of London, 
medical inspector of the Local Government Board, has clearly shown that since the 
effectual draining of certain towns, the number of deaths from phthisis in them has 
materially decreased. Thirdly, we may mention as a probable source of tuberculosis 
any irritation which may persist in the body of an individual Thus, if bronchitis, or 
what only seems to be a common cold, be allowed to go on unchecked, the glands of 
the chest become irritated and inflamed, and when this is the case, the risk of general 



58 DISEASES OP CHILDREN. 



tuberculosis being set up from these infecting centres seems to be very much 
increased. Irritations of all kinds are apt to cause glandular enlargements, and a 
glandular enlargement once set up (in the lungs, bowels, or elsewhere) in a person 
predisposed to tuberculosis, the risk of that predisposition being confirmed is very 
greatly increased. This mention of glandular enlargements must not lead the reader 
to confound the tuberculous with the scrofulous constitution. The two conditions 
differ widely, as he will see if he turns to the article on scrofula. 

Tuberculosis is characterised by the presence of " tubercles " in the body, and to 
the uninitiated it is no easy matter to convey a notion as to what tubercles are. 
They are little white particles, insignificant in size and appearance; but wherever 
they are inflammation is apt to occur, and it is this tendency to chronic inflam- 
mation in tissues which are the seat of tubercles which constitutes the danger of the 
condition. The most common positions for tubercles are (as we have said) the 
intestines and their glands, the lungs, and the brain. 

Children who are prone to tuberculosis are generally pretty. They are slim, fair- 
haired, with lithe active figures, delicately-formed limbs, slender chests and waists, 
blue eyes and clear red and white complexions. They are the favourite little heroes 
and heroines of the novelists, who appear like fairies to gladden the hearts of parents 
and friends for a short season ; whom the gods love, and who die young. They are 
intelligent, quick, and volatile, and are -a source of pride to their mothers and nurses. 

The onset of tuberculosis may be sudden or gradual. When sudden, it very 
closely resembles an attack of fever. The child is probably convalescent after one of 
the diseases of childhood — measles, whooping cough, chicken pox, or scarlet fever — 
when its convalescence seems arrested. It becomes languid, irritable, peevish, dull, 
and heavy. It neglects its playthings, and its appetite fails. Then it becomes, 
feverish, has a dry skin, and complains of thirst. The cheeks are flushed, or 
are alternately flushed and pale. The eyes are bright and glistening, the pulse 
is quick, and the temperature (as measured by a thermometer) rises considerably. 
The lips are dry, and the edges of the nostrils also are inflamed, and the child picks 
them and makes them sore. The loss of flesh is rapid — rapid in proportion to 
the rise of temperature ; and, in fact, the state of fever and the increasing wasting 
are often the main features of the condition. The child may die, worn out 
by its persistent febrile condition, but this is rarely the case, and usually the disease 
terminates by determining, as it were, to one or other of the organs which are prone 
to be attacked. 

If the lungs are attadced, the child coughs, and sometimes coughs up a little blood, 
which is always a serious symptom. Sometimes it coughs up a little matter from 
the lungs, but this is not often the case, and it should be borne in mind that 
children may have, and often do have, very serious disease of their lungs without 
coughing up anything at all. We have known the lungs of children almost 
completely ulcerated away, and yet the little patient has never raised any matter by 
coughing during life. One may often hear the rattling and wheezing within 
the chest, and sometimes the wheezing may be felt when the child is taken in 
the arms, but the certain determination of the amount and character of the disease 
in the lungs is only to be made by a practised ear, aided by a stethoscope. This 



TUBERCULOSIS. 69 

condition of the lungs is exactly comparable to " consumption w in the adult, and is 
usually tolerably rapid in its course. 

If the bowels are the parts mainly attacked, we have, in addition to the symptoms 
attributable to the constitutional state, special symptoms referable to the intestines, 
the liver, the mesenteric glands, and other organs of the abdomen, as the kidneys and 
spleen. When tubercular disease attacks the lining coat of the bowels, it causes 
extensive ulceration of them, and round the ulcerations the bowel gets inflamed. 
As a result of this, the child complains of pain, usually little twistings and gripings, 
which elicit sliglic expressions of pain, and are then forgotten. The condition of the 
bowels is variable, but usually diarrhoea *is a marked symptom, and sometimes this 
diarrhoea is so profuse as to rapidly exhaust the patient. These cases of tuberculosis 
accompanied by diarrhoea are often mistaken for typhoid fever ; and, indeed, the two 
diseases are often so alike that even the most practised eye is unable to distinguish 
them. Alternating with the diarrhoea we get periods of constipation occasionally. 
The motions are usually of a pale yellow colour, and offensive, and contain sometimes 
a little blood. The abdomen of the child may be normal in appearance, and not the 
least tender ; but if the ulceration should cause, as it occasionally does, general 
inflammation of the cavity of the abdomen (peritonitis), the symptoms are very 
different. The abdomen becomes tender to the touch, and is usually blown up with 
wind. The peritonitis in these cases, however, runs a gradual and not a rapid course 
as a rule. 

If the kidneys are attacked, which is by no means uncommon, we get a little 
tenderness in one or both loins. The child complains of pain, and the urine is 
occasionally, when passed, thick with the matter which has been discharged by the 
damaged organs. 

When the disease attacks the head we are confronted with one of the most terrible 
of the diseases to which children are liable, and which is known technically 
as tubercular meningitis — known also as acute hydrocephalus, but to be carefully 
distinguished from chronic hydrocephalus, or water on the brain {which see). 
Before describing the symptoms of this disease, we would remind the reader that 
it often happens that the local disease in tuberculosis precedes the general con- 
dition, and the symptoms of the one are frequently the cause of our distinguishing 
the other. Thus the symptoms of tubercular meningitis may make their appearance 
in a healthy child, as may also the symptoms of tuberculous disease of the lungs or 
bowels. The child complains of its head. It stops suddenly, perhaps in its play, 
cries out, " Oh, my head ! " and then resumes its game. Any child complaining of 
its head should be carefully watched, and should have the advantage of medical 
supervision for a time. The headache varies in severity from a trifling pain to agony. 
The child avoids the light, and prefers the blinds down, and turns its head from a 
glass. The face is alternately flushed and pale, and if the fontanel (the opening 
between the bones on the crown of the head) be open, it will be found to be 
prominent and not depressed. The appetite fails, the bowels are usually confined, 
and the child is troubled by persistent vomiting. This is a very characteristic 
symptom, and whenever a child vomits persistently, and without adequate cause 
referable to the stomach, one must always be uneasy lest it be the premonitory 



60 DISEASES OP CHILDREH. 



symptom of tubercular meningitis. The surface of the abdomen is flat and pinched 
in. The pulse is rapid at first, but when the child gets drowsy and dull it usually 
becomes slow. After the child has been ill a week or ten days, and sometimes earlier, 
the head symptoms are more marked. There may be attackfi of convulsions, and 
occasionally the child has a habit of sighing deeply. Then wandering comes on, and 
drowsiness makes its appearance, and gradually deepens into coma. Th6 child may 
squint, or one eyelid may droop, or one or both pupils may become enormously 
dilated. Sometimes there is paralysis of one side of the body. Death occurs in 
these cases either from the general weakness, or in a fit of convulsions, or by a 
deepening of the insensibility. 

The duration of this disease varies a good deal, and this seems to depend on 
whether or not it appears at the beginning or the close of a general attack of 
tuberculosis. It rarely lasts more than six weeks or a couple of months, and 
is sometimes fatal within a week of the first appearance of the symptoms. 

We have purposely included in our description of the general disease known as 
tuberculosis a detailed enumeration of the symptoms of the chief local manifestations, 
because we thought that by so doing we should be able to give a better general idea 
of what is meant by a "constitutional tendency," and of the consequences which may 
result therefrom. This method of treating the subject, too, has this advantage, that 
the remarks which we purpose making on treatment will appear more coherent and 
more rational than would otherwise be the case. 

In discussing the treatment of tuberculosis, then, it will be necessary to bear in 
mind its causes and its consequences, and it will be found that the former may not 
unfrequently be prevented, and the latter averted. First and foremost, then, we 
would impress upon our readers that tubercular people before marriage should 
be made well aware of the possible consequences of the step. They should take the 
best advice before doing so, and, although the blindness of love is a fact which 
nobody can doubt, they should be advised not to select as their partners for life those 
who are prone to the same constitutional conditions as themselves. If a child have 
the tubercular appearance, and come of a tubercular stock, we may still do much to 
ward off that which threatens it, and if the remarks we have made about 
over-crowding and damp soils be borne in mind, and if the circumstances of the 
parents are such as to allow of a choice in such matters, they will be particularly 
careful not to allow it to run the risk of sleeping in a close bedroom, of working in 
an over-crowded schoolroom, or of living in a damp cold situation. 

These children require more than ordinary care during and after their children's 
diseases, for these periods, which are trying to all children, are often fatal to the 
tubercular. As long as a child who inherits tuberculosis be kept in perfect health, 
it may escape its inheritance, but if, through want of proper supervision, its health 
fails, it is at once laid open to the attacks of its acknowledged enemy, and if any 
organ become diseased it may prove the centre and starting-point of the constitutional 
disorder. Any irritation or undue excitement of any part may determine the 
tuberculous change in that part. Many a child has had its tubercular meningitis 
started by the carelessness of its nurse, who has neglected to properly protect 
the child from the heat of the sun. Or, again, we believe that the eternal worrying 



TUBERCULOSIS. 61 



of children by some unwise parents brings about the same result The tuberculous 
children are generally forward, and they begin to take notice and to prattle earlier 
than others. This being the case, their brains are never allowed a moment's peace, 
and incessantly during its waking hours it is made to " take notice " of this, that, 
and the other, to answer stupid questions, and repeat stupid rhymes, All this to 
so young a child is mental labour, and this mental labour often, we believe, is 
answerable for the induction of tubercular disease of the brain, and the premature 
death of the child. 

Again, undue exposure to cold or insufficient clothing may bring on bronchitis, 
and bronchitis in these constitutions will almost certainly determine tubercular 
disease of the lungs. Children are often insufficiently clothed, and when they begin 
to run about their dresses not unfrequently begin so low down and end so high up 
that the chest and legs are left practically bare. We grant that children thus dressed 
look uncommonly pretty, and we are ready to admit that this costume is adopted by 
parents very often from a mistaken notion about " hardening their constitutions ; *' 
but we fear there is good reason to suppose that this hardening process often ends in 
death. These children should be very carefully clothed, and their legs, arms, and 
chests should be kept carefully covered up, except during the summer months. If 
the parents can afford it, it is advisable for them to pass the winter in a warmer and 
more certain climate than is to be found in England, except in some favoured 
localities. The skin should be kept scrupulously clean, and should be washed daily 
with soap and water. The tendency to disease of the bowels should make one very 
careful about the diet of such children. It should be carefully adapted to their age, 
and should be bland and unirritating. Any unwholesome particle may lodge in the 
bowels, set up irritation, and cause a tubercular deposit. Uncooked vegetables, 
underdone potatoes, a piece of gristle, the outside white skin of the orange, or the 
stones of a grape or raisin, may be sufficient to induce the trouble. Milk, soups, 
carefully boiled or roast meat, wheaten bread (not oatmeal or brown bread), carefully 
and thoroughly cooked vegetables, soft puddings of custard, rice, tapioca, or other 
farinaceous articles, and cooked fruit, ought to constitute the diet of such children. 
The actions of the bowels must be carefully looked to, and constipation or relaxation 
must receive immediate attention. Dosing, always a dangerous proceeding, is 
especially so in these cases, and if purgatives are necessary they must be of a very 
mild character. The bowels may often be relieved by giving a simple injection of 
soap and water by the bowels, but this is a measure which ought only to 
be used occasionally, and ought never to be allowed to become a practice. The best 
drugs to be used in these cases are the salts of soda, senna, or castor oiL Half 
a drachm of phosphate of soda in a little broth or some hot milk is a very efficient 
purgative, and, being tasteless, is of great service in the nursery. Half a tea-spoonful 
of spmp of senna or a tea-spoonful of castor oil may be given when necessary, but 
the employment of the stronger purgatives — rhubarb, jalap, grey powder, or calomel 
— is not to be thought of, except with the advice of a medical man. 

Certain medicines are of undoubted service in tuberculosis, and first among these 
we must mention that which is so useful in all conditions of disordered nutrition in 
childhood — cod liver oil. If this be given during convalescence from the infantile 



62 DISEASES OF CHILDREN. 



fevers, benefit, almost always accrue* to the patient, and the manner in which 
children grow, make flesh, and improve in appearance generally; is one of the most 
remarkable facts which the physician is ever called upon to observe. If the patient 
be pale and bloodless, steel wine or some other preparation of iron may be given in 
conjunction with the oil or separately. If oil cannot be taken, cream is sometimes 
given, and is indeed a very pleasant substitute, but its medicinal properties are 
inferior to those of the oil. Pancreatic emulsion we firmly believe to be of no use. 
A difficulty is often experienced in getting children to eat fat, and as a rule 
they carefully cut off and put at the side of their plates every particle of fat that is 
given them. It is no good correcting children for this, and the ability to appreciate 
and digest big pieces of fat will not be engendered by talking. Fatty things 
are undoubtedly good for children, but fat is better given them in a state of fine 
division. New milk contains an abundance of fat, and for this reason, as well as for 
its other high dietetic values, milk should form a large part of the nursery dietary. 
Bread and milk for breakfast, and milk puddings of all kinds, are appreciated 
by all children. Bread and butter is, of course, the staple food of children from two 
years old and upwards, and in this form they get a large amount of fat. Eggs, too, 
contain fat, and there is seldom any difficulty in getting them to eat eggs. Never 
let a child be wasteful with its food, nor allow it to be foolishly capricious ; but, on 
the other hand, children should not be bullied to eat that which they do not like. 
If they do not like fat in its grosser forms, give the more delicate varieties. 

So long as wholesome flour and cow's milk are obtainable, do not give any of the 
innumerable patent foods which are so freely advertised, and which are sold in the 
form of powder in hermetically-sealed tins. The labels of these tins are often 
covered with the analyses of eminent chemists and the testimonials of equally 
eminent doctors, and possibly some of these patent articles may be good substitutes 
for the unwholesome trash which is often given to the children of the poor ; but it 
must stand to reason that their dietetic value cannot excel, and probably falls 
far short of, a mixture of wheaten bread and new milk. If the appetite fails, much 
good may often be done by giving a very small quantity (half a grain or a grain) of 
quinine dissolved in one drop of dilute sulphuric acid, and mixed with a little 
infusion of orange peel, about half an hour or twenty minutes before dinner. 

When the more acute symptoms appear, the treatment of the case necessarily 
passes out of the hands of the friends into those of the doctor, so that we shall not 
say much on that point. For diarrhoea, it is best to give a little chalk mixture, or 
chalk combined with some astringent medicine, such as catechu, or tannic acid. 
Laudanum or opium in any form is never to be given to children without medical 
advice. The treatment of the lung condition does not call for any very particular 
remarks, and we must refer the reader to the article on consumption for information 
on this point. The treatment of the head symptoms also can hardly be discussed 
here. Very few cases of recovery after well-established tubercular meningitis are on 
record, and these have been effected by the employment of measures which would 
necessitate the supervision of a medical man. 

Ulceration of the Gums. — This, among the lower orders, is a not uncommon and 



VACCINATION. 63 



very troublesome condition. It occurs generally just after the child has cut its first 
teeth, and is characterised by a foetid ulcerating condition of the gums, which usually 
begins behind the front teeth, but soon spreads to the front. The gums are red and 
swollen, and the margins next the teeth are sore, and covered with a buff-coloured, 
pasty, sticky matter, which adheres to the surface of the sores, and usually smells 
most offensive. TBs condition may be limited, or it may spread till it affects the 
whole of the gums, and may be so deep as well as so extensive as to cause loosening 
of the teeth. In extreme cases, the child is in a pitiable state, and runs no small 
risk of being poisoned by the constant inhalation of the foetid exhalations from its 
own gums, and the absorption of putrid matter. The disease is caused by 
bad hygienic conditions, and is usually attributable to foul air and injudicious 
feeding. 

The treatment consists chiefly in a most scrupulous attention to cleanliness. The 
mouth must be constantly washed out with water to which some disinfecting fluid 
has been added— and perhaps Tilden's Bromo-Ohloralum, one part to ten of water 
is the best for this purpose. 

Always after taking food the mouth must be washed out, and all offensive matter 
removed with a camel's-hair brush. For a local application to the gums there is 
perhaps nothing better than a saturated solution of chlorate of potash. Glycerine of 
tannin is also a valuable remedy in these cases. Good may also be done by applying 
a solution of nitrate of silver. The child must be carefully and constantly fed with 
milk and strong broths, and it is generally necessary to give some stimulant also. 
The state of the bowels must be attended to, and the internal administration of 
quinine in doses varying from half a grain to a grain, according to age, is very 
strongly to be recommended. 

Ulcerations of the Mouth are exceedingly common in children who are in a weak 
state of health, or who are injudiciously fed, or who are not kept clean ; and ulcera- 
tions may generally be taken to indicate one of these three conditions. The most 
common form of ulceration is small circular abrasions, situated generally on the 
inside of the lips, or the cheek, or the side of the tongue. They are called aphthous 
ulcers. 

They are not usually difficult to cure. The first indication is to keep the child's 
mouth perfectly clean; and the mouth should be washed out whenever it is fed. The 
best thing to apply to the ulcers is glycerine of borax, or glycerine of tannic acid, 
which may be got at any chemist's, and should be applied with a camel's-hair brush. 
Another favourite and valuable application is chlorate of potash, a strong solution of 
which may be used to wash the mouth, or the child may drink a mixture containing 
four grains of the salt to every ounce of water. Borax and honey is also an old and 
useful application, but inferior probably to the preparation made with glycerine. The 
child's general health wants attending to, and it is often advisable to give a brisk 
purgative of rhubarb, soda, and grey powder, or even a little calomel and jalap. The 
diet should be as simple as possible. If any of the ulcers show a reluctance to heal, 
it may be advisable to touch them with a solution of lunar caustic. 

Vaccination. — -Vaccinia is the name given to the slight constitutional disturbance 



64 DISEASES OP CHILDREN. 



which occurs in children after vaccination, and although it is hardly fair to count it 
among the diseases of childhood, we shall nevertheless discuss the topic at some 
length, because of the agitation against the practice which has sprung up of 
late years. The reasons for the anti-vaccination agitation seem to be twofold, 
and the most important of these lies in the fact that the present generation 
cannot be said to have any real acquaintance with the disease which vaccination 
protects us against. It is true that now and again we have an epidemic of small pox, 
but the epidemics of modern times are nothing when compared with the horrible 
pestilences of a century ago. When an enemy is in sight, and still more when he is 
in our very midst, we gladly submit to any amount of taxation in order to be rid of 
him ; but when the enemy retires again, we are very apt to grumble even at the 
moderate taxation which serve to support the armaments, the existence of which 
keeps him at a distance. Vaccination is the tax as it were which has enabled us to 
compel the small pox to surrender at discretion ; and the enemy being driven off, the 
thoughtless have raised a fruitless agitation against the tax. 

Before the days of Jenner (a man whose memory should be enshrined with the 
memories of the greatest names that have adorned our history), small pox raged 
to an extent that was simply appalling. It was estimated that half a million 
of deaths annually were due, to small pox in Europe alone, and in London one- 
fourteenth of the entire deaths were attributable to this cause. Mr. Simon, in 
an able paper appended to the report of the Select Committee on Vaccination 
(1871), reminds us that a fourteenth of the total deaths meant much more, when 
the total, " as compared with the population, represented perhaps double our 
present death-rate." 

It was a pestilence doubly horrible because the seeds of it seemed capable of 
nourishing in any soiL It smote the wealthy living in palaces equally with the poor 
in their hovels, and proved as destructive to Indian tribes encamped upon the opeD 
prairie as to populations crowded in close cities. 

Mr. Simon, in the report above alluded to, says : — 

" For a popular notion of the disease it may be enough to cite what it did in 
royal families. In the circle of William the Third, for instance, his father and 
mother died of it, and, not least, his wife ; and his uncle the Duke of Gloucester ; 
and his cousins, the eldest son and youngest daughter of James the Second ; and he 
himself (like his friend Bentinck) had suffered from it most severely, barely surviving 
with a constitution damaged for life." 

Or again in the Court of Austria, " Joseph the First," says Vehse, " was carried 
off, when not more than thirty-three years of age, by the small pox, to which, in the 
course of the eighteenth century, besides him, two empresses, six archdukes and 
archduchesses, an elector of Saxony, and the last elector of Bavaria, fell victims." To 
this list might have been added, no doubt, many other names; among them, for 
instance, a Dauphin (1711) and a King (1774) of France, a Queen (1741) of Sweden, 
and an Emperor (1727) of Russia." 

It would be thought an awful epidemic nowadays that should strike like this in 
high places. 

The following account (taken from the same source) will show that we are not 



VACCINATION". 65 



speaking without facts in our assertion that savage tribes suffered equally with the 
rich and the civilised. Mr. Simon was indebted for the ensuing interesting 
paragraph to Mr. Lloyd's translations of "Prince Maximilian's Travels in the Interior 
of "North America " : — 

"The disease first broke out about the 15th of June, 1837, in a village of 
Mandans, a few miles below the American fort, Leavenworth, from which it spread 
in all directions with unexampled fury. The character of the disease was as 
appalling as the rapidity of the propagation. Among the remotest tribes of the 
Assiniboins, from fifty to one hundred died daily. The patient, when first seized, 
complains of dreadful pains in the head and back, and in a few hours he is dead ; the 
body immediately turns black, and swells to thrice its size. In vain were hospitals 
fitted up in Fort Union, and the whole stock of medicines exhausted. For many 
weeks together our workmen did nothing but collect the dead bodies and bury them 
in large pits , but since the ground is frozen, we are obliged to throw them into the 
liver. The ravages of the disorder were the most frightful among the Mandans that 
ever broke out. That once powerful tribe, which by accumulated disasters had 
been reduced to 1,500 souls, was exterminated with the exception of thirty persons. 
Their neighbours, the Big-bellied Indians and the Bicorees, were out on a hunting 
excursion at the time of the breaking out of the disorder, so that it did not reach 
them till a month later; yet half the tribe was already destroyed on the first of 
October, and the disease continued to spread. Very few of those attacked recovered 
their health ; but when they saw all their relations buried, and the pestilence still 
raging with unabated fury among the remainder of their countrymen, life became a 
burden to them, and they put an end to their wretched existence, either with their 
knives and muskets, or by precipitating themselves from the summit of the rock near 
their settlement. The prairie all around is a vast field of death, covered with 
unburied corpses, and spreading for miles pestilence and infection. The Big-bellied 
Indians and the Eicorees, lately amounting to 4,000 souls, were reduced to less than 
half. The Assiniboins, 9,000 in number, roaming over a hunting territory to the 
north of the Missouri, and as far as the trading-posts of the Hudson's Bay Company, 
are, in the literal sense of the expression, nearly exterminated. They, as well as the 
Crows and the Blackfeet, endeavoured to fly in all directions, but the disease 
everywhere pursued them. At last every feeling of mutual compassion and 
tenderness seems to have disappeared ; every one avoided the others. Women and 
children wandered about the prairie seeking for a scanty subsistence. The accounts 
of the situation of the Blackfeet are awful. The inmates of above one thousand of 
their tents are already swept away. They are the bravest and most crafty of all the 
Indians, dangerous and implacable to their enemies, but faithful and kind to their 
friends. But very lately we apprehended that a terrible war with them was at hand, 
and that they would unite the whole of their remaining strength against the whites. 
Every day brought accounts of new armaments, and of a loudly-expressed spirit of 
vengeance towards the whites ; but the small pox cut them down, the brave as well 
as the feeble, and those who were once seized with this infection never recovered. It 
is affirmed that seve 1 bands of warriors who were on their march to attack the fort 
all perished on their way, so that not one survived to convey the intelligence to their 
5 



66 DISEASES OF CHILDREN. 



tribe. Thus, in the course of a few weeks, their strength and their courage 
broken, and nothing was to be heard but the frightful wailings of death in their 
camp. Every thought of war was dispelled, and the few that are left are as humble 
as famished dogs. No language can depict the scene of desolation which the country 
presents. In whatever direction we go, we see nothing but melancholy wrecks of 
human life. The tents are still standing on every hill, but no rising smoke announces 
the presence of human beings, and no sounds but the croaking of the raven and the 
howling of the wolf interrupt the fearful silence. The above accounts do not 
complete the terrible intelligence we receive. There is scarcely a doubt that the 
pestilence will spread to the tribes in and beyond the Rocky Mountains, as well as to 
the Indians in the direction of Santa Fe and Mexico. It seems to be irrevocably 
written in the book of fate that the race of red men shall be wholly exterminated in 
the land in which they ruled the undisputed masters, till the rapacity of the whites 
brought to their shores the murderous firearms, the enervating ardent spirits, and 
the all-destructive pestilence of the small pox. According to the most recent 
accounts, the number of Indians who have been swept away by the small pox, on 
the western frontier of the United States, amounts to more than 60,000." 

Having endeavoured to present to the mind of the reader some notion of what 
small pox really was in the days before Jenner's great discovery, we now pass on to 
a consideration of the question of vaccination. "Among the dairy-folks of Glouces- 
tershire there was a curious tradition that a certain pustular eruption observed on 
the teats of cows, and supposed to be engendered in them by contagion from * the 
grease ' of horses, might extend its infection to the human subject ; and that persons 
who had suffered from this cow pox, as it was called, were by it rendered insuscep- 
tible to small pox." This was the tradition which Edward Jenner had heard, and 
which he set himself to investigate, and which culminated in the great discovery of 
vaccination, which was first made publicly known in 1798, and which was first 
practised in London in 1799. It is well known that the spread of vaccination and 
the decline of small pox have gone hand-in-hand, and there is every reason to believe 
that the disease which once was the terror of Europe may become ultimately extinct. 

There is one fact concerning vaccination which, taken alone, would almost 
be sufficient to prove the great boon it has been, and the real and undoubted 
protection that it is. It is this, that at the small pox hospital it is always the 
custom to vaccinate the nurses, whether they have been previously vaccinated or 
not, before they enter upon their duties, and it has resulted from this that no nurse 
employed in the small pox hospital has ever contracted small pox. Jenner never 
claimed for his discovery that it was absolutely preventive of small pox, but he 
asserted that it was as good a safeguard against the disease as small pox itself. 
Many people have had small pox twice, and many even of those who have been 
thoroughly vaccinated suffer from small pox, but the disease in both these cases is so 
modified and of such a mild type that it is robbed of all its terrors. It has been 
observed also that the mortality among those who have been vaccinated is infinitely 
less than among those who are not so protected. Whenever small pox becomes 
epidemic, the writer of this article is always vaccinated, and he is thus enabled to 
move about among the sufferers from the disease without a shadow of apprehension, 



YACCIffATION. 67 



and he wishes he could persuade his readers to adopt the same custom, which is a 
common one among members of the medical profession. 

Vaccination is a very simple operation, and is performed upon healthy children 
at the age of three months. The left arm is selected, and the surface should be 
lightly scratched in four or five places with the point of a lancet or even an ordinary 
darning-needle. The scratching should be done very lightly (across and across like 
the " cross-hatching " of an artist), so as to cause a very very slight oozing of blood. 
To these patches the vaccine matter is applied. It is applied either from little ivory 
points (which have been previously dipped in the ripe vaccine vesicle of a healthy 
child), which may be wiped on the oozing surface, or from fine glass tubes filled with 
vaccine lymph, from which the lymph readily flows when the ends are broken off. 
No point or tube which has any blood upon it, or which is yellow and mattery ', should 
on any account be used. It is from using such points that the danger of inoculating 
the child with some disease other than vaccinia is incurred. After the lymph has 
been applied to the arm, care must be taken that it is not removed again by rubbing 
or washing. If too much blood be drawn, the lymph is apt to be washed away in 
the stream. 

For two days after the performance of vaccination the parts remain quiet. At 
the end of the second or on the third day a little raised pimple, or papule, appears 
&i each of the spots which have been inoculated. 

On the fifth or sixth day the vesicle makes its appearance, and it is perfect by 
the eighth day — that is, the day week on which the vaccination was performed 
The perfect vesicle is a little bluish-white pearl-coloured bladder, which has a 
cup-like depression usually in the centre. The eighth day is the time, before the 
contents of the vesicle become yellow and mattery, at which points or tubes may be 
charged for the vaccination of others. After the eighth day, the areola begins to 
form round the vesicla The areola is a red circle of inflammation, and its formation 
is usually accompanied by swelling of the arm, enlargement and tenderness of the 
glands in the armpit, and occasionally considerable constitutional disturbance. At 
this time the contents of the vesicle may become mattery. On the tenth day the 
areola begins to fade and the vesicle to dry. At the end of a fortnight a scab forms, 
which falls off in about another week. The scar left by vaccination endures for 
ever, and is highly characteristic and unmistakable, and resembles a depression 
made with the top of a thimble more than anything else. 

Vaccination, if properly performed, is a protection against small pox for the 
whole of life, probably, but its protective power seems to weaken with the lapse of 
time, so that it is advisable to repeat the operation at intervals. Every seven years 
has been mentioned as the period after which it is advisable to repeat the operation, 
but the number seven has more association with superstition than with science, 
probably. We think, however, and should strongly advise that re- vaccination should be 
performed whenever small pox becomes epidemic. The agitation against vaccination 
has been partly based also on the fear which many people entertain of inoculating 
other diseases (and notably syphilis) with the vaccine matter. That such cases have 
occurred there can be no doubt, but their number is infinitely small when compared 
with the millions of cases of vaccination which occur throughout Europe in the 



68 DISEASES OP CHILDREN. 



course of a year, and it has fallen to the lot of very few physicians to encounter a 
single case. Let us take for example the experience of Sir William Jenner, as 
given by him before the Select Committee on Vaccination in 1871. Sir William 
(Parliamentary Blue Book, p. 259), after stating that his experience had been gained 
in three metropolitan hospitals (including the Children's Hospital), and in his 
private practice as well, goes on to say, in answer to Question 4,508 : — 

"I have never seen any evil arising from vaccination except the local troubles. 
It may sometimes cause inflammation of the arm, but nothing beyond that — nothing 
that the patient did not recover from in a week or two. 

"4,51 1. — Have you ever known of any case of syphilitic infection which you have 
reason to suppose came from vaccination 1 — Never. 

"4,512. — Never in your private practice? — Never in my private practice nor in 
my public practice. 

"4,513. — Have you had any case brought before you which would seem to you, 
with your medical experience, to prove that syphilis has been given by vaccination ? 
— No, I never had one such case. 

"4,514. — I suppose that I may judge that you, with your medical knowledge and 
experience, would think yourself not justified in not recommending every parent to 
have his child vaccinated early in life 1 — I should think myself wicked and really 
guilty of a crime if I did not so recommend." 

The experience of Mr. Thomas Stone, the medical officer of Christ's Hospital, 
London, is so remarkable that we think it should be as widely known as possible, 
and therefore we make no excuse in reproducing a summary of it here. He 
furnished the committee with a statistical table of the number of deaths from all 
causes, and the number of deaths from small pox, which occurred in each year in the 
century included between the years 1751 and 1850. During the first half of 
the century (1751 to 1800) there was no rule either in respect of inoculation and, 
of course, not in respect of vaccination, although Mr. Stone thinks it highly probable 
that many of the children had had small pox either naturally or by inoculation prior 
to their entrance at the school. During this period the average number of boys in 
the school was about 550 per annum, and the total deaths amounted to 264, of 
which 31 were from small pox. Thus it appears that the death-rate from all cause* 
in that period was '96 per cent., and those from small pox '11 per cent. In the half- 
century included between 1801 and 1850, vaccination was made compulsory on 
every child entering at Christ's Hospital. In that period the total number of deaths 
was 235, or -59 per cent, and there has only been one death from small pox in these 
fifty years, and that took place in 1820. 

We devoutly wish that those who agitate against vaccination would read (and 
try to understand) the Parliamentary Blue Book from which we have so largely 
quoted, and in which they will find details of all the solid facts in favour of 
vaccination, as well as the windy assertions which have been made against it. 
Those who refuse to have their children vaccinated have, perhaps, a right to do what 
they like with their own, but they ought to remember that they have a certain duty 
to perform towards their neighbours ; that every child who has not been vaccinated 
runs enormously-increased risks of contracting small pox; and that every case of 



WATER ON THE BRAIN". 69 



small pox may be the starting-point of an epidemic which, if it spare the unconscious 
child who is the fons et origo, may nevertheless be a source of mourning for many a 
surviving parent. 

It is true that children are occasionally ill after vaccination, and that just this 
period — i.e., the first six months of life — is that which is most fatal to children in 
general, and that in which constitutional maladies are very apt to show themselves. 
It is also true that the slight disturbance caused by vaccination is occasionally 
sufficient in delicate subjects to determine the appearance of eruptions on the head or 
skin, just as a common cold, or any trifling disturbance, would occasion them ; but 
our experience has been that the vast majority of troubles which have been ignorantly 
alleged by mothers to be caused by vaccination could not by any possibility of means 
have had any connection with it, although they may have nearly coincided in the 
matter of time. 

The treatment of local troubles which may occasionally occur in the arm after 
vaccination is simple enough. If the arm gets painful, and the glands in the armpit 
become tender after the eighth day, the arm should be carried in a sling, and if 
there be much swelling or redness round the punctures, warm and moist applications 
will be found to give relief; at the same time the bowels and digestive functions may 
want attention. Care must be taken that the child does not scratch the punctures, 
which often itch considerably when they are healing, and equal care must be taken 
that they are not rubbed or irritated by the dress. It is often a good plan to cover 
them with a piece of soft rag on which a little cold cream has been spread. This may 
be covered with some soft cotton wool, and the whole retained by means of a 
bandage. In this way all irritation will be reduced to a minimum, and any risk of 
the dress sticking to the sores will be obviated. Do not pick off the scabs, but allow 
them to loosen gradually and fall off by themselves. 

Water on the Brain, or Chronic Hydrocephalus, is happily a very rare disease. 
It consists of a dropsy of the brain — a collection of water within the cavity of the 
skull The disease begins to make its appearance about the sixth month of life, just 
when the child begins to cut its first teeth. As the water collects inside the head, 
the bones of the skull, being soft and not yet united together, yield to the pressure 
from within, and grow thin and separate from each other, so that the head becomes 
enormously large, the natural openings between the bones are much bigger than 
ordinary, and the bones themselves are sometimes so attenuated as to allow of the 
detection of the fluid beneath them. The head is sometimes nearly as big as the 
whole of the rest of the child's body, and these unfortunate children are the " big- 
headed monsters " who are shown as curiosities at country fairs. Although the head 
grows big, the face remains of a natural size, and this disproportion between the size 
of the head and face gives the child a very extraordinary appearance. The forehead 
overhangs the eyes, and the eyes themselves have a peculiar appearance owing to the 
lower half of the " whites " being completely obscured. The veins of the head are 
usually large, and if the child is able to walk about, it gets a peculiar oscillating gait, 
owing to the great size and weight of its head. The disease often occurs in the 
tubercular and the rickety. The appetite is usually fairly good ; but in spite of this 



/0 DISEASES OP CHILDREN. 



the child loses flesh steadily. The duration of such cases, which are (happily perhaps) 
generally fatal, is from one to three years, but now and again they live on into adult 
life. 

Great care must be taken to distinguish this condition from the large head of 
rickets, which is not by any means so serious a condition. In rickets we find the 
other signs of the constitutional state in other parts of the child's body, and although 
the fontanels are late in closing in rickets, they do not remain so widely open as in 
chronic hydrocephalus ; and a farther distinction is found in the fact that the bones 
in rickets are rather thicker than ordinary. "The peculiarity of the eyes present in 
hydrocephalus is not present in rickets. 

The treatment of these cases does not usually afford much ground for hope. The 
general health of the child must be carefully attended to. Tonic and alterative 
medicines may be given, and its general hygienic arrangements must be carefully 
supervised. Iodine, in the form of iodide of iron or iodide of potassium, has been 
highly recommended. The head has been blistered with advantage, and the adminis- 
tration of diuretic medicines, such as carbonate of potash, acetate of potash, and 
infusion of broom, has been supposed to assist in the reduction of the fluid. In some 
constitutional states the administration of mercury might be highly advisable. The 
head may be tapped, and some cases have of late years been published which show 
the advantage of this form of treatment. The tapping is best done by means of an 
instrument called an aspirator, and as the fluid is drawn off the head should be 
compressed slightly by means of a bandage. These are of course measures which can 
only be done by persons thoroughly conversant with disease ; and, indeed, the 
treatment generally of this very grave disorder must be left entirely in the hands of 
professional advisers. % 

Whooping Cough. — This disease owes its name to the loud whooping, crowing 
sound with which the sufferer draws breath after a violent attack of coughing. The 
whoop is a very variable symptom of the disease. It may be very loud, and consti- 
tute the principal feature, or, which is important to bear in mind, it may be absent 
altogether. Whooping cough seems to be more infectious even than measles, and, as 
mentioned while discussing the last-named disease, it is often established during its con- 
tinuance or the subsequent convalescence. It should be borne in mind that whooping 
cough is a general disease — a disease, that is, affecting the whole body, and although 
the symptoms are mainly referable to the lungs and windpipe, the disease is by no 
means limited to those parts. The disease is most common in childhood, but is not 
confined to that period of life. The phenomenon of an old person suffering from 
whooping cough is far from uncommon. 

The attack begins generally as a common cough — an ordinary attack of bronchitis. 
The child has attacks of coughing, and wheezing can not unfrequently be both heard 
and felt in its chest. After this ordinary cough has lasted for ten days or a fortnight, 
it becomes violently spasmodic in character, and the well-known sound is developed. 
To see a child during a severe paroxysm of whooping cough is a truly piteous sight. 
It is probably playing with its fellows, and enjoying its game as much as the others, 
when suddenly it is conscious of the approaching trouble. It ceases to play, stands 



WHOOPING COUGH. Tl 



still, and catches hold of the nearest object for support. The cough is loud, severe, 
and repeated five or six times, and then comes the prolonged whooping inspiration, 
followed by a fresh series of coughs and a fresh whoop. This is repeated again and 
again until the child becomes blue in the face, and gasps for breath. The eyes look 
bloodshot, and stream with tears. Sticky tenacious mucus is coughed through the 
mouth and nose, and not unfrequently the straining efforts at coughing are so severe 
that the contents of the bowels and bladder are discharged. It is very common for 
an attack of coughing to terminate with vomiting, and whenever a child vomits with 
a cough, the nurse should suspect that it is suffering from whooping cough. "With 
the vomiting the cough ends, the complexion becomes natural, and in a few minutes 
the child is again playing, quite forgetful of the trial it has passed through. These 
attacks of coughing recur at uncertain intervals, which vary with different indi- 
viduals. In bad cases, or when the attack is at its height, they may come as 
frequently as one in half an hour, and as the patient gets better the attacks become 
not only less severe but less frequent also. The attacks of coughing are brought on 
by anything which irritates the child, and if ever it be allowable to spoil a child, the 
period of its whooping cough is one of those times. Any sudden rebuke, or rapid 
and sudden movement, will to a certainty induce an attack, and occasionally even 
the slight irritation caused by taking food is sufficient to produce them. The disease 
is one of very uncertain duration, and often proves very trying to the friends by its 
obstinate persistence, for as long as any member of a family has whooping cough, the 
whole of the household is placed in quarantine by its social circle. In favourable cases 
the disease completely subsides in about three weeks ; but it is no unusual thing for 
it to persist for twice as many months. It is commonly supposed, and with reason, 
that the whooping noise occasionally lasts long after the infectious period of the 
disease has passed away, and that consequently many a child with pronounced 
whooping inspiration might with perfect safety mix with its fellows at school and 
elsewhere. It is impossible, however, in our piesent state of knowledge to say where 
the infectious period of the disease ends and the non-infectious begins, so that it is 
better to be on the safe side, and to keep a child entirely separated until it has 
absolutely ceased to whoop. Any child who is whooping would certainly get the 
credit of spreading the disease should any children with which it had come in 
contact succumb to whooping cough. 

Whooping cough must at all times be looked upon as a serious disease, and the 
slightest attacks must be a source of some uneasiness to the friends of children. It 
is a more common cause of infant mortality than is generally supposed ; but when it 
is fatal, it is so usually by the complications which are apt to be established during its 
continuance. Thus, the bronchitis, which is always present to a certain extent, may 
become unduly severe, and may attack the fine tubes of the lung, in which case the 
gasping for breath becomes a marked feature, the respiration is hurried, the cough 
frequent, and the countenance livid, according to the amount of suffocation which is 
present. True inflammation of the lung may be set up, and when this is the case 
the characteristic features of whooping cough subside until the inflammatory attack 
has passed off. Bleeding from the lungs or nose will sometimes occur, and prove very 
weakening to the patient. 



72 DISEASES OF CHILDREN. 



Convulsions are a serious complication, and are very frequently fatal. The 
lungs, from the incessant cough, may drift into the condition which is technically 
known as emphysema — i.e., they become over-blown, a state analogous to " broken 
wind " in the horse. In this case the child remains short-breathed and asthmatic, 
and this coniition once established is very liable to be permanent. Tubercular 
disease is very often established during whooping cough, and the patient may be- 
come consumptive or suffer from tubercle of the brain, and die with symptoms of 
hydrocephalus, or drift into the condition which is known as marasmus or atrophy. 

The treatment of whooping cough varies according to the stage of the disease. 
These stages may be considered as three in number. (1) the febrile stage, in which 
cough and cold are the ordinary symptoms ; (2) the paroxysmal stage, in which the 
patient is tormented with cough and spasm ; and (3) the nervous stage, in which the 
other symptoms having passed away the whoop alone remains. During the first 
stage it is necessary to carefully regulate the diet and clothing of the invalid, and to 
guard him as much as possible from the effects of cold. Perspiration should be 
encouraged at night by the administration of warm drinks, and the chest should be 
wrapped in flannel or cotton wool, and covered with oiled silk. If the bronchitic 
symptoms be severe, some spirits of camphor or spirit of turpentine may be 
previously sprinkled upon the wool or flannel. It is necessary to regulate the 
action of the bowels, and it is usually advisable to restrict the patient to a slop 
diet if the amount of the febrile symptoms be considerable. The next thing 
necessary is to encourage expectoration. If old enough, patients should be told 
to expectorate, and not to swallow the secretion which is coughed from the lungs, 
and medicines should be given in order to loosen the phlegm. The best of these, 
perhaps, are ipecacuanha, squills, syrup of tolu, and ammonia, and these drugs may 
be administered singly or combined. Sometimes, when the lungs are much choked 
with secretion, great advantage is derived from the administration of an emetic, 
such as warm mustard and water, but these are points which can only be decided 
by the practised judgment of a medical man. When the febrile stage has passed, 
we may try to allay the spasm and paroxysmal cough, and here we think we may 
well give a word of warning as to the danger of having recourse to patent quieting 
medicines, of whose composition we are ignorant. Nearly all of these preparations 
contain laudanum or opium in some form or another, and we have no hesitation 
in saying that opium has been the cause of some thousands of deaths when 
administered ignorantly and thoughtlessly for the relief of the severe troubles of 
whooping cough. Children are at all times peculiarly susceptible to the influence 
of narcotic medicines, and they are particularly so when their breathing power is 
impaired by disease of the lungs. A child who is under the influence of opium, 
even though its lung-tubes be filled with secretion, has its sensibility so dulled 
that it "forgets" to cough, and to forget to cough in such a plight is to die. 
The child who is incessantly coughing becomes quiet, and the conclusion drawn 
is that it is better, whereas, as a matter of fact, it is being slowly suffocated by the 
secretion in its lungs. Soothing medicines, and especially opium, should never 
be given without authoritative advice ; and, indeed, we hardly know of any 
condition in which it is warrantable to give opium to very young children. Few 



WHOOPING COUGH. 73 



diseases have been so variously " drugged " as whooping cough, and the number of 
specific remedies which at one time or another have been put forward for its cure 
is prodigious. Syrup of chloral has been much in fashion of late, and although it 
is of undoubted service, we should deprecate the employment of so powerful a 
remedy by unpractised hands. Bromide of ammonium, bromide of potassium, 
belladonna, camphor, and prussic acid have all been useful. More important than 
drugs, however, is it to bear in mind to abstain from all things that are likely 
to induce a fit of coughing ; and, as we have said before, the child should be rather 
" spoilt " than otherwise for a time. 

In the third stage, tonic medicines, combined with anti-spasmodics, are of great 
service, and it should be borne in mind that a good supply of wholesome and 
digestible food and an abundance of fresh air are the best of all tonic medicines. 
If the circumstances of the child allow of a supply of both of these, recovery is 
usually rapid. We do not mean to say, however, that drugs are not of very great 
service, and if the child be pale and weak, and has lost flesh during its illness, 
a tea-spoonful of cod liver oil combined with an equal quantity of steel wine 
will be found a most excellent means of restoring the vigour which has been lost. 
The nervine tonics are also of great service, and first among these we should place 
quinine, which may be given in doses of a grain or less. If the whooping noise 
persist obstinately, belladonna combined with sulphate of zinc is perhaps the most 
generally-approved remedy. The dose of each of these should be very small to 
begin with, and after a few weeks may be increased. Sulphate of zinc is a 
powerful emetic, and if any injudicious attempt be made to give large doses from 
the first, the object will be defeated by the vomiting of the patient, but by 
gradually increasing the dose the recipient can ultimately be made to tolerate 
enormous quantities. The same remarks apply to belladonna, and by gradually 
increasing the dose we are enabled to give it in quantities sufficient to airest 
the spasm of the windpipe. It should be remembered, however, that zinc and 
belladonna are both poisonous drugs, and when they are administered it would 
be well to keep the patient under the supervision of one who is well accustomed 
to the observation of disease. If the child be still much disturbed at night by the 
cough, a dose of bromide of ammonium or bromide of potassium (ten grains of 
either) may be given at bedtime. Nitric acid is a remedy which has been regarded 
with favour, and from two to ten minima of the dilute acid given with a little syrup 
of orange-peel is often of great benefit ; and it has this advantage over some othei 
medicines, that the child does not object to it, and swallows it without difficulty. 
By some, the application of a solution of nitrate of silver at regular and frequent 
intervals to the larynx itself has been recommended, and it has been stated that 
this is often sufficient to arrest the cough at once. The application of caustic 
solutions to the throat is a somewhat severe measure, requiring considerable skill 
on the part of the operator, and should not be attempted by an amateur. The 
liability of a child recovering from whooping cough to fall into bad states of health, 
and to fall a victim to tuberculosis or scrofula, must be always borne in mind, 
and the greatest care must be exercised in the general hygienic arrangements 
of the convalescent A short sojourn at the seaside, at the southern coast in 



74 DISEASES OF CHILDREN. 



winter or early spring, or the eastern coast in summer, is strongly to be recom- 
mended. For children living in cities, the mere removal for a time to any healthy 
country district is often sufficient to completely re-establish the health, 

Worms. — Children are mainly affected by two varieties of intestinal worms. 
These are known as thread worms and round worms. Thread worms, of which the 
scientific name is ascaris vermicularis, and which are commonly spoken of as 
ascarides, inhabit the lowest part of the bowel, and live just within the lower orifice 
or anus, and indeed crawl in and out. They resemble pieces of white thread, hence 
their name. They are innumerable in quantity, and are about a quarter of an inch 
in length. They cause an intolerable itching, and often provoke painful contractions 
of the bowel (tenesmus). The bowel generally gets into a semi-inflamed condition, 
and slimy mucus is often discharged from it. The irritation may set up that most 
troublesome condition known as falling down of the bowel (prolapsm cmi). The 
irritation in the rectum is occasionally the cause of fits, and it often sets up 
a sympathetic irritation in the genito-urinary organs which is very undesirable. 
Now it must be borne in mind that a healthy child hardly ever has thread worms, 
but a sickly child is hardly ever without them. They are always an indication 
of ill-health, and the ill-health is the cause of the worms. 

Treatment. — Injudicious feeding often occasions irritation of the rectum and the 
secretion of mucus, in which mucus the worms live and flourish. Look first of all, 
therefore, to the child's diet, and correct whatever is amiss, and take particular care 
that the child has no access to trash. It may be necessary to give a mild purgative, 
in fact, this course is generally to be advised. Next we may treat the worms locally, 
and the best method is usually by throwing injections into the bowel. Several 
injections have been recommended. Salt and water is very effectual. So also is 
infusion of quassia. Half a drachm of the tincture of the perchloride of iron in 
four ounces of rose water or lime water is very valuable also. The injection should 
not be too large, and it is not necessary to inject it with great force, as the worms 
inhabit the lower part of the bowel. The injections act, no doubt, in a large degree 
mechanically, and it is quite sufficient in most cases merely to keep the bowel clean. 

The most important part of the treatment is the constitutional treatment 
The child in these cases almost invariably needs tonics. Cod liver oil and iron, 
or a dose of steel wine alone after meals, must be given in almost every case. 
These measures are usually successful, and it is not necessary as a rule to have 
recourse to those drugs which are recognised as worm medicines. If it be requisite, 
however, the best of these is santonin, which should be given at bedtime in doses 
varying from two to six grains, according to the age of the child. This should be 
followed in the morning by a brisk purgative, such as senna tea. 

Round worms. — This worm is technically known as the ascaris lumbricaides, 
and it is usually spoken of as the lumbricus. It usually inhabits the small 
intestine, but it may be found in any part of the intestinal canal between the 
stomach and the anus. They closely resemble the ordinary earth worm, and vary 
in length from two to sixteen inches. The child may void them by vomiting, 
but they are usually passed from the bowel. The worm being a creature of some 



WORMS. 75 



considerable size, the symptoms -which they cause are often serious. They occasion 
griping pains in the abdomen, with itching about the anus and nose. Occasionally 
diarrhoea is produced by them, and they are certainly a tolerably frequent cause 
of epileptic fits, of squinting, and of enlargement or inequality in the size of the 
pupils of the eyes. They are said to have been the cause of St. Yitus's dance, but 
this is very doubtful. It is certain, however, that in many cases they occasion 
no symptoms at all, and the first indication of their presence is the finding them 
in the evacuations from the bowels. Again, the various symptoms which are said 
to be due to the presence of round worms very frequently exist without any evidence 
whatever of the presence of worms. The treatment of round worms consists first 
in the improvement of the general health by attention to diet and the administration 
of tonics, and secondly in the giving a dose of santonin at bedtime, followed by a 
brisk purgative in the morning. 



, 



THE TBEATMENT OF DISEASES. 

ABSCESSES. 

A* abscess is usually regarded as a purely surgical affection, but no one willingly 
submits to the ordeal of an operation, and really much may be done by appropriate 
medicinal treatment. 

Probably the most generally useful remedy for abscess is sulphide of calcium. 
When given quite at the commencement it will arrest or prevent the formation of 
matter. When matter has already formed it diminishes and limits inflammation, 
and quickly brings the abscess to a head. The judicious administration of 
this remedy will often relieve us of the disagreeable necessity of having an abscess 
opened by the lancet. For children who are subject to abscesses about the neck or 
on the buttocks, sulphide of calcium proves singularly useful. It does admirably, 
too, for a threatened abscess of the breast. In all these cases one of the sulphide of 
calcium powders (Pr. 78),* or a pill of the same strength (Pr. 68), should be given 
every two hours for three or four days, or longer if necessary. They will do 
good, even when the abscess has commenced discharging. Should any difficulty 
be experienced in inducing a child to take the powders, or should they cause 
vomiting, the dose may be reduced to a half, or a third, or even a sixth ; but it 
should still be given every two hours — at all events, during the day. In addition, 
the part should be thickly smeared with a mixture of equal parts of glycerine 
and extract of belladonna, and over this a good hot linseed-meal poultice should 
be applied. The poultice should be changed frequently — every two hours if possible 
- — and each time the application of the glycerine and belladonna should be renewed. 
When a poultice is used to disperse inflammation, or to bring an abscess to a head, it 
should be large, and should extend beyond the limit of the red and inflamed part, 
but as soon as the abscess has come to maturity and has burst, the poultice should be 
but little larger than the opening in the skin, through which the matter is escaping. 
A large poultice applied over-long soddens and irritates the part, and is very apt to 
bring out an eruption of little pimples. This mode of treatment rarely fails to do 
good, and it can under no possible circumstances do any harm. 

From the success which attends the external application of belladonna to abscesses 
it might be supposed that it would do good when given internally, and such is the 
case. It has been found that taking belladonna will prevent the formation of 
abscesses in the neck and elsewhere, and that even when matter is present it will 
check the pain and inflammation. The internal administration will also be found 
of service for the abscess of the breast which is so common in women who have been 
obliged suddenly to give up suckling. From five to ten drops of tincture of belladonna 

* This and the other references are to the list of Prescriptions which are given together at the end 
of this work. 



f8 THE TREATMENT OF DISEASES. 

should be taken in a little water, three or four times a day, the external application 
of the glycerine and belladonna being continued. 

The aconite mixture (Pr. 38) often' does good when high fever is a prominent 
feature. In such cases it may be given alternately with the belladonna or sulphide 
of calcium. 

Phosphate of lime (Pr. 77) succeeds best when there is a large abscess which has been 
discharging for a considerable time. Painting round the margin of an abscess with 
tincture of iodine will often limit the inflammation and prevent it from spreading. 
After an abscess has been opened and its contents have been discharged, healing may 
be promoted by the application of a calendula lotion made by mixing a tea-spoonful 
of tincture of the common marigold with three table-spoonfuls of water. It may 
be applied by saturating a piece of lint, or two or three thicknesses of linen, and 
covering it with oil-silk to prevent evaporation. The dressing must be renewed 
two or three times a day. 

During the formation and discharge of an abscess the patient should be " fed up." 
It is a most exhausting process, and plenty of good nourishment is required. The 
diet should include good strong soup or broth, mutton chops, plenty of milk, and a 
fair allowance of stimulant, given preferably in the form of port wine. Change of air, 
with residence by the sea-side, or right out in the country, becomes an important 
element in the treatment, especially in old standing cases, or where the discharge has 
been very great and the health is much depressed. 

Further particulars as to the treatment of abscess will be found in the surgical 
portion of this work. 

ACIDITY. 

Acidity or heartburn is caused by an excessive secretion of gastric-juice in 
the stomach. It is a form of dyspepsia or indigestion, and will be found described 
in detail under the former of those headings. 

One of the best remedies for the immediate relief of an attack of acidity is 
sal-volatile. A single dose of half a tea-spoonful should be taken in a wine-glassful 
of water. Twenty grains of bicarbonate of potash or bicarbonate of soda dissolved 
in a little water will answer equally well,* although sometimes it leads to the 
formation of a quantity of gas, which causes distress by distending the stomach. 
When the bowels are confined, a twenty-grain dose of magnesia or carbonate of 
magnesia dissolved in water is preferable. Where there is diarrhoea, a couple of 
table-spoonfuls of lime-water may be taken, either alone or mixed with an equal 
quantity of milk. These remedies usually act very promptly, and speedily afford 
relief. They can only be regarded as palliative, for they in no way diminish 
the tendency to acidity, and in fact rather increase the liability to future attacks. 
To obtain a radical cure acids must be given before food. Fifteen drops of dilute 
hydrochloric acid should be taken three times a day, in a wine-glassful of water, 
half an hour before meals, for a week. When the acidity is associated with loss of 
appetite, the acid should be combined with a bitter, as in the gentian and acid 
mixture (Pr. 15). The dose of this is two table-spoonfuls, and it should be taken three 
fones a day, half an hour before meals. It is to be taken as it is, and noi 



AGUE. 79 

mixed with water. Should this fail, relief may often be obtained by taking the 
bismuth mixture (Pr. 18) in two table-spoonful doses three times a day, half an hour 
before meals. When the acidity is accompanied by pale-coloured motions, it is 
an indication that the liver is not properly performing its functions, and one of the 
sugar and grey powders (Pr. 71) should be taken three times a day. 

For the acidity from which pregnant women often suffer the best remedy is two 
or three drops of tincture of nux-vomica taken in a little water a few minutes before 
meals. Should this fail, it is somewhat controlled by drop doses of ipecacuanha 
wine taken every three hours in a little water. 

In all cases of acidity it is advisable to avoid any article of food which has been 
observed to excite an attack. 

AGUE OB INTERMITTENT FEVER. 

Whoever has read Robinson Crusoe — and who has not revelled in its pages? — must 
have formed some idea as to the nature of ague. The fits are so graphically 
described, and the description is so true to nature, that we feel assured that even 
if Defoe did not himself suffer from the malady, he must have had opportunities 
of carefully watching its progress. Ague resembles many other diseases in coming 
on in paroxysms or fits. The patient suffers from a certain series of symptoms, 
and then reverts to his ordinary condition of health. This alternation may occur 
several or many times, according to the duration of the attack. 

Ague is caused by the entrance into the system of a poison called " malaria." 
What malaria is, it is not very easy to say. We must pause, however, for a 
moment, and consider what we know about it. It is nothing we can see or feel, 
or that the chemist can detect, even by his most subtle tests, and we know of its 
existence only by the marked effects which it produces on those who are exposed to 
its influence. It is not simply " bad air : " at all events, in the sense in which we 
usually use that term. The impure air of all large cities is injurious enough 
to the health, but that alone never gives rise to ague. Malaria is something quite 
distinct. 

It is commonly met with in the neighbourhood of marshes in hot climates, and is 
often spoken of as " marsh miasm." It is believed to arise from the decomposition 
of vegetable matters in moist places, and under high temperatures. It is sometimes 
met with in sandy soils, but a careful examination will nearly always disclose the 
fact that there is water and vegetable matter not far from the surface, the moisture 
being in all probability retained by a bed of clay or some similar cause. It is 
curious to observe what a small quantity of decomposing vegetable matter is, under 
favourable circumstances, sufficient to excite ague. A few years ago, at a hospital 
in Germany, a large day-ward was used for convalescents. As soon as a patient had 
been in this ward for two or three days, he invariably had a bad attack of tertian 
ague. In no other ward did this occur, and the matter remained a mystery until 
on close inspection a large rum cask full of rotten leaves and brushwood was found. 
This had overflowed and formed a stagnant marsh some four or five feet square, 
close to the doors and windows of the room, which on account of tho heat had 
left open at night. On its removal the occurrence of ague at once ceased. 



80 THE TREATMENT OF DISEASES. 

Malaria is seldom met with in cold climates, nor in the winter months of more 
temperate regions. Decomposing vegetable matter is not in itself sufficient to 
produce malaria, a certain amount of moisture being essential. It is generally 
believed that in the case of marshes the poisonous emanations proceed from those 
parts which are only occasionally covered with water, and then undergo a process 
of gradual evaporation, and not from those which are more or less completely 
submerged. Malaria loves low-lying districts, and in temperate climates seldom 
ascends above a height of 500 feet. It is always found in the greatest 
intensity near the ground, but why this is we don't quite know. It may be due 
to the action of gravity, or it may be that the poison is entangled by the fog, 
and carried down by it. It is well known that in malarious districts it is 
much more dangerous to sleep on the ground-floor than in the upper storeys. It has 
often been found that in barracks the number of soldiers taken ill with ague 
in the lower apartments is greatly in excess of those who suffer in the upper, 
and consequently in many places abroad it is customary, if possible, to leave the 
ground-floor untenanted. Malaria is capable of being carried by the wind in a 
manner analogous to that of fogs. This is a matter of no little importance in 
tropical climates, where the wind frequently blows for days, weeks, or even months 
together from the same quarter. When malaria exists above its ordinary level, a 
careful examination will usually show that it has been carried up ravines by 
means of currents of air, or that it is due to some local cause. Sometimes even 
the poison has been blown right over a hill, and dropped, so to speak, on the other 
side Malaria has been found to act with by far the greatest intensity at night. It 
may be that it is at these times more copiously evolved, or it may be that at night 
the system is more susceptible to its influence. 

It is a curious though well-established fact that malaria loses its noxious pro- 
perties by passing over even a small surface of water, particularly if it be salt water. 
It would seem as if the water dissolved it, and this is in all probability the case, for 
in India it is a common belief that water over which malaria has passed is quite 
unfit for drinking purposes, and that when taken into the system it is capable of 
producing not only ague, but dysentery, and even cholera. Belts of trees exert almost 
as powerful an influence as sheets of water in arresting the progress of marsh miasm. 
It is supposed that foliage has a special attraction for malaria, and that it has the 
power of decomposing it. It is said that woods and groves were first regarded 
as sacred from the protective powers which they exert from ague, and in many 
regions settlers live with impunity close to the most pestiferous marshes, provided 
only that a belt or screen of trees be interposed. Such, then, is the poison which 
causes ague. 

Every one is susceptible to the action of the poison, and consequently every one 
is liable to suffer from ague. Neither the old nor the young can claim exemption 
from the effects of its pernicious influence, and the malady attacks indifferently 
children of a few days old and men of threescore and ten. Practically the largest 
number of cases occur in men in the prime of life, and for the very obvious reason 
that they, the pioneers of civilisation, are more likely to be exposed to the influence 
of the poison than are women or old men and children. 



AGUE. 81 

Debility greatly favours the action of the exciting cause. On many occasions 
soldiers have been exposed to the action of malaria without suffering in any way 
whilst strong and in good health, but have speedily succumbed when weakened 
by exertion and fatigue, or dispirited by defeat. It must be distinctly understood, 
however, that no amount of debility or privation would in itself excite ague, and 
that the presence of the malarial poison is absolutely necessary. 

Take England, for example. There it is confined almost exclusively to Essex, 
Cambridgeshire, Norfolk, and Lincolnshire; counties in which there are either marshes 
or fens or low-lying ground which is occasionally covered with water. The disease 
is very uncommon in London, and you might go to half the hospitals in the 
metropolis without seeing a single case. The majority of our cases are fortunately 
not of home manufacture, but are, so to say, imported. The bargees on the Thames 
occasionally suffer, but even this is quite exceptional. London, however, has not 
always been so fortunate, and a couple of centuries ago the disease was extremely 
prevalent in this city. It will be remembered that both James L and Oliver Crom- 
well died from tertian ague contracted in the metropolis, and that Sir "Walter Raleigh 
was suffering from the same malady at the time of his execution. In the account 
of Raleigh's last moments we are told that as the morning was very cold the sheriff 
said would he come down to a fire for a little space and warm himself, But Sir 
Walter thanked him, and said no, he would rather it were done at once, for he was ill of 
fever and ague, and in another quarter of an hour his shaking fit would come upon 
him if he were still alive, and his enemies might then suppose that he trembled 
for fear. It is evident that it was to his complaint that he referred when, before laying 
his head upon the block, he felt the edge of the axe and said that it was a sharp 
medicine, but would cure the worst disease. Our modern methods of treatment are 
almost as certain, and far less disagreeable. As regards the prevalence of ague, the 
Dutch at the present day are not much better off than the English were a couple of 
hundred years ago, for the malady is still very prevalent amongst the inhabitants of 
the low and level coast of Holland. In Italy the Pontine Marshes near Rome have 
for ages enjoyed an unenviable reputation for the production of malaria. 

We must now consider the phenomena which characterise an ordinary fit of ague. 
It is usually composed of three distinct stages, which are distinguished as the cold, 
hot, and sweating stages. A person who is about to have stn ague fit usually suffers 
from certain warning or premonitory symptoms, and these ordinarily consist of nausea, 
languor, lassitude, and pains in the back and legs. Soon he begins to feel chilly, he 
grows pale, his features shrink, and his skin becomes dry and rough. Gradually the 
feeling of cold becomes more intense, the sufferer shakes and trembles all over, his 
limbs are shrunken, his teeth chatter, his hair bristles, his cheeks, lips, ears, and nails 
get blue, the breathing becomes hurried, the pulse quick and feeble, and the pains in the 
head, back, and loins are increased. After a time this condition of distress is succeeded 
by another of quite a different kind. The sensation of cold gradually decreases, and the 
shrunken condition of the limbs and features disappears. The face then becomes red 
and turgid, the skin hot, dry, and pungent, the temples throb, the pulse is full and strong, 
as well as rapid, and the patient is parched with thirst, and is in an extremely restless 
and uncomfortable condition. At length another change occurs, the skin feels softer 
6 



82 THE TREATMENT OF DISEASES. 

and more natural, and gradually a moisture appears on the forehead and face, and this 
goes on increasing until the patient is in a state of the most profuse perspiration. 
He is then in a condition of comparative comfort, the pulse soon regains its natural 
frequency, the pains depart, and after a time the sweating subsides, and the fit is 
over. 

The cold from which the patient suffers in the cold stage of ague is purely sub- 
jective : he feels cold, but is not so in reality, and if you put your hand to his skin 
you will find that it is burning hot. A thermometer placed in the armpit usually 
indicates a temperature of from 105° to 106° Fahr., a temperature as high or 
higher than we meet with in scarlet fever. And yet at this very time the patient is 
shivering with cold, often so violently as to shake the bed, and perhaps the 
whole room. Sometimes the chattering of the teeth has been so violent as to break 
them, or if loose, to shake them out of the jaw. 

Sometimes the fits are incomplete, and the patient suffers from only one or two 
of its stages. Thus he may shake and yet have no subsequent heat or sweating, or, 
on the other hand, the sweating stage may be the only one to manifest itself. "We 
have all heard of the man who was so lazy that he wouldn't shake when he had the 
ague, and it is to be presumed he suffered from the heat and sweating, without 
the previous rigors. When the paroxysm begins at once with the hot stage, the com- 
plaint is popularly called the " dumb ague," to distinguish it from the more common 
form, what is called the " shaking ague." These incomplete fits are generally to be 
regarded as an indication that the complaint is about to take its departure, but they 
occasionally occur at other periods of the disease. One of the most curious cases on 
record is that of a man who had his fits backwards, the usual order of the stages being 
reversed. Among the vagaries of the paroxysm, a very singular one has been 
noticed, in which the affection is confined to a single limb, which passes through the 
several stages regularly, the remainder of the system being apparently undisturbed. 

The most curious and annoying thing about an ague fit is that it always returns. 
If one could only have it out and then have done with it, we should not care so 
much, but it is sure to come back again in a few days, unless, indeed, we succeed by 
the use of appropriate remedies in arresting its progress. 

The frequency with which the fit returns varies very much in different attacks, 
and certain terms are used to designate this difference. Thus, when there is a fit 
every day the type of the ague is said to be quotidian. When the fit occurs every 
alternate day, say Monday, Wednesday, and Friday, the ague is a tertian. The mode 
of reckoning is to count the day on which the preceding fit happened as the first, 
so that the next fit in this form occurs on the third day. When the paroxysm 
occurs, say on Monday, Thursday, and Sunday, the ague is a quartan. These are 
the regular types of ague, but others are recognised which are termed irregular. 
Thus a double tertian differs from a quotidian only in having on alternate days fits 
of corresponding severity, character, and duration. In the triple terticm there are 
two fits on one day, and one on the next. In the duplicate tertian there are two 
fits on alternate days, with an intermediate fever-free day. In & double quartan 
there is a fit on one day, a mild one on the next, and then a fever-free day, and so 
on. These terms are not very easy to understand, and it must be confessed, that 



AGUE. 



83 



although they are frequently used, they are not of much practical value. The 
following table will enable the sufferer to see at a glance from what type of ague he is 
suffering. We havejn each case supposed that there was a fit on the Monday, and have 
employed the two kinds of crosses to indicate paroxysms differing in character and 
intensity. 



Quotidian . • « 
Tertian. . . • 
Quartan . . , 
Double Tertian • 

Triple Tertian . 

Duplicate Tertian 
Double Quartan 



Hon. 
X 


Tues. 


Wed. 


Thur. 
X 


Fri 


Sat. 


X 


X 


X 


X 


X 


... 


X 




X 




X 


... 




X 


... 




X 


+ 


X 


+ 


X 


+ 


{^} 


X 


{**} 


X 


{*} 


X 


\i\ 


... 


{$} 


... 


{$} 


... 


X 


+ 




X 


+ 


... 



Sun. 



{**} 



It is only right to mention that there are certain cases in which the fits from 
first to last observe no definite type or order of succession, and these are usually 
spoken of as erratic forms of ague. 

What is it that determines whether the type of the attack shall be a quotidian, 
tertian, or quartan % It is very difficult to say, but it probably depends upon the 
dose of malaria which is taken into the system. When the body is saturated with 
the poison, it induces a fit every day, but when the poison is less concentrated, a 
paroxysm at longer intervals suffices for its elimination. 

It is a curious fact that the hour at which the paroxysms commence is more 
or less dependent on the type of the disease. Thus the paroxysms of quotidian ague 
usually begin in the morning, those of the tertian at noon, and those of the quartan 
in the afternoon. 

The duration of the paroxysm is also more or less influenced by the type. Thus 
the fits last in the quotidian from ten to twelve hours, in the tertian from six to 
eight hours, and in the quartan from four to six hours. It has been often remarked 
that as the patient is on the point of recovering, as the result of successful 
treatment, the paroxysms are postponed, or occur an hour or two later every day, 
until finally they disappear. At the commencement of an attack, when the patient 
is getting worse, the paroxysms not unfrequently anticipate, or occur before the 
expected hour. As the result of repeated attacks of ague, the spleen becomes 
greatly enlarged, and may be felt as a hard mass under the ribs on the left side. 
This readily attracts attention, and is usually known as the " ague cake." Ague is 
sometimes complicated or modified by other complaints. Thus in summer the 
patient is apt to suffer in addition from irritation of the stomach, diarrhoea, or 
dysentery ; and in winter from bronchitis or congestion of the lungs. Occasionally 
each paroxysm is attended with violent delirium, and sometimes even with 
convulsions. 

Is ague a very dangerous disease ? Yes, sometimes. In England, curiously enough, 
there is a very prevalent opinion that ague is rather a good thing than otherwise. 



84 THE TREATMENT OF DISEASES. 

and this notion may be traced back from the present day to the earliest records of 
physic. It has with them passed into a proverb that " an ague in the spring is physic 
for a king," and when this was repeated to James I., he being ill of the disease, he 
said it might be good for a young man, but would not do for an old one like 
him. He was quite right, for, as we have seen, it killed him. Sufferers from ague 
are seldom, even in the intervals of the paroxysms, capable of either much physical 
or mental exertion. Persons in England not unnaturally think somewhat lightly of 
ague, but in warmer climates it affords ample evidence of its appalling powers, and 
we know only too well that whole armies have been almost exterminated by its 
ravages. Fortunately nowadays death from ague, or at all events from uncomplicated 
ague, is very rare in this country. 

It is a curious fact that ague exhibits a strong tendency to return, even after it 
has been apparently cured. People who have once suffered from the disease should 
be very careful to avoid over-fatigue and exhaustion of all kinds, as the slightest 
excess in any shape or form will in many cases induce a relapse. 

What should we do to avoid taking ague ] The most obvious thing is, of course, 
not to go into a malarious district; but this is a piece of advice which it is not 
always possible to follow. Should your affairs necessitate your residence in an ague 
district, even for a short time, there are certain precautions which you will do well 
to adopt. You will remember that the poison never ascends to any great height, 
and you will if possible live on high ground, as on the top of a hill. For the same 
reason you will prefer to sleep in the attic to any room in the house, and if you are 
obliged to be out at night, you will walk about in preference to lying down. You 
will remember that the poison is often carried for great distances by the wind, and 
you will consequently prefer to live on that side of the marsh from which the 
prevalent wind blows. You will remember that water absorbs malaria, and if you 
have the choice you will let a tract of water intervene between the source of origin 
of the poison and your residence. You will remember that foliage attracts malaria, 
and you will be careful not to sleep under a tree, although you would if possible 
allow a belt of trees to intervene between you and the marsh. If there happen to 
be any trees round your house, you of course would not cut them down. You will 
remember that malaria is most active at night, and you will be careful not to stay 
out after sunset, and not to go out early in the morning. For the same reason you 
will see that the windows are closed after nightfall. You will remember that ague 
readily attacks those who are debilitated, and you will be careful to live generously, 
but to avoid excesses. You should never go out in the morning without a good hot 
breakfast ; but if you can't get that, a pull at your sherry-flask won't hurt you. A 
moderate allowance of wine or of some fermented liquor at meals is advisable. 
Quinine is almost as useful in warding off ague as it is in curing it, and you will 
do well to take a little occasionally. A table-spoonful of the strong quinine mixture 
(Pr. 10), or a tea-spoonful of tincture of quinine, three times a day, for a few days, will 
prove of the greatest benefit. A respirator or the pocket-handkerchief placed over 
the nose and mouth will on special occasions do much to act as a protective. It is 
said that by surrounding the head with a gauze veil the action of the malaria is 
prevented, and that by its use it is possible even to sleep in the most pernicious 



AGUE. 80 

parts of Italy without fear of taking the fever. The following summary will, we 
trust, prove of service. 

Rules pos the Maintenance op Health in Ague Distbicts. 

1. Build your house on a height, to the windward side of any swampy ground or marsh, and 
If possible let a piece of water or belt of trees intervene. 

2. Don't cut down the trees round your house, but encourage their cultivation. 

3. Sleep at the top of the house, and see that all your windows are shut at sunset. 

4. Don't be out after nightfall, and don't go out early in the morning, and never befcnrt 
breakfast. 

6. If you must be out at night, don't lie down, and don't stop under trees. 

6. Don't drink water over which the ague poison has passed. 

7. Live generously, but not too freely, and take a moderate amount of stimulant. 

8. Take a course of quinine occasionally. 

It is obviously the duty of the master of the house to make his servants and 
dependents acquainted with the best methods of avoiding ague, if they are new 
to the country. It would be advisable for him to serve out quinine all round 
occasionally, and if the purpose for which it is given is explained, no difficulty will 
ever be made about taking it, particularly if a little spirit and water be added to 
wash it down. 

"What is the best method of treating ague 1 In the first place, is it necessary to 
send for a doctor 1 If the attack is not very severe, then perhaps professional aid is 
hardly necessary, and if you have your wits about you, you can as a rule dispense 
with medical attendance. If, however, you are taken ill where the people are 
known to suffer severely from the complaint, you had better send for the best 
advice you can get. 

Supposing, then, you determine to treat the case yourself, what are you to do ? 
In the first place, as regards the fit, what is to be done during the paroxysm 1 The 
patient's own feelings are a very good guide. During the cold stage you should 
cover Mm up well, apply hot water bottles to his feet, and give him something hot — 
but not strong — to drink. puring the warm stage you will find that he will throw 
off the bed-clothes, and ask for some cooling beverage, and there is not the slightest 
objection to his having it. During the sweating stage he is comparatively 
comfortable, and there is nothing to be done except to wipe the skin dry, if the 
sweating should be very profuse. Above all, don't interfere too much. Don't keep 
on talking to him under the impression that you are doing him good, for you are in 
all probability worrying him to death. When a man is really ill he doesn't want to 
be bothered with questions. It is no good asking him where he thinks he got it, or 
worrying him every moment about how his head feels now. It is easy enough to 
talk when you are well, but when you've got the ague you've something else to do. 
Sit down by the bed-side quietly, and if you can help the patient do so, but don't be 
officious. You must remember that in ague there is often a good deal of irritation 
of the bladder, and that in certain cases your occasional absence from the room 
would be desirable. 

Now what is to be done when the fit is over ? A good many remedies have at 
one time and another been recommended for ague, but quinine is our sheet-anchor. 



86 THE TREATMENT OF DISEASES. 

Before we had quinine we used bark, and before bark camomile-flowers, and 
calomel, and bleeding, and all kinds of things. Some years ago, a favourite remedy 
for ague was a spider's web, and there are many people still living who will 
remember having been given in their youthful days a great big black spider wrapped 
up in a split raisin, for the cure of this complaint. It is quite possible that by 
the powerful impression it made upon the mind, it may have been efficacious in 
warding off an approaching fit. 

Nowadays we always give quinine ; always, that is to say, if we can get it, for on 
a long journey it sometimes runs short. In the case of a first attack you will do 
well to assume that the type is quotidian, that is, that the patient will have a fit 
every day. You must manage to give thirty grains of quinine between the 
termination of the first paroxysm and the time on the following day at which 
the second may be expected. You must give the first dose of ten grains towards 
the termination of the sweating stage, and you must give your last ten grains about 
two hours before the next fit is due. ■ The strong quinine mixture (Pr. 10) contains 
five grains in the ounce, so that your dose of ten grains will be contained in two ounces 
or four table-spoonfuls. Let us take an example. Suppose the first fit to begin at 
ten o'clock in the morning, It will be almost sure to be over by eight in the 
evening, or perhaps earlier, and you must then give your first dose of four table- 
spoonfuls of the strong quinine mixture. About one or two in the morning you will 
give your second dose, and your third and last dose at eight o'clock. What else is 
there to be done"? If the bowels are confined you had better get them open by 
a calomel pill (Pr. 61) given at bed-time, but this is of course not necessary in every 
case. Some people strongly recommend the use of emetics in ague, but they are not 
often required. If the tongue is very foul, or the stomach loaded with food, they may 
be useful and yon may give relief by an emetic dose of ipecacuanha wine ; but it should 
be distinctly understood that such cases are exceptional Sometimes the stomach is 
so irritable that it won't retain anything, and the quinine is thrown up as soon as it 
is taken. "What is to be done in this case ? The quinine must be given, and if the 
stomach won't tolerate it, it must be administered by the bowel. There is not the 
slightest difficulty in giving an injection, but if you don't understand how to do it 
you had better get some one who does. The quinine mixture may be poured into 
about a tea-cupful of beef-tea or gruel, and then injected. Don't use too much 
fluid, for it will only be rejected, and the medicine wasted. If this treatment 
doesn't succeed in arresting the progress of the complaint, you must wait patiently till 
the next fit is over, and then try again. Should you, however, succeed in preventing 
the recurrence of the fit, you may consider that you have done very well ; but for 
all that your work is not yet over. The patient should take two table-spoonfuls of 
the strong quinine mixture, in other words, five grains of quinine every four hours, 
until he is pretty fully under the influence of the drug. When he tells you that be 
has a ringing in the ears you will know that he is suffering from "quinism," 
or " cinchonism," as it is called, and that he has had enough, and that you may 
discontinue the drug, or at all events give a smaller dose less frequently. The 
phenomena which constitute cinchonism will be described when we speak of quinine. 
If the patient have no more fits you may consider that you have cured him ; but if 






AGUE. 87 

he is not careful he will have a relapse. The most likely time for a relapse is a 
lunar month from the date of the first attack, and preparatory to this the system 
should again be brought under the influence of the quinine. An old West Indian, 
who has suffered much from ague, informs us that the best way to take large doses 
of quinine is in a cup of green tea. He says, too, that in the tropics you require 
much more quinine to produce the constitutional effects of the drug than you do 
elsewhere. 

But what is the patient to have in the way of diet all this time 1 Just at first you 
must support his strength by milk, plenty of good strong beef-tea, and other similar 
nutritious substances. An occasional glass of hock or champagne, or a little brandy 
and soda, won't do him any harm ; but if you give him wine it must be good. You 
can't expect to get cured of the ague on a cheap, common claret. As soon as the fits 
are subdued, the patient may have anything he likes to eat in moderation, and care 
should be taken to see that his strength is supported. You can't fight a fever on 
an empty stomach. 

And what about complications 1 Well, don't trouble very much about them, but 
go on treating the ague. Cure the disease, and the concomitants will get well of 
themselves. Don't be induced on any account to give up the quinine for the sake of 
a cough-mixture or anything of that kind, or you will suffer for it. At the same 
time, if any serious complication is suspected, you had better get in a doctor without 
delay. If there is at any time much irritation of the bladder, a little bicarbonate of 
soda may be given. 

What is to become of the patient when he gets well 1 Of course he must not stop 
in the malarious district. A change of scene, nutritious diet, and plenty of exercise in 
the open air, will usually soon make things all right again ; but if there is any return 
of the symptoms, recourse must be had to the quinine in moderate doses. A couple of 
table-spoonfuls of the tonic quinine mixture (Pr. 9) three times a day may be taken 
with advantage. 

But suppose quinine fails to effect a cure? Such cases do undoubtedly 
occur. The addition of ten minims of the tincture of gelseminum to each of the 
three doses of quinine should then be tried. A combination of quinine and gel- 
seminum will often prove successful when quinine alone has failed. There is no 
doubt that even by itself gelseminum is a very valuable remedy for ague. 

The objection to quinine is that it is a little bit expensive for poor people. In 
the French army they give arsenic because it is cheaper. As we have said before, 
economy in medicine is only another name for reckless extravagance. Arsenic is a 
good remedy for ague, although it is far inferior to quinine. We must say, however, 
that it has sometimes succeeded where quinine has failed. Five drachms of the arsenic 
mixture (Pr. 40) may be given three times a day. Sometimes it may be used as an 
adjunct to quinine. Thus, when the complaint has been checked by quinine, the 
cure may be conveniently completed or confirmed by a little arsenic. Or on the 
other hand, when little benefit has been experienced from quinine, the arsenic may 
stop the fits, and quinine may then serve to prevent their recurrence. 

Salicine, obtained from willow-bark, is sometimes used in the treatment of 
ague, when from any reason quinine is not obtainable. Thirty grains dissolved in an 



88 THE TREATMENT OF DISEASES. 

ounce and a half of water should be taken every two hours. Little or no benefit 
will be derived from smaller doses. The decoction of willow-bark itself may be 
used, and fortunately the willow abounds and nourishes in marshy places. 

We have not spoken definitely of the use of bark in the treatment of ague, for 
of course it will be understood that quinine is the active principle of, and is obtained 
from, cinchona bark. 

In conclusion we give a summary of the best method of treating ague. 

Utiles foe the. Treatment oe Aoub. 

1. No active treatment is required during the fit. 

3. Between the fits give three ten grain doses of quinine. 

8. Support the strength by milk and beef-tea and a moderate allowance of win*. 

4. If the bowels are confined give a calomel pill. 

6. If the quinine does no good, add ten drops of tincture of gelseminum to each of the three doses. 

6. Should this not succeed, give the arsenic mixture three times a day in five drachm doses. 

7. Resume the treatment a few days before the expiration of a lunar month. 

8. On recovery, change of air, good feeding, and plenty of exercise are necessary. 



ALCOHOLISM. 

By alcoholism we mean the condition which is induced by over-indulgence in 
alcohol. It may occur either in a chronic or an acute form. Acute alcoholism is 
only another name for delirium tremens, and we will describe it in detail under that 
heading. It is of chronic alcoholism that we are now about to speak. We know of 
no other name for it, but it is from this complaint that we wish to indicate that a 
man is suffering when we say that he is a tippler. 

What are the causes of alcoholism % We can sum them up in one word — drink. 
But how is it that some people " take to drink " whilst others show no inclination 
to do so ? This is the question we will now consider. 

It is a very general opinion amongst medical men that a tendency to alcoholism 
is, in a certain sense, hereditary, and the children of a drunken father or mother are 
very likely to be drinkers. Undoubtedly the force of example is not without its 
influence, but still there is something over and above this. We frequently find that 
of the children of intemperate parents, one is a drunkard, a second an idiot, and 
a third suffers from fits, whilst the remainder exhibit other forms of nervous dis- 
turbance. We believe that the majority of the most inveterate and hopeless 
cases of alcoholic excess occurring among the higher classes of society, are produced 
less by the circumstance of external momentary temptation in which the patient is 
placed, than by an inherited weakness of the nervous system, which renders all kinds 
of mental and bodily trouble especially hard to be borne. Occupation is undoubtedly 
a powerful predisposing cause of alcoholism. In hospital practice we find that a 
large number of cases are distinctly traceable to the frequent presence of temptation, 
as for example, in workmen at breweries and distilleries, and barmen and waiters in 
saloons. In a somewhat higher grade of life, public-house keepers and the clerks 
and travellers for wine and spirit houses are very liable to alcoholism. Gentlemen's 
servants, and especially butlers, afford a fair proportion of cases. 



ALCOHOLISM. 89 



Then again poverty often leads to drink. The home is wretched, and the man 
resorts to the bar-room. He sleeps in a close, badly-ventilated room, and gets up in 
the morning suffering from headache, and a feeling of listlessness and depression. 
He seeks temporary excitement in drink, and the day so commenced is often con- 
tinued as it was begun. There is a very common opinion that drink is the simple 
and uncomplicated cause of the greater number of crimes committed by the poor. 
The truth is that in recognising the indisputable fact that drunkenness is often 
followed by crime of a worse kind, we are apt to overlook a large portion of the 
history of the criminal, and especially the wretched poverty in which he is 
usually reared. The demoralising influence of this poverty is the central fact on 
which we ought to concentrate our attention ; it i3 a common cause of general reck- 
less behaviour, of which drunken habits are only a part, although they undoubtedly 
render the commission of fresh crimes more probable. People who are under-fed, or who 
have their meals badly cooked, or at irregular intervals, often exhibit an intense craving 
.for alcoholic stimulants. Starvation — actual severe deprivation of food — cannot be a 
positive predisposing cause of drunkenness, for the opportunity of getting liquor is cut 
off by the extreme degree of poverty which brings about such a state of things. It 
is rather the continual sense of embarrassment of and misery consequent on the 
difficulty or impossibility of paying debts, so common in the lowest ranks of the 
middle classes, which provokes the habits of drinking. 

A monotonous life often leads to alcoholism, and this is more frequently the case 
in the upper and middle classes than in the lower, and more frequently in women 
than in men. Take the wife of a professional man, without children, for example. 
When her husband has gone out in the morning to his business, whatever it may be, 
she feels lonely and depressed, she has nothing much to do, and soon gets tired of 
her ordinary amusement, reading or sewing. She feels dull and listless, and what more 
natural than that she should resort to the chiffonier for a little temporary stimulus. 
Generally it begins with a glass of sherry or port, but gradually it grows on her and 
becomes almost a necessity, and the dose has to be increased to produce the desired 
effect. The want of active out-door exercise represses elimination, and much 
increases the evil It may be thought that this statement is overdrawn, but it is 
not ; we wish it were. Every doctor in the course of his practice has met with 
scores of such cases. We have known women who would drink their eau-de-cclogne 
if they could get nothing else. 

Inclemency of weather is another predisposing cause. A man is a cab-driver, 
out in all weathers, wet and fine. He gets wet through, and has no means of changing 
his things, but has to stand about, or sit on his box, perhaps in a biting east wind. 
It is hardly to be wondered at if he tries to put a little warmth into his body by a 
glass of gin or whiskey. It is of no use telling him that alcohol lowers his tem- 
perature, and that it lets in the cold instead of keeping it out. You may prove it 
to him most conclusively in your own way, but if you finish up by asking him what 
he will take, he will probably choose alcohol in some form or other. 

Long-continaed pain sometimes makes people seek ease in alcohol. This is the 
case very often with young women who suffer from neuralgia. Those who have 
vague uneasy feelings about the stomach sometimes endeavour to relieve them by 



90 THE TREATMENT OF DISEASES. 

wine or spirits. The depression and faintness attending the menstrual period in 
some women, and the debility and low spirits which often distress nursing mothers, 
may lead to the use, or rather abuse, of alcohol. "Women who have a tendency tc 
be hysterical, have often a craving for strong drinks, which should be most carefully 
kept in check. 

In the higher classes of society we not unfrequently see men who have failed in 
some cherished speculation, or women who have lost the only object they cared for 
in life, take to drink with an almost insane vehemence, although they may never 
have shown any such tendency before. It is not that there is any particular 
temptation in the taste of the drinks to which they have recourse, for it is a fact 
that even the most refined and delicate women, when they resort to these practices, 
do not drink wine, but brandy or gin, or some equally coarse and strong spirit. It 
is a mere accident that leads them to select alcohol : under other circumstances they 
would take opium or hashish, or any other intoxicant which they could most 
conveniently obtain, or they would plunge into the indulgence of some special vice, 
or resort to any form of excitement which would promise them oblivion. 

Often enough there is nothing which can be regarded as a predisposing cause of 
alcoholism ; and yet people take to drink. They have a liking, nay, an earnest 
longing, for it, and they will do almost anything to gratify their desire. Some 
people never drink except in company ; with others the mania is for secret drinking. 
It is difficult to say which practice is the more pernicious. 

Now as to the symptoms induced by the continual excessive indulgence in 
alcohoL Nothing more surely undermines the constitution. One of the first 
symptoms is' indigestion and want of appetite, especially for breakfast. If a man 
can't eat his breakfast it is a bad sign — there must be a screw loose somewhere. 
Then there is a little tremulousness of the hands, and about the legs. Tell the 
fellow to hold out his hand, and you will see how shaky he is. He may keep it 
quiet for a time by a great effort, but never for long. A man's hand should be as 
steady as a rock. You find on inquiry that he is restless at night. He tells you he 
can't sleep; he turns and twists about hour after hour, and dozes a bit, but 
never goes right off. The slightest noise wakes him, and he hears every hour 
strike. Yery often he dreams the most horrible dreams, and acts and re-acts all the 
events of the day over and over again. The brain, he says, is always on the work, 
and he can't rest. He complains of noises in the ears, feels giddy, and sees specks 
or bright lights floating before his eyes. There is< never any distinct hallucination, as 
there is in delirium tremens. Another prominent symptom is morning vomiting, or 
perhaps a little retching before breakfast. If a person tells you he is always sick 
the first thing in the morning, directly he gets up, you may be pretty sure that he 
drinks. You must, of course, exclude the case of women who are pregnant or 
suffering from some disorder of the womb, as that would be quite sufficient to 
account for it. Tenderness of the feet is another indication of alcoholism. You see 
old drinkers going about in their slippers all day long. These people are often 
great sufferers from piles. 

You can often recognise a drinker from his general appearance. Curiously 
enough, some people get fat on drink, whilst others get thin. You may meet with 



ALCOHOLISM. 91 



every degree of fatness, from the unwieldy bulk of the lager-halle owner, who 
fuddles himself with beer, to the slight frame of the London hairdresser, who 
often enough makes away with two or three quarterns of gin or rum in a day. You 
can often tell that a man drinks by his face. It is flabby and bloated, with red 
watery eyes, the whites of which have a tendency to become yellow from slight 
jaundice. Every one recognises the significance of a red nose, although in certain 
exceptional cases this condition arises from mere dyspepsia. The smell of the breath 
is usually very characteristic, and there is no mistaking it, even if spirits have not 
been recently taken. 

The first thing to be done in the treatment of chronic alcoholism is to knock off 
the drink entirely. If you are not prepared to do this, it is of no use going further 
into the matter, for we can do you no good. This is a point on which we must 
positively and absolutely insist. But this alone is not enough ; you will have to 
take medicine as welL A very good prescription is the following : — Epsom salts, 
one ounce ; infusion of quassia, eight ounces ; mix. Two table-spoonfuls three times 
a day. We have given this in hundreds of cases, and with the greatest success. It 
does not as a rule purge. Sometimes it is advisable to add five drops of tincture of 
nux-vomica or two grains of sulphate of iron to each dose. Very often a table- 
spoonful of the tonic quinine mixture (Pr. 9) taken three times a day answers admirably. 
When morning vomiting is the chief symptom a small tea-spoonful of the arsenic 
mixture (Pr. 40) three times a day is the best remedy. The first dose should be taken in 
the morning before rising. Very often the great trouble is the persistent wakefulness 
and the appearance of black specks or flashes of light before the eyes. It would be 
a mistake to take any narcotic, such as laudanum, with the view of inducing sleep, 
for it often does more harm than good. The prescriptions we have already given 
will generally remove this condition in a day or two. Should they prove insufficient, 
it is a good plan to take half a drachm of ether in a wine-glassful of water three 
times a day, or a single dose of a drachm at bed-time. Another good remedy is 
bromide of potassium — two table-spoonfuls of the mixture (Pr. 31) three times a day, 
the last dose being taken on retiring to rest. Sometimes it upsets the stomach and 
cannot be taken, but this difficulty is not of frequent occurrence. The oxide of zinc 
pills (Pr. 66) have often a powerful effect in inducing sleep. It is best to take one twice 
a day, and two at bed-time. They should be taken shortly after a meal, and never 
on an empty stomach, or they may produce nausea. But a medicine which is quite 
as effectual in many cases is good bottled stout taken in one single dose of half a 
pint at bed-time. This is the only exception to the rule that no alcohol is to be 
taken. When the more prominent and distressing symptoms have been relieved, but 
the patient is still suffering from the effects of his indiscretion, hypophosphite of lime 
does good. The dose is from one to two table-spoonfuls of the mixture (Pr. 54) 
three times a day. Phosphorus pills, each containing one-tenth of a grain, usually 
succeed equally well ; or the capsules, or the phosphorus solution may be used (Prs. 
53 and 55). Cod liver oil taken systematically three times a day for a couple of 
months or longer will do much to restore the general condition of the health. 

We have no intention of entering into the question of drink as a national vice. 
It is a subject too vast for discussion in a work on domestic medicine. We hav«, 



92 THE TREATMENT OP DISEASES. 

however, no hesitation in saying that if we could provide better and healthier 
dwellings for the poor, there would be a great decline not only in the amount of 
drunkenness, but of other forms of crime with which it is associated with such 
frightful frequency. Dickens once said : — " Gin-drinking is a great vice in 
England, but wretchedness and dirt are a greater; and until you improve the 
homes ot the poor, or persuade a half-famished wretch not to seek relief in the 
temporary oblivion of his own misery with the pittance which, divided among his 
family, would furnish a morsel of bread for each, gin-shops will increase in number 
and splendour. If Temperance Societies would suggest an antidote against hunger, 
filth, and foul air, or could establish dispensaries for the gratuitous distribution of 
Lethe-water, gin-palaces would be numbered among the things that were." 



ANEMIA, OR POORNESS OF BLOOD. 

Anaemia, or poorness of blood, is of frequent occurrence not only as a distinct 
disease, but as a symptom of many other diseases. It arises generally in cases 
where there has been deprivation of the proper materials necessary for the formation 
of healthy blood, and in the course of severe chronic diseases. It occurs more 
commonly in women than in men, and more frequently in young people than in old. 
The majority of cases are seen in young women of from fifteen to twenty. 

The symptoms are usually well marked, and no difficulty is experienced in 
recognising the nature of the complaint. There is always more or less pallor of 
the face and lips, which is very characteristic. It is quite distinct from the bilious 
yellow colour you see in jaundice, and has rather a tendency to shade off into olive. 
In some cases of anaemia this paleness of the face may be obscured by accidental cir- 
cumstances. For instance, you would not observe it in people who had been browned 
by exposure to the sun, and probably not in cooks and others who spend much of 
their time over the fire. The nature of the case is, however, at once apparent if you 
examine the skin of the neck or some other part of the body protected from exposure. 
Another good way of detecting the presence of anaemia is to look at the nails, or to 
turn down the lip or lower eyelid, and see if they present their natural red colour, 
or are paler than usuaL In turning down the eyelid you must be careful not to 
make it tense, or you will drive the blood out of the part, and you may be deceived 
by the pallor so caused. In cases of anaemia there is generally a little puffiness not 
only about the face but about the legs and ankles. There is no fever, but the pulse 
is usually increased in frequency, and is small and weak. The circulation is languid 
and depressed, and even slight exertion will bring on palpitation of the heart. 
Headache is very common, and is usually felt over the region of the temples, and at 
the top of the head. As a rule it is not an intense or an agonising pain, but a dull 
heavy sensation, as if something were pressing down and out It is increased by 
abstinence from food, and by the erect posture, but is better on lying down. It 
usually comes on in the morning whilst dressing, goes off after breakfast, and comes 
on again before lunch or dinner, and so on. It is aggravated by exertion, and is of 
a throbbing character. It is sometimes accompanied by a feeling of fulness and 
weight, and by noises in the ears, and a sense of pulsation all over. The noise in 



ANAEMIA. 93 



the ears is on both sides, is rumbling and low-pitched, and is often described as being 
like cart-wheels in the distance. It is intensified by any mental effort, such as 
thinking, or reading, or writing. There may be occasionally a little giddiness for a 
minute or two, and things may seem as if they were going round and round. The 
muscles are weak, and a difficulty is experienced in making any prolonged or forcible 
exertion. From the defective state of the circulation the fingers are often blue, and 
the patient complains of " pins and needles." The patient is usually a little lethargic 
and disinclined for exertion, and the relations between sleeping and waking are apt 
to be upset. The appetite is probably poor, and it often happens that nothing but a 
cup of tea with perhaps a little bit of bread-and-butter is taken after the early 
dinner. At bed-time the patient is depressed for want of food, and probably passes 
a sleepless, restless night. The next day the requisite rest is taken in the arm-chair, 
or the patient has his " forty winks " on the sofa, and so the thing goes on. The 
secretions are more or less disturbed, the urine is thick and forms a deposit on 
cooling, and the bowels are sluggish, constipation sometimes alternating with 
diarrhoea. The poorness of the health may give rise to great despondency. Anaemic 
people often take on odd fancies and do odd things, and are very apt to get strange 
notions into their heads. They often have specks before the eyes, or, perhaps, little 
bright shining spots. Sometimes they see spectra, and sometimes their sight is 
peculiarly affected so that they see only halves of things. They are very apt to 
suffer from confusion of ideas, and feel stupid from noises in the street. Yery 
frequently in women there is some disturbance of the menstrual function, the 
periods being scanty or altogether absent. Anaemia is said to be a common cause of 
barrenness. 

The conditions which may give rise to anaemia are very numerous. In the first 
place it may have been caused by loss of blood, which may have arisen spontaneously 
or as the result of accident. It matters little from what part of the body the blood 
flows, the result is the same. For instance, a vessel may have been cut across by a 
stab, or the patient's nose may have been bleeding, or he or she may have been 
spitting up blood from the lungs, or vomiting it from the stomach. In the case of 
women the periods may have been excessive either in quantity or frequency, or there 
may have been excessive bleeding at a confinement. The continuous loss of blood 
from piles may give rise to anaemia. Then again, although there may be no loss of 
blood, there are other ways in which the strength may be exhausted. A woman 
may continue to suckle her child long after her health has shown signs of giving 
way, probably thinking that in this way she may succeed in warding off another 
pregnancy with its attendant trouble and expenses. Anaemia is very readily 
produced by the " whites," or any discharge of a similar nature. The result is the 
same when the natural secretions are in excess, as for instance in chronic diarrhoea, 
or in diabetes where very large quantities of water are passed. When there is no 
excessive discharge to account for the presence of anaemia, it may be found to depend 
on a defective supply of food. It is not, so to speak, the expenditure which is in 
excess, but the income which is deficient. It is to be feared that even in the middle 
classes of society the number of people who from some reason or the other are unable 
to obtain a proper supply of food is very great. Where the quantity is sufficient, 



94 THE TREATMENT OF DISEASES. 

the quality may be bad, or there may be a want of variety. Even where the food 
is obtainable in abundance the patient may have no appetite, and may be unable 
to eat it. We may even go a step farther, for the patient may eat his food and yet 
from the presence of some disease or disorder of the stomach may not digest it. 
Anaemia may result from a deficient supply of daylight-. The patient becomes 
blanched just as many vegetables do when grown in the dark. Many chronic diseases, 
such as cancer, are attended with anaemia. It commonly occurs in people suffering 
from ague. It is produced in the course of slow poisoning by many metals, as for 
example, lead, mercury, arsenic, and copper. As we shall presently see, iron is the 
great remedy for anaemia ; but iron, when taken into the system in large doses and 
for long periods, proves a powerful agent in the production of this complaint. Blood- 
poisoning, as the result of over-indulgence in alcohol, whether in the form of beer, 
wine, or spirit, may give rise to anaemia, and so may excessive smoking. Over- work 
is a very common cause, and it is said that taking excessive exercise may be attended 
with the same result. Running up and down stairs has been found in many cases to 
produce anaemia, probably because during the effort the chest is fixed and respiration 
is interfered with. Working at a great elevation, or at a great depth, as in mines, 
produces poorness of the blood, as does working in a constrained position, like a tailor 
or cobbler. Worry, anxiety, and mental and moral disturbances have all a similar 
effect, and so has long-continued pain, such as you suffer from in neuralgia. A well- 
known physician, speaking of anaemia says : — " The sufferers are the victims of our 
subterraneous kitchens, and back shops, and of that atrocious domestic system which 
deprives young women in service of open-air exercise and enjoyments peculiar to their 
age. Secondarily a depraved appetite arises, and tea with bread-and-butter comes 
to form their sole diet, as all healthy desire for meat soon vanishes. These devitalised 
plants which never see the sun languish in nervous power and furnish our worst 
cases of hysteria." 

When marked anaemia occurs in young women about the age of puberty, it is 
often spoken of as "chlorosis." Chlorosis is commonly associated with some disturbance 
of the menstrual function, but there is no essential difference between chlorosis and 
anaemia. The causes by which it is produced are those to which we have already 
referred. Chlorosis is sometimes called the "green-sickness," from the excessive 
pallor of the face. It is not uncommonly an accompaniment of hysteria. Young 
women suffering from this combination often display a perverted or even depraved 
appetite. They often fancy acids and highly-seasoned foods, and sometimes they 
swallow and apparently relish such substances as chalk, paper, ashes, coals, plaster 
of Paris, hair, and earth. There is generally some disturbance of the organs of 
digestion, and not uncommonly the breath is very offensive. Menstruation is 
absent or performed imperfectly, irregularly, and with pain, and the flow is thin 
and watery, or mixed with " whites." The periods are not only irregular in their 
return, but inconstant, of short duration, deficient in quantity, and pale in colour. 

Anaemia is often confounded with consumption, and many of the cases of cured 
consumption of which one hears so much are in reality nothing but cases of anaemia. 
We don't mean to say that consumption is not curable, but it is just as well to 
make sure that the sufferer is really consumptive before attempting to cure that 



ANEMIA. 95 



complaint. It is undoubtedly a great thing to be assured that you have been cured 
of consumption, but you would naturally feel far more thankful to learn that it was 
all a mistake, and that you never had consumption at all. There is no difficulty in 
distinguishing ansemia from consumption. In anaemia the patient does not look 
consumptive, at all events to the practised eye, and in spite of the paleness and 
delicate appearance, there is neither loss of flesh to any extent, nor fever. In all 
doubtful cases a physician should be consulted, for by a simple examination of the 
chest he may be able to assure you that everything is right, and that you are 
neither consumptive nor in danger of becoming consumptive. There are thousands 
of women amongst us, wives and mothers of children, who, because they were 
anaemic when they were about seventeen, were thought to be "weak about the 
chest," and were said to be " going into a decline." The fact is that ansemic people 
seldom become consumptive, and the two conditions are apparently antagonistic. 
A few years ago a physician carefully examined one hundred and twenty-five 
people who were suffering from marked amemia, and in not one of them was a trace 
of consumption to be detected. 

Is ansemia curable 1 Undoubtedly. And chlorosis 1 Quite so. And it's nothing 
to be alarmed about ? Not at all And people don't die from it 1 Not a bit ; they 
couldn't if they wanted to. And what is to be done to get rid of it? In the first 
place you should try and find out what it arises from. Perhaps you don't get out 
much. A good brisk walk in the Park every morning will do you all the good in 
the world, and if you can get a pleasant companion to accompany you, so much the 
better. Possibly your work keeps you in till it is dark, and then you don't care to 
go out. Never mind, you had better get out ; a walk in the dark will do you more 
good than no walk at all. Only take care that you don't over-exert yourself just at 
first. Your appetite is bad, and you don't care much for anything? Well, you 
must try and live a little mos»e generously. You are an over- worked student, and 
have been poring over your books too much lately, reading for that wretched 
examination. Just put yonr books aside for a bit, and run down to Brighton 
beach and have a salt bath, or take a trip up the Hudson on one of the boats. 
Don't hesitate to accept an invitation to dinner if any one will ask you. Well, if no 
one will " do the civil," you might invest a couple of shillings and go to the theatre, 
only go and see a good comic piece, not a tragedy. You had better go in the pit, 
and not in the stalls : you won't have the bother of dressing, and it will do you ever 
so much more good. Oh, you think you've been smoking too much lately ? 'Well, 
you look as if you had. You know, you'll have to knock it off. No, not altogether, 
but three or four pipes a day will be quite enough just at present. And you must 
give up that strong perique, you really must. Try lone-jack, or at all events 
something mild. Did we ever hear of any harm come of giving up smoking 1 
No, never, and we don't believe that your health would suffer in the least if you 
never smoked another pipe in your life. Is brandy and soda a good thing to take in 
the morning ? No, wretchedly bad ; it's poison to you. B. & S. has been the ruin 
of many a man. If you didn't drink so much overnight you wouldn't feel the want 
of it in the morning. Only took four glasses of whiskey cold last night 1 And far 
too many. Where do you expect you'll go to if you go on drinking in that way 1 



96 THE TREATMENT OP DISEASES, 

It ruins you in pocket and it ruins you in health. And you, sir, you neither smoke 
nor drink 1 What can we do for you ? Have piles, have you ? Had them for the 
last thirty years 1 Ever, since you were at college 1 And bleed very much every 
morning, after you have paid your usual visit? Well, no wonder you're anaemic. 
Just turn to what we said on piles, will you? Yes, hamamelis will probably be the 
remedy for you. We'll stop the bleeding, and then we'll see about curing the 
anaemia. Think the water is bad, do you 1 Have been told that it contains lead ! 
Very likely. You had better have it seen to, and don't drink any more of it till 
you are sure it's all right. Keep to beer or light claret for a time. 

Well, now you've removed the cause of your anaemia, what are you to do next 1 
You must take iron. Iron is the remedy par excellence for anaemia. You've taken 
it already, have you 1 Well, you'll have to take it again ; you probably didn't take 
enough of it. But you don't like iron ? It can't be helped, you'll have to take it 
whether you like it or not. But it's sure to upset you % No, it won't, not if you 
take it in the way we are going to tell you. You will have to try those sulphate of 
iron pills (Pr. 63) we recommended when speaking of the preparations of iron. They 
are the best remedy we know for anaemia, and they hardly ever upset the stomach. 
You don't like pills 1 Well, these are not at all nasty to take, and they haven't a 
bit of smell to them : well, very little at all events. And see how beautifully hard 
they are: you might almost give them to the children to play marbles with. If 
they are so hard, they must be insoluble, and can't do any good 1 Not at all ; just 
get a tumbler of water and drop one of them in, and you will see how quickly it 
dissolves. That reminds us that we once knew a patient, a young lady, who really 
couldn't take these pills ; they wouldn't go down, she said. And what did she do ? 
Why, she took a tumbler of water, just as you have been doing, and dissolved one 
of them up, and drank the solution. And would they act as well that way ? Every 
bit as well, only if you want to take sulphate of iron in water there's no occasion to 
make it up into a pill first. You don't like the taste of it ? Tastes like ink, does it 1 
Well, of course, all iron preparations do more or less, and ink is made with 
iron ; in fact, with sulphate of iron, the very salt you have here. Then ink might 
do good in anaemia ? Quite so ; in fact, years ago there was a physician who was in 
the habit of prescribing a mixture of iron which looked so much like ink that 
people called it after him " Heberden's ink," and he really cured a good many cases 
with it. And there are other preparations of iron? Just so; and by-and-by, 
in the Materia Medica, we shall have to enumerate a great many, and discuss their 
respective merits. If you don't like the pills you needn't go on with them, only 
don't give them up without a fair trial — say one twice or three times a day for 
at least a fortnight. Yes, the tincture of steel, or tincture of perchloride of iron, 
as we commonly call it, is a capital preparation. You may take it alone in a 
wine-glassful of water, say thirty drops three times a day ; or if you like it better, 
you may take it in the form of one of the mixtures (Prs. 1 and 2). But wouldn't 
some of the milder preparations, such as the tartrate of iron, or. the citrate of 
iron and quinine, do equally well 1 We think not ; we have always seen more 
benefit derived from one of the more astringent preparations, such as those we have 
recommended. Very often it is well to humour the stomach, and to change the 



ANEURISM. 9t 

form in which you take your iron. You might lead off with ike pills — we hare 
great faith in those pills — and then go on to Prs. 2, 3, 6, and 7. 

Mineral waters containing iron undoubtedly do good in anaemia, especially when 
you drink them at the source. Very likely the change of scene and the difference 
in living have something to do with the improvement, for the quantity of mineral in 
any of these waters is very small. You find " ferruginous " or " chalybeate " waters, 
as they are called by people who like long names, at Stafford, Conn., Rawley, Ya., 
Schooley's Mountains, N.J., and many other place*. The waters of Saratoga, 
in New York State, also contain sulphate of iron. 

And is it a fact that some people really can't take iron '? Well, w§ suppose it is — 
in fact, there can be no doubt about it. What does it do to them 1 It upsets their 
stomachs, and produces pain and fulness in the head. Do we know of anything that 
will do them any good ] Yes, but nothing which at all equals iron. They should try 
the quinine or quinine and iron mixtures (Prs. 9 and 11). They often prove of great 
benefit to the pale badly-fed inhabitants of large populous towns. Then there is the 
hypophosphite of lime, of which we have spoken favourably. It usually does more good 
in young than in old people * Phosphate of lime is useful in the anaemia of boys and 
girls who have outgrown their strength. It is also of service in the case of women 
weakened by rapid child-bearing, prolonged suckling, or excessive menstruation. 
Sometimes small doses of arsenic (Pr. 40) will do good, especially when the anaemia 
has arisen from an excessive discharge of some kind, and when it is accompanied by 
shortness of the breath and excessive languor. Pulsatilla is indicated when the 
periods are scanty or absent, when there is loss of appetite or taste, and when there 
is a tendency to relaxed bowels. These remedies may, and probably will, do good, 
but none of them are equal to iron, or will act with equal quickness and certainty. 

And is this all that there is to be done? Yery nearly. There are certain 
accessory measures, such as the morning tub, sea bathing, a good gallop around the 
park, and so on, but these would so obviously prove beneficial that we need not 
refer to them at greater length. What about the headache and noises in the ears ' 
These will take their departure as soon as you get rid of the anaemia. As we have 
already said, the headache you suffer from before breakfast is due to faintness. Take 
a cup of tea and a piece of toast, or a glass of rum and milk before getting out of 
bed, and that will generally ward off the headache. When you get tired of plain rum 
and milk try this : — Dissolve in a little hot water over the fire a pinch of the best 
isinglass, lot it cool, and mix a dessert-spoonful of rum with it in a tumbler, and fill 
up the glass -F>th new milk. This gives a pleasant variety. 



ANEURISM. 

An aneurism is a tumour containing blood, either formed by the dilatation of an 
artery, or communicating with an artery. It may occur on any artery in the body 
but is more commonly found in the chest in connection with the aorta, the large 
vessel which carries the blood from the heart. An aortic aneurism may vary much 
in size, and it may at first be quite small and subsequently increase till it is half as 
big as the fist At first it is contained quite in the chest, so that nothing can ba 



98 THE TREATMENT OP DISEASES. 

. 1 — __________ _____ c 

seen of it externally, but by-and-by it may press out the ribs or breast-bone, and cause 
a swelling on the front of the chest as big as an egg or a small orange. At first, too, 
the symptoms to which it gives rise may be very obscure, and its presence can be 
detected only by a careful examination by a skilful physician. Afterwards, when it 
comes nearer the surface of the body, comparatively little difficulty will be experienced 
in recognising its nature. The great thing is not to mistake it for an abscess. An 
aneurism nas before now been opened on the supposition that it was an abscess, the 
patient quickly bleeding to death. 

Our account of aneurism must of necessity be short, not because it is an unim- 
portant disease, but because it is essentially unsuited for domestic treatment. Any 
one who thinks that he has an aneurism should consult a doctor in order that, if it 
exist, appropriate treatment may be commenced, or that if non-existent the harassing 
suspicion may be removed. Aneurism occurs most frequently between the ages of 
thirty and forty. It is met with almost exclusively in men, and especially in 
individuals whose muscular system is called upon to make sudden, violent, and 
intermittent exertions, as for instance in those who habitually lead sedentary lives, 
but occasionally take a change and indulge in sport, such as hunting, rowing, or a 
long day's shooting. It is comparatively rare in those whose work, although 
laborious, is steady and continuous. If you are not over thirty, if your work is 
moderately uniform in character, or if you are a woman, it is extremely unlikely that 
you have aneurism, whatever your symptoms may be. It must be remembered that 
aneurism in any form is not a common complaint, although it occurs more frequently 
in Great Britain and Ireland than in any other country. 

The symptoms to which aneurism in the chest may give rise are very variable, 
and the majority are common to many complaints. Sometimes they are closely 
simulated by simple indigestion, and it would be difficult for any one not a medical 
man to distinguish between them. Usually when the tumour is large or is increasing 
rapidly in size, there is some disturbance of the heart's action, and one or both arms 
become distinctly dropsical. Sometimes the tumour presses on the wind-pipe, 
causing shortness of breath, or on the gullet, giving rise to difficulty in swallowing ; 
sometimes in addition to shortness of breath, there is considerable wheezing, and a 
particularly troublesome cough. Aneurism usually causes pain either in the back 
or beneath the breast-bone ; moreover, it generally affects the pulse, rendering it 
altogether imperceptible or much weaker on one side than on the other. Sometimes 
it gives rise to spitting of blood, which may be very profuse. It should be under- 
stood that the existence of two or three of these symptoms would be no indication 
of the existence of aneurism, and that unless several are distinctly present, they are 
probably due to some other complaint. 

Even in such a serious disease as aneurism much may be done in the way of 
treatment. The agents on which more especially we rely are rest and limited diet. 
By rest we mean not merely abstinence from hard work, but absolute rest in 
bed in the recumbent posture. In some cases, this has been uninterruptedly 
maintained for many months, and with the happiest results. Confinement to bed 
is undoubtedly at first a great hardship to a person who has been accustomed to 
an active life, but it is wonderful what habit will do, and we have known people, 



ANGINA PECTORIS, 99 



happy, contented, and cheerful under the circumstances. The pa&ent may be allowed 
to sit up in bed cautiously to take his food, but at other times he will have to remain 
in the recumbent position. He is in no way debarred from the society of his friends, 
and may read and be read to, and although he cannot write his letters himself he 
may dictate them. Bed-sores must of course be carefully avoided, but ihey are 
easily guarded against by a little attention and the daily examination of the back. 
The diet is restricted to three meals a day taken at regular intervals. Usually it 
consists of two ounces of white bread-and-butter, with two ounces of cocoa or reflTr, 
for breakfast ; three ounces of broiled or boiled meat, three ounces of potatoes or 
bread, and four ounces of water or light claret for dinner ; and two ounces of bread- 
and-butter, and two ounces of milk or tea for supper ; in all ten ounces of solid and 
eight ounces of fluid food in the twenty-four hours. We do not mean to say that 
these weights and quantities are to be strictly observed, or that every article of food 
must be weighed, but they serve to indicate about the amount of food that should 
be taken. The object of this restriction in diet is to lessen the volume of blood, and 
reduce the activity of the circulation so that a deposit from the blood may take place 
in the interior of the tumour and so reduce its size. 

This dietetic treatment is often combined with the internal administration of 
iodide of potassium. Five grains may be given three times a day, and gradually the 
dose may be increased to ten, fifteen, or twenty grains. We have at the present 
time under observation a man with aneurism of the aorta, who has remained in 
bed for the last eighteen months, and has taken iodide of potassium the whole of 
that time, with very great benefit. When palpitation is a prominent symptom the 
addition of five minims of tincture of aconite to each dose may do good. When 
the pain is great it may have to be allayed by laudanum, or by hypodermic injec- 
tions of morphia. When the tumour protrudes on the surface of the body, it 
should be covered with belladonna plaster spread on leather to protect it from 
accidental injury. 

Should the method of treatment we have indicated fail to effect a cure or 
alleviate the symptoms, it may be necessary to resort to surgical measures. An 
electric current passed through the tumour by means we need not describe in detail 
is often attended with the happiest results. The application of a bag of ice to the 
tumour for an hour once or twice a day often does good. We remember one case in 
which it afforded the patient very great relief. 

Occasionally an aneurism bursts, and then, as a rule, nothing can be done. 



ANGINA PECTORIS. 

Angina pectoris, or the " suffocative breast-pang," as it is sometimes called, was 
first described by the celebrated Dr. Heberden, in the year 1768. The symptoms 
consist of paroxysms of intense pain about the chest, accompanied by a sensation of 
impending death. The paroxysm quickly reaches its climax, and is relieved, or 
disappears entirely, in a few minutes, or at the most within an hour. The attacks 
recur at uncertain intervals, sometimes without any obvious cause, at others as the 
result of exertion. The pain is peculiarly liable to be excited by walking up-hill, 



LofC. 



100 THE TREATMENT OP DISEASES. 

or iii tike face of a strong wind, and then usually eeases immediately on standing 
still. It is instinctively associated in the mind of the sufferer with the idea of a 
particularly severe form of oppression or suffocation, or rather with some indefinite 
sense of impending danger, which is simply indescribable. The patient is not 
merely suffering, but he feels that the very springs of life are implicated, and that 
under a prolongation or increase of the pain the whole fabric of life must give way. 
It is from this sense of impending dissolution, and from the fact that death may 
occur at any moment, that the disease derives its fearful distinctiveness. 

The pain of angina pectoris is quite distinct from the fear of impending death to 
which we have alluded, although they are nearly always associated. Its character 
will be gathered from a short description of a case which recently came under our 
care. The patient was thirty-seven years of age, and was a carman by occupation. 
He was, to the best of his belief, in perfect health until he met with an accident, 
and was thrown from his van, falling on the left arm. He was not seriously hurt, 
but was unable to use the limb for nine weeks. At the expiration of that time he 
resumed his work, and then first experienced the symptoms we are about to describe. 
He suffered from a severe pain in the chest, which came on in fits, and seized him 
on the slightest exertion. He could only describe it as " a heavy, dull pain, like a 
great weight /' and it was often so severe as to make him cry out with anguish. It 
was always first felt about the middle of the breast-bone, extending on either side as 
far as the nipple. In a second it would seize his shoulders, which he said seemed 
as if they were being squeezed with a grasp of iron. It then ran down to the 
elbows, where it usually ceased ; but sometimes extended to the hands and even to 
the tips of the fingers. The pain was equal in severity in the two limbs, and was 
never confined to one side. It was more severe in the shoulders and elbows than 
in any other part of the arms. It always began in the chest, and its direction was 
never reversed. It never passed through the chest to the back, and never extended 
to the head and neck or to the legs. During a paroxysm of pain, the arms felt dead 
and heavy, and the patient had a difficulty in raising them, the hands at the same 
time becoming white and shrunken. Such is the usual character of the pain in 
angina pectoris. 

The sensation of impending death to which we have referred is, from its very 
nature, almost indescribable. Sometimes for the want of a better term it is 
likened to suffocation; but it is something quite distinct from that. It is this 
even more than the pain which renders an attack so terribly awful. 

These two symptoms coming on in paroxysms, may be said together to constitute 
angina pectoris. There are other symptoms, but they are of l^ss constant occur- 
rence. Usually the face is deadly pale during an attack, but sometimes we have 
seen it quite red, so that the sufferer looked just as if he ha* 1 been inhaling nitrite 
of amyL In the case of the man of whom we have been speaking, the face was 
always flashed at the commencement of an attack, but became deadly pale as the 
pain increased in severity. The pulse is usually slow and feeble, the breathing 
short and hurried, and very often the surface of the body is covered with a cold 
clammy sweat, the intellect remains unimpaired, and c ven to the last the patient is 
Veenly alive to his frightfully critical condition. I» the intervals of the seizures he 



ANGINA PECTORIS. 101 



apparently ails nothing, lie looks well, eats well, and were it not for the deadly foe 
that may attack him at any moment, would be in perfect health* 

Let us now consider the circumstances which are likely to induce a paroxysm. 
In the man to whom we have referred exertion of any kind would always excite an 
attack. The act of stooping, as in putting on the stockings, or lacing tip the boots, 
or even washing the face, would be almost sure to induce the pain, A sharp turn 
up and down the room would bring it on ; but, contrary to rule, walking up-Mll or 
going up-stairs was not more likely to excite it than exertion, on level ground. 
Coughing always brought on the pain, and once, when the patient happened to catch a 
little cold on his chest, he displayed the greatest anxiety to get rid of it on this 
account. He remembered only one occasion on which an attack had seized him at 
night. Excitement of any kind would induce a paroxysm, so that, as the poor 
fellow said, he was obliged to be good-tempered, he durst not get in a passion, It 
may be mentioned in connection with this fact that the great comparative anatomist 
and physiologist, John Hunter, who suffered from this complaint, was deeply 
sensible of the risk to which he was exposed by an uncontrollable temper, and was 
accustomed to say that his life was in the hands of any rascal who chose to tease and 
annoy him. 

In our patient the attacks always came on without warning. They gradually 
increased in intensity, reached their acme, and then gradually passed off When 
the pain seized him he was afraid to move ; if in the streets he stood quite still, 
supporting himself by the railings, or anything that might be at hand; If sitting 
or lying down, he would make an effort to stand up, as the pain was less severe 
when in the upright position. He was always able to speak, even during the most 
violent paroxysms, but he preferred not to, as it often increased the pain. The 
average duration of an attack was with him about a quarter of an hour, but it 
varied from six or seven to twenty minutes. He stated that he had often stood in 
the street for over twenty minutes, afraid to move a step. During these attacks he 
suffered from a little shortness of breath, but not enough to cause him any incon- 
venience. He added that the termination of a paroxysm was always preceded by 
an attack of palpitation. As soon as the palpitation commenced, the pain decreased 
in severity, and in a few minutes passed off. During the paroxysms the patient 
had often been given hot spirits and water by anxious friends and bystanders, but 
it never cut short the attack. 

So little is positively known about the real cause or nature of angina pectoris, 
that it is not worth while discussing this subject. We may mention, how- 
ever, that in many cases where death has occurred suddenly during an attack, the 
heart has been found perfectly healthy. Angina pectoris predominates vastly in 
men, the disease in women being a rarity. It is rare before the fiftieth year, 
excessively so before the fortieth, and unknown in infancy and childhood. It is 
very much more common in the upper classes of society than in the middle or lower. 
It is said by some writers never to occur among the poor, but this is certainly not 
true, for we have met with at least half-a-dozen well-marked instances in the wards 
or out-patient rooms of a metropolitan hospital. 

It is doubtful what part, if any, gout plays in 



102 THE TREATMENT OF DISEASES. 

angina. The disease of necessicy often occurs in gouty people, because gouty, like 
anginal sufferers, are usually elderly men of the well-to-do classes. It has been 
supposed that in some cases the excessive use of tobacco has promoted the develop- 
ment of the disease, but this, to say the least of it, is problematic. 

There is, unfortunately, no difficulty in recognising the occurrence of angina 
pectoris ; its symptoms are only too well marked to admit of any doubt as to their 
nature. The intensity and situation of the pain, and the attendant dread of im- 
pending death, at once declare the character of the disease. Asthma is almost the 
only other complaint which comes on in such sudden paroxysms, and for this it 
could hardly be mistaken. Sometimes over-eating, indigestion, and flatulent dis- 
tension of the stomach may simulate angina, but there is never that frightful fear of 
sudden death which is so essentially a symptom of the real disease. Moreover, 
these symptoms often occur in people under forty years of age, in whom, as we have 
seen, true angina is rare. 

Respecting the duration of the disease the greatest diversity occurs. Life may 
be prolonged for years after the first seizure, in spite of more or less frequent recur 
rence. In the generality of instances, the complaint undoubtedly runs a somewhat 
protracted course. At the same time, it is only right that we should say, and say 
most distinctly, that the life of a man who has had an unmistakable attack of angina 
pectoris is not insurably safe for a single hour ; he may live for twenty years, or 
he may die to-morrow. He should recognise the possibility of a sudden cessation of 
his troubles, and should put his worldly affairs in order. People often procrastinate 
in the matter of making their wills, but a man with angina pectoris must never 
put it off even for a day. The cardinal fact of the disease is its uncertainty. Death 
may occur with startling suddenness. Such was the end of John Hunter. The 
mode of its occurrence is well known, and there is reason to think that it was 
almost foreseen by him. A dispute of a painful nature had embittered his relations 
with the governors of St. George's Hospital. On the 10th of October, 1793, he 
determined to be present at a meeting, at which, however, he apprehended a personal 
dispute. He expressed to a friend his fear that such an encounter might be fatal to 
him ; but went nevertheless. Something that he said in the board-room was noticed 
and flatly contradicted. He stopped, left the room in silent rage, and had just time 
to reach an adjacent apartment, when he gave a deep groan and fell down dead. 

Have we any remedy for this fearful affection ? Yes ; during the last ten years 
a remedy has been discovered which is almost a specific, and that remedy is nitrite 
of amyl. It is a pale straw-coloured liquid, having an odour which is likened to that 
of pine-apple, or more commonly to pear-drops. It is used as an inhalation. A few 
drops are poured on a piece of lint or pocket-handkerchief, or even into the palm of 
the hand, placed under the nose, and the vapour inhaled. It causes flushing of the 
face, and almost immediately the pain ceases. It really acts like a charm. At first, 
a little caution will have to be employed in regulating the quantity, but the sufferer 
soon becomes accustomed to its use, and may be safely trusted with the bottle. We 
know three or four sufferers from angina who always cany a small bottle in the 
waistcoat pocket. The carman to whom we have so frequently referred has now 
done so for nearly three years. Although he still suffers from his attacks he has 



ANGINA PECTORIS. 103 



been able to resume his occupation. When he is on the box driving, and he 
experiences the onset of the pain, he pulls out the bottle and takes one long snh% 
and is all right again. On one occasion when in the country he broke his bottle. 
He fortunately managed to save a few drops, and with this to help him on his way, 
he at once started off to the city to obtain a fresh supply. Nothing would induce 
him to be without it ; it is more than gold to him — it is life itself. When he has the 
amyl in his possession he feels perfectly safe. So confident is he of its power to cut 
short an attack that he has no hesitation in stooping down and inducing the pain, if 
requested to do so. The nitrite of amyl has for him robbed the disease of half its 
terrors. This case is not an isolated one. We have had many opportunities of 
closely observing the effects of the remedy, and entertain not the slightest doubt of 
its efficacy. It succeeds quite as well in cases in which the face is flushed during a 
paroxysm, as in those in which it becomes deadly pale. This is strikingly illustrated 
by the case of a medical man residing at Torquay. His first attack occurred in 1872, 
suddenly and without the slightest warning. In about three days the frequent 
recurrence and increased severity of the attacks compelled him to desist from all 
professional duty. Notwithstanding the rest so obtained, th© attacks, after a few 
days' interval, continued to increase in severity, lasting, for the most part, for a 
quarter of an hour or twenty minutes, and recurring frequently at intervals of about 
three hours. Various remedies were tried with little or no benefit. Finally, he was 
induced to use nitrite of amyl, which he had previously supposed to be suitable only 
for those cases in which the face was pallid during an attack. " As mine was 
flushed," he says, in contributing an account of his case to a medical journal, " I 
dismissed from my mind all thought of trying it, and paid the penalty of hasty con- 
clusions in the shape of a large amount of acute suffering." The result of the first 
trial of five drops inhaled during a severe attack in the night, was " truly wonderful. 
The spasm was, as it were, strangled at its birth. It certainly did not last two 
minutes, instead of the old weary twenty. And so it continued. The frequency of 
the paroxysms was not diminished for some time, but then they were bagatelles as 
compared with their predecessors. Under these improved circumstances strength 
gradually returned ; the attacks became gradually less and less frequent, and finally 
ceased." After an interval the doctor was enabled to resume his ordinary duties, 
of course with care. We commend the attentive study of this case to every 
sufferer from angina pectoris. After this striking testimony we need say nothing 
more in favour of a trial of this truly marvellous remedy. 

Nitrite of amyl is now a pharmacopceal drug, and no difficulty will be ex- 
perienced in obtaining it. Many chemists keep little glass capsules, each containing 
enough for a single inhalation. Half-a-dozen may be carried in the waistcoat 
pocket, and on the onset of an attack one may be placed in a handkerchief and 
broken. They have the advantage of being portable, and with them it is impossible 
to use more than the prescribed quantity, but usually the patient prefers having 
the bottle. But should an attack come on suddenly when there is no nitrite of 
amyl at hand, what are we to do % The best thing is to give a tea-spoonful of sal 
volatile, or half a tea-spoonful of chloric ether, in a wine-glassful of water, or the two 
combined with, perhaps, the addition of a little bicarbonate of potash or soda. Id 



104 THE TREATMENT OP DISEASES. 

■ ■■«■ 

a case like this, one naturally feels inclined to give a glass of hot gin or brandy and 
water, bnt it seldom does much good ; the pain seems to be too great to be raider its 
control. The hands and feet should be briskly rubbed if they are cold or pallid. 
You should send for a small bottle of nitrite of amyl as soon as possible, so as to be 
prepared for any future attack, but a medical man should be called in at once. 

What should be done in the intervals of the attacks ? The general health should 
be improved by every means in our power, and the greatest care be taken to 
avoid worry and excitement of all kinds. Tranquillity both of body and mind, and 
the suspension of all occupations, and even amusements, tending to excite the heart 
or hurry the breathing, is essential. Moderate daily exercise on level ground, and 
only to such an extent as is requisite for preserving the bodily health, and for 
ensuring good digestion ; the avoidance of all kinds of food tending to flatulence ; 
and the regular but strictly moderate evacuation of the bowels, either spontaneously 
or by the mildest laxatives, are measures to which too much importance cannot be 
attached. If stimulants are used at all they should be employed in the very strictest 
moderation, none but the lighter wines being taken. Whether smoking should be 
altogether abandoned or not we cannot say, for really every man is the best judge of 
his own sensations, but it is obvious that excess in this, as in everything else, must be 
strictly avoided. It must be always borne in mind that what might be a moderate 
allowance for a healthy man, would be a debauch for a person in the critical condition 
of an anginal subject. We have simply laid down the broad rules for the guidance 
of the sufferer, and can do no more. They may have to be modified in individual 
cases. A person who has long suffered from a complaint of this description soon 
finds out what agrees with him best, and knows better than any doctor can tell him. 
People are not all alike in illness, any more than in health, and an article of diet 
which may agree admirably with one person might half kill another. We have, 
as we have said, laid down the broad rules ; the details must rest with the patient 
himself. 

When gout or dyspepsia occurs concurrently with the paroxysms, or in the 
intervals of the attacks, it should be treated by the appropriate remedies 
(Gout ; Dyspepsia), and the removal of the complication may be followed by the 
alleviation or cure of the attacks themselves. It is generally considered that gouty 
angina is more amenable to treatment than any other form. A visit to Carlsbad, 
or Vichy, or Bath, may be attended with benefit should the patient's means 
allow him to travel under favourable conditions as regards freedom from hurry and 
excitement. Should the angina be associated with neuralgia, the different remedies 
recommended for that complaint may do good (Neuralgia) ; in fact, by some 
eminent authorities it is supposed that angina pectoris is essentially a neuralgia itself. 
In these cases the administration of arsenic is often attended with marked benefit. 
When anaemia is a prominent symptom, it should be removed by the judicious use 
of iron. Phosphorus has been recommended in angina pectoris, but has not 
as yet come into general use. In one case under our care it was cautiously *»d 
carefully tried, but the patient derived little or no benefit from it 



APHASIA. 105 



APHASIA. 

By aphasia is meant loss or impairment of the faculty of language. It is quite 
a different thing from an affection of the voice. It is a brain disease, and there is 
nothing wrong with the throat, or larynx. Sometimes there is a loss only of the 
faculty of articulate language, but more frequently there is likewise an inability to 
express the thoughts by writing or by gestures. There is loss, not only of the 
memoiy of words, but also of those acts by which these words are articulated. 

This curious condition is a form of paralysis, and is not unfrequently the result 
of a " stroke." It is very generally associated with some other form of paralysis, 
and more especially with loss of power in the right arm and leg. The faculty of 
language is supposed to be situated exclusively in the left half of the brain, and it is 
well known that injury or disease of one side of the brain results in paralysis of the 
opposite side of the body. This readily accounts for the frequent association of 
aphasia with paralysis of the right side, for they would both be caused by some 
affection of the left half of the brain. 

A patient who is suffering from aphasia, or who, as we say, is aphasic, may 
present several different manifestations of his complaint. He may be altogether 
wordless, or may utter inarticulate sounds, or mere unmeaning gabble. He may 
use to express all his wishes only one or two familiar words, such as " yes " or " no," 
or perhaps both of them. For example a young lady who became aphasic could for 
a long time say nothing but " oh, no," " papa," and " Bob." The case, too, is related 
of a young man, twenty-five years of age, who was attacked with aphasia and 
paralysis of the right side. In time some power of moving the right leg, and then 
the right arm returned, but he could articulate only two words, " no " and 
w mamma." " What is your name 1 " — " Mamma ; " " What is your age 1 " — 
" Mamma, no." He was unable to say anything else, but yet was perfectly aware 
that his reply was incorrect. Sometimes all the aphasic patient can do is to utter 
some word or sound that has no intelligible meaning. Sometimes he has an almost 
unlimited flow of words, and yet may be unable to use them to express his desires 
or wishes. The mother-in-law of a medical man had an attack of aphasia. When- 
ever a visitor entered her room she rose from her chair with an amiable look, and, 
pointing to a seat, exclaimed, " Pig animal, stupid fool." She did not in the least 
understand the meaning of these insulting expressions, and her son-in-law had to 
explain her wishes. 

The patient often substitutes one word for another in a manner which would be 
intensely amusing were it not for the knowledge that it is the result of brain disease. 
Sometimes he uses instead of the right word some other that somewhat resembles it 
in sound ; thus, for example, he may say " pamphlet " for " camphor," " dispersion " 
for " dispensary," and so on. Sometimes he substitutes some word which has an 
obvious connection or association with that he wishes to express, as " breakfast " for 
" supper," or " toast " for " hot." He may invert the whole of a word, and say " mug " 
for " gum," for example ; or may roughly invert certain syllables, like the man who 
always said "gippin" for "pigeon." It has been remarked that, curiously enough, 
it is only rndividu^, words that are misplaced, or mispronounced, and that the 



10$ THE TREATMENT OP DISEASES. 

grammatical framework of the sentence seldom suffers. It has been noticed, too, 
that substantives only are substituted for substantives, verbs for verbs, numerals 
for numerals, and proper names for proper names. The words with which the 
greatest difficulty is experienced are usually nouns. 

Sometimes a patient when aphasic may repeat everything that is said to him, 
and never say a word besides. A curious circumstance is that under strong emotion 
or excitement a patient may be able to swear, although at other tim@s he cannot 
utter a word. Swearing is with many people almost an involuntary act, and it is 
remarkable that disease should draw a line between the emotions and the intellect, 
between signs of feelings and signs of ideas. Another fact worth mentioning is 
that aphasic persons who cannot talk can often sing quite correctly. 

Certain aphasic patients can write, while others fail to do so; those who are 
capable of the act occasionally write sense, frequently nonsense, but more frequently 
either unintelligible characters, or distinct but unconnected words. Sometimes the 
patient may be able to copy manuscript, or even to convert printed sentences into 
ordinary writing, when he could not write the same words if dictated to him. 
Curiously enough an aphasic who is unable otherwise to write will often readily 
sign his own name. Some aphasics can point out letters that are named to them, 
whilst others fail to do so. If they be given a children's bone or wooden alphabet, 
they make curious attempts to spell a word, and often enough can achieve no 
more than a dim yet perceptible resemblance to it. Thus a man named James 
Simmonds put together the letters JICMNOS in a vain attempt to represent his 
own name. 

As a rule, in aphasia there is some impairment of intelligence, but usually it 
is not very great. The aphasic recognises his friends, remembers where he lives, 
and can often play correctly at cards, backgammon, dominoes, or any game of 
skill or chance with which he may be acquainted. He is not only able to play 
Ms own game, but is quite capable of cheating, should he be desirous of so 4oing. 
The case is recorded of a Kussian gentleman resident in Paris, who spoke French 
like a native, yet after an attack of aphasia he was unable to utter a word of that 
language. When questioned, he smiled and said " Da," a Kussian word meaning 
"Yes." He was unable to construct even part of a sentence in his own language. 
When shown a spoon he could make signs showing its use, yet had forgotten its 
name both in Kussian and French. Nevertheless, he could play at whist correctly, 
and noticed any errors of his adversary by making a gesture. 

With regard to the general symptoms of aphasia, we should state that usually 
the deprivation of speech occurs suddenly. Perhaps in a short time two or three 
words can be uttered, which, as we have seen, are then used in reply to all questions. 
The face is intelligent, and the movements of the lips and tongue and palate 
are in no way interfered with. In cases in which aphasia is not accompanied by 
paralysis of the limbs, recovery often occurs quite suddenly. It is believed by 
many that transitory attacks of aphasia are by no means uncommon. 

There is very little difficulty in recognising the existence of aphasia. Hysterical 
women sometimes pretend that they are unable to speak, but here the most super- 
ficial examination will detect the real nature of the complaint. Impostors some- 



APOPLEXY. 107 

times pretend that they have suddenly lost their voice. We should suspect a 
person if* he could not speak, and yet could swallow and write well. The impostor 
nearly always pretends to be absolutely dumb, and seldom knows enough about 
his pretended complaint to see the necessity of uttering some word' or word-like 
syllable, as the true aphasic nearly always does. This reminds us of the case of 
a soldier who, with the view of obtaining his discharge, pretended that he had 
been suddenly struck dumb. He was taken to the doctor, who at once suspected 
the real nature of the case. The man was told to try and say "Ah," it being 
explained to him that he would have no difficulty, as it was " a purely laryngeal 
sound, unconnected with the faculty of language." The effort was successful. He 
was then told to say " No," which, it was explained, was " a sound of similar 
character." Not seeing the trap, he promptly replied as directed, "No." "Well, 
my friend," said the doctor, " if you can say ' No ' you can say anything ; so good 
day." . 

Respecting the duration of an attack of aphasia we can say nothing definitely 
— it may last only a few hours, or many months. An attack, as a rule, indicates 
no immediate danger, but at the same time a medical man should be called in 
without delay. 

APOPLEXY. 

When a person falls down suddenly, and lies without sense or motion, except 
that his pulse keeps beating and his breathing continues, he is said to have been 
attacked with apoplexy, or to have had a " stroke." He appears to be in a deep 
sleep, but it would be impossible to awaken him by the same means which would 
rouse a healthy man. He is not in a simple faint, for his pulse beats perhaps 
with unnatural force, and often his face, instead of being pale, is flushed, and his 
breathing continues, although it may be laboured and noisy. The cause of this con- 
dition is usually the rupture of a blood-vessel in the brain, and the consequent 
pouring out of blood which ensues. Anything tending to produce congestion 
of the head favours the occurrence of apoplexy. It often follows a fit of passion 
or excitement, or some unusual act of exertion. 

We all recognise the fact that certain people are likely subjects to become 
apoplectic. A seizure is most likely to occur in those whose parents suffered in 
the same way ; in men and women of sedentary habits, accustomed to high living, 
with protuberant bellies, large heads, florid features, and short thick necks; in 
individuals above fifty, and those who are addicted to habits of intemperance. 
Bright's disease of the kidney also favours the occurrence of an attack. It is 
probable that in almost all cases in which a man has had a stroke, the blood- 
vessels of the brain have been weakened or rendered brittle by degeneration. 

This dreadful visitation is seldom experienced without some warning, which, 
properly interpreted, should put the patient on his guard. These are usually 
fugitive attacks of congestion of the head, indicated by mental confusion and 
dulness, a feeling of heat about the head, with coldness of the hands and feet, 
and a diminished secretion of urine, with constipation. Among suspicious 
gigns may be enumerated — headache and giddiness, experienced principally on 



THE TREATMENT OP DISEASES. 



stooping; a feeling of weight or fulness in the head, with roaring noises in the 
ears and temporary deafness; dimness of sight or double vision; bleeding from 
the nose, with fits of nausea and sluggishness of the bowels ; a loss of elasticity 
in walking, with numbness or a sense of pins and needles in the feet, or a feeling 
as if there were some foreign body in the boot; loss of memory, great mental 
depression, and peevishness or irritability of temper, or the use of wrong words 
in talking; and drowsiness with heavy sleep, and a tendency to dreaming or 
nightmare. Any one of these symptoms occurring singly would probably be of 
little significance; but a combination of them in a person who is a likely subject 
for apoplexy should be regarded as a warning. 

An apoplectic seizure may commence in several different ways. Sometimes 
the patient falls down suddenly, deprived of sense and motion, and lies like a 
person in a deep sleep — his face flushed, his breathing laboured, and his pulse full 
and usually less frequent than natural. There may be convulsions or contraction 
of the muscles of the limbs, often confined to one side. Sometimes insensibility 
is not the earliest symptom ; the attack begins with a sudden sharp pain in the 
head, the patient becomes pale and faint, and usually vomits. He may, perhaps, 
fall down in a state of insensibility, with a bloodless and cold skin and a feeble 
pulse. This may be accompanied by convulsions. Yery often he does not fall 
down, the sudden attack of pain being accompanied only by slight and transient 
confusion. In either case he commonly recovers in a short time from these 
symptoms, and is quite sensible and able to walk, but the headache continues. 
After a certain interval — varying from a few minutes to several hours — he becomes 
heavy, forgetful, and incoherent, and sinks into a state of insensibility, from which 
he never emerges. Sometimes the seizure begins by an abrupt attack of paralysis 
cf one side of the body, often with loss of speech, but no diminution of conscious- 
ness* The paralysis may pass gradually into apoplexy, or may remain without 
further urgent symptoms, or in certain favourable cases may slowly pass off, and 
the patient recovers. Such are the different modes in which apoplexy makes its 
appearance. It may be painful to have to consider the details so minutely, but 
it must be done, or there is danger of overlooking the real nature of the attack. 

"When the apoplectic state is fully formed — in whatever manner the attack 
may have commenced — the patient lies totally unconscious of all that may be going 
on about him. He replies to no questions, he is unmoved by the cries and lamen- 
tations of his family, and, in fact, does not hear them. The pulse is at first slow 
and almost imperceptible, but becomes quicker and stronger as the system recovers 
from the prostrating shock, although it usually remains less frequent than natural, 
and is sometimes irregular. The breathing is peculiar, being slow and interrupted 
or irregular, and attended with a snoring noise, and a puffing out of the cheeks 
I'ke a person smoking a pipe. There is frothy saliva about the mouth, and the 
Ijdy is covered with a cold clammy sweat. The face is pale, the eyes are dull 
md glassy, the pupils are commonly neither much contracted nor much dilated, but 
very often they are unequal in size. The teeth are clenched, all power of swallow- 
ing is lost, and if you put fluids in the mouth they run out again at the corners 
jf the lips. The limbs lie motionless, and if you raise ono of them it falls passively 



APOPLEXY. 109 

down again when you leave it, like a dead limb. Sometimes they are stiff and 
rigid, or they may be convulsed. The bowels are usually torpid ; or, if they act, 
the motions are passed in bed, without the patient's knowledge or concern. The 
urine flows involuntarily, or is retained in the distended bladder until it overflows 
and dribbles away perpetually. 

It is often a very difficult matter to say whether a person is suffering from 
apoplexy, or is stupefied by a large dose of opium, or is merely dead drunk. It is 
very important to make the distinction, as much depends on the treatment, but it is 
far from easy. In many cases a personal knowledge of the general habits of the 
sufferer will at once solve the question, but with a stranger it is sometimes almost 
impossible to decide. The insensibility is profound in each case, although arising 
from so different a cause. If any one-sided symptoms are noticed — if, for instance, 
one pupil is larger than the other, or if there are twitchings of the arms or legs on 
one side only — it is to be feared that it is apoplexy. If the patient can be roused 
even for a moment or two, so as to give intelligent replies to questions, he is pro- 
bably suffering from opium-poisoning or is drunk. His general appearance and age 
may assist you in solving your doubts. You must inquire whether he is known to 
have been drinking ; you must tiy if you can perceive the odour of wine or spirit in 
the breath ; and you should endeavour to make out from his friends whether he has 
been low-spirited, or in difficulties, or is a likely person to have taken poison. Even 
when the odour of drink is distinctly appreciable too much reliance must not be 
placed on it, because a man who has been drinking may be seized with apoplexy. 
A story is told which illustrates forcibly the curious circumstances under which one 
may be called upon to distinguish between apoplexy and drunkenness, and the 
difficulties that may be experienced in making the diagnosis. Some years ago a 
doctor living in Edinburgh, was called out late one evening to visit an old gentleman 
of that city. He found him completely insensible, his wife crying, and the whole 
family plunged in grief and distress. He was told that the patient whom he now 
saw in a fit had come home, and upon the servant's opening the door to him, had 
fallen into the passage on his back in a state of insensibility. The doctor learned, 
however, that he had been at the club, and he knew well enough that the club was 
composed of choice spirits, fond of their cups, although the gentleman's wife did not 
know so much. He therefore ventured to express a hope to the wife that her 
husband was only drunk, a view of the case at which she was extremely affronted 
and indignant. He persisted in his opinion, and not long afterwards the patient 
began to recover his senses. It turned out that he had partaken more liberally than 
the rest of the club, and was the first to be intoxicated. Two of his companions 
carried him home quite incapable of motion, but not liking to introduce themselves 
to his wife in that predicament, they placed him with his back against the door, 
rang the bell, and decamped. Of course, when the servant came to open the door 
his master tumbled senseless on the floor. The doctor certainly deserved some 
credit for the cleverness of his diagnosis, for much harm might have resulted if the 
patient had been treated energetically for apoplexy. 

On the other hand, so many cases of apoplexy occurring in the streets have been 
mistaken for intoxication, that it should be a strict rule that no person found insert 



110 THE TREATMENT OF DISEASES. 

sible by the police should be placed in a cell until an examination has been made 
by the doctor. It frequently appears at the inquest that what was supposed to be 
drunkenness was in reality apoplexy. Even putting aside the question of treat- 
ment, the feelings of the relatives surely deserve some consideration, for it must 
be no small aggravation of their grief to find that one whom they loved and 
cherished was locked up on a charge of drunkenness. 

An apoplectic seizure may terminate in any one of three different ways. Either 
it gradually passes off, leaving the patient apparently none the worse for the stroke ; 
or it terminates in incomplete recovery, the mind being impaired and some parts of 
the body paralysed ; or it ends in death. In any individual case it is very difficult 
to say what the result will be. An attack of this kind is always replete with 
danger, the severity of which may to some extent be estimated by the depth of the 
insensibility, the degree of prostration, and the difficulty in swallowing. There is a 
very common opinion that a person suffers from three different attacks of apoplexy, 
the first being mild, the second resulting in paralysis, and the third terminating 
fatally. This is not literally true, but undoubtedly the danger greatly increases 
with every successive attack. In fatal cases death very rarely occurs immediately, 
as it may do from heart disease, or the rupture of an aneurism, or a broken neck. 
There is almost always an interval of some hours, so that there is time to send for 
the friends or relatives, unless they live at a great distance. In favourable cases, 
even when partial recovery has taken place, there is still a fear, especially during 
the first fortnight, that there may be a recurrence of the bleeding in the brain, or 
that the clot will set up inflammation. , When the symptoms gradually diminish 
there is, in the first place, a recovery of mental power. Eor a time this may be 
imperfect, so that the patient is childish, his memory is impaired, and he experiences 
a difficulty in expressing his wants in appropriate language. This soon passes off, 
there being simultaneously an improvement an the condition of the limbs, the 
capability of movement appearing first in the arm and then in the leg of the 
paralysed side. 

What are you to do when a person is suddenly struck down with apoplexy ? In 
the first place, send for the doctor and say what is the matter. Undo the things 
about the neck, especially the shirt-collar and necktie. Have the windows opened, 
so as to admit plenty of fresh air and cool the room. Place the patient in an easy- 
chair, and let him remain in a half-recumbent position, or put him on the bed or 
on the floor, with his head well supported. The less he is moved the better, but 
take care to see that the head is raised. Sponge the head with the coldest water 
you can get, and send for ice. When the ice comes, put it in a bag and apply it to 
the head, Gutting short the hair if long. It is necessary to have the bowels opened, 
and as the patient cannot swallow put three drops of croton oil right at the back of 
the tongue, when it will run down. You will have no difficulty in doing this, and 
can use the end of a pen or a little brush if necessary. Apply mustard-poultices 
to the calves of the legs. Keep the patient absolutely quiet. This is all that is to 
be done ; in fact, the danger is of doing too much rather than of not enough. After 
what we have said, we need hardly remind you of the absolute necessity of making 
sure that the patient is in reality suffering from apoplexy and not from opium- 



ASTHMA* 111 

poisoning or drink. In former days a man "who had a stroke was always bled. 
Nowadays it is a mode of treatment which is seldom resorted to. There are a few 
cases in which it might do good, but this is a point you must leave to your doctor. 
Blisters applied to the scalp or back of the neck are, as a rule, to be avoided. When 
the urine is not passed for some hours a catheter will have to be employed to 
draw it off. Supposing the patient to recover from the fit, great care will be re- 
quired to prevent a second attack. People who have a predisposition to apoplexy 
should carefully avoid excessive exertion, violent mental emotion, over-indulgence 
in eating or drinking, exposure to extremes of temperature, straining at stool, long- 
continued stooping, tight collars or neckties, and very warm baths. It is important 
to observe a moderately spare diet, which should be almost free from alcoholic 
drinks. Heavy meals at long intervals are to be particularly avoided. Sleep should 
be sought, with the head high, on a mattress, rather than on a feather bed, in a cool, 
well- ventilated room, and for not more than eight hours out of the twenty-four. 
Daily exercise should be taken in the open air, but over-fatigue should be avoided. 
The bowels should be carefully attended to, and constipation at once removed. It 
is a good plan to wash the head every morning in cold water. When there is 
giddiness or headache, or a feeling of fulness or throbbing about the head, a purg( 
will do good. The general health should be carefully supported, and should the 
patient get below par, iron or quinine may be given with advantage. 



ASTHMA. 

Spasmodic asthma is such a common complaint that we need offer no apology for 
entering somewhat fully into its consideration. Not only is it a common disease, 
but it is one of the direst suffering, the horrors of an attack far exceeding any acute 
bodily pain. With a face expressive of the most intense agony, unable to speak, 
move, or even make a sign; the chest distended and fixed; the head thrown back between 
the elevated shoulders ; the sinews rigid and stiff, like cords, tugging and straining 
with every breath — the patient struggles with his overpowering foe. Even in the 
intervals of the attacks his sufferings do not cease ; he is not a free man ; he goes 
about, it is true, like his fellows, and among them, but he knows he is altogether 
different — he is not sure of himself even for an hour ; he can never make an engage- 
ment without a proviso ; from many of the occupations of life he is cut off; and in 
many of its enjoyments and indulgences he dare not join ; his life is marred, 
his existence is crippled, and he knows that a large proportion of his days are destined 
to be spent in the severest suffering. Not only is asthma superlatively distressing, 
but it is proverbially intractable ; the asthmatic must be regarded as an asthmatic 
for life, as one for whom medicine may do much, but of whose ultimate restoration 
to perfect health there is very little hope. 

We have no intention of entering into a discussion as to the nature of asthma. 
Nowadays it is usually regarded as a purely nervous affection — as a disease, that is, of 
the nervous system — and there are many circumstances that favour this view. We 
know that with many people the exciting cause of an attack is often something affecting 
the nervous system, something that with others would give rise to symptoms acknow- 



112 THE TREATMENT OF DISEASES. 

ledged on all hands to be of nervous origin. For example, fatigue and physical 
exhaustion, and sudden or violent mental emotion, will, in many people, at once 
excite an attack. The case is recorded of a gentleman in whom a very severe fit of 
asthma was induced by his having, as he imagined, accidentally given his wife an over- 
dose of medicine. In another instance mental emotion was, on the other hand, equally 
efficacious in cutting short an attack. A gentleman, a confirmed asthmatic, was 
suffering from an unusually bad attack of his complaint ; so bad indeed that he was 
unable to move from his chair, or even to speak, except in monosyllables. He had 
been suffering all day, and in the evening his sister was on the point of giving him 
some ipecacuanha as an emetic, when she went off into hysterics, to the occurrence 
of which she was subject. The suddenness of the attack so alarmed the brother 
that he sprang from his chair, reeled to her assistance, and having placed her in a 
more comfortable position, ran down two flights of stairs to procure the restoratives 
that were usually administered. He then rushed up-stairs again; and having 
applied the remedies, was delighted to find that his own attack had quite left him, 
and that he was breathing as freely as ever he was in his life. The asthma, however, 
gradually returned, and within an hour he was as bad as ever. Again, in illustration 
of the influence of mental emotion on asthma, we may mention the case of a patient 
who stated that when a little boy he found his disease a convenient immunity from 
correction. " Don't scold me," he would say, if he had incurred his father's 
displeasure, " or I shall have asthma ; " and so he would, as his fears were as well 
founded as they were at times convenient. A doctor recently stated that he had had 
patients come to him who lost their asthma the moment they entered his house to con- 
sult him. Suddenly the difficulty of breathing had vanished, without any apparent 
cause, except the mental perturbation at being within the precincts of the physician. 
We see just the same thing in the toothache : the sight of the dentist's house will 
often cure it. As an argument in favour of the nervous origin of asthma, we may 
point out that many of its most popular remedies are such as act on the nervous 
system ; tobacco and stramonium, for instance. Perhaps the effect of chloroform is, 
of all remedies, the most striking, and at the same time the most illustrative of the 
purely nervous nature of the affection : a whiff or two, and the asthma is gone ; a 
dyspnoea that a few seconds before seemed to threaten life, is replaced by a 
breathing calm and tranquil. 

The precursory symptoms of a fit of asthma vary greatly in different individuals ; 
some people never experience any, but having been guilty of some imprudence, or the 
regular period of an attack having recurred, they are seized suddenly with shortness 
of breath. The majority of asthmatics, however, do know when an attack is coming on 
by certain peculiar sensations. These symptoms generally present themselves on the 
night previous to the attack, but in some cases a longer time before. Some people feel 
very drowsy and sleepy, and are unable to keep their eyes open, and that without 
having undergone any particular fatigue, or done anything to account for it. Others, 
again, know by extreme wakefulness and unusual mental activity and buoyancy of 
spirits that a paroxysm awaits them. At other times the precursory symptoms are 
connected with the stomach, and consist of loss of appetite, flatulence, costiveness, 
and certain peculiar uneasy sensations at the pit of the stomach. Many people 



>m 




COPYRIGHTED BY L.W.YAGGY & JAMES d. WEST. I&QS 



MftJPTI BmH 







ASTHMA- 113 

at the onset of an attack pass large quantities of clear pale urine, almost like 
water. 

Of all the circumstances attending the commencement of an asthma attack, none 
are more constant than the time of its occurrence. This is almost invariably in the 
early morning, between three and six. In some cases the usual time is the evening ; 
in some just after getting into bed or going to sleep ; whilst in others there is no 
particular time at all, the attack coming on at any hour of the day or night, on the 
occurrence of some particular exciting cause, such as a fit of laughter, or an over- 
distended stomach. In the large majority of cases, however, the shortness of breath 
first declares itself on the patient waking in the morning, or rather in waking him 
from his sleep when he has had but half a night's rest. There are probably two 
reasons for the attack coming on at this time : one being the horizontal position of the 
body, and the other the greater readiness with which sources of irritation act during 
sleep. That the position of' the body tends to induce the attack we know, because an 
extra pillow may prevent it. Some asthmatics dare not go to sleep after the com- 
mission of any imprudence in eating or drinking, whereas they may be guilty of any 
irregularity with impunity provided they only keep awake for some time afterwards. 
In one case, for example, an asthmatic would often sit up half the night after taking 
supper, because he knew that if he went to sleep his asthma would come on imme- 
diately, but by waiting till the supper was fairly digested, the stomach empty, and 
the source of irritation removed, he might go to sleep fearlessly, and have a good 
night's rest. A curious circumstance with regard to the time of the attack is that it 
varies according to the intensity of the cause; the more intense the source of 
irritation, the shorter the sleep before the asthma puts a stop to it. We are told of 
an asthmatic who was always awoke by his disease with an earliness proportionate 
to the size of the supper he had taken. Certain airs disagreed with him just as did 
food before sleeping ; and if the two causes acted conjointly he would wake with 
asthma much earlier than if they acted singly. Thus, if he went to a place that did 
not agree with him, he might wake about five o'clock with his asthma, and the same 
if he ate supper in a place that did agree with him ; but if he took supper whilst 
staying at a place that did not agree with him, he would get no sleep after two 
or three o'clock. In many cases it would appear that this morning occurrence of 
asthma is an essential feature, and is not dependent on external circumstances. 
This peculiarity was noticed in an asthmatic night-porter, whose duties compelled 
him to turn night into day. He went to bed at seven o'clock in the morning, and 
slept till one or two. But although the ordinary time of sleeping and waking were 
thus transposed, the asthma came on at the usual hour, from five to six in the 
morning, towards the end of his vigil, and when he was awake. 

We must now consider the phenomena which characterise an attack of asthma. 
For the following description, as for many of the statements contained in this 
article, we are indebted chiefly to a medical writer, who was himself a great sufferer 
from this complaint. The patient goes to bed in his usual health, with or without 
premonitory symptoms ; he goes to sleep, and sleeps for two or three hours ; he then 
becomes distressed in his breathing, and dreams perhaps that he is under some 
circumstance that makes his respiration difficult. While yet asleep, the characteristic 
8 



114 THE TREATMENT OF DISEASES. 



wheezing commences, often to such an extent as to sound as if a whole orchestra of 
fiddles were tuning in the chest, and to make so much disturbance as to arouse those 
in the same or an adjoining room. The patient half wakes up, and changes his 
position, by which he gets a little ease, and then falls asleep again, but only to have 
his distress and dreams renewed, and again partially to wake and turn. Shortly, 
the increasing difficulty quite wakes him, but only perhaps for a minute or two ; 
he sits up in bed with a distressing half-consciousness of his condition, gets a 
temporary abatement, sleep overpowers him, and he falls back, to be again awoke, 
and to again sit up ; and so the miserable fight between asthma and sleep may go on 
for an hour or more, the dyspnoea arousing the sufferer as soon as sleep is fairly 
established, and sleep again overpowering him as soon as the wakefulness and change 
of position have a little abated the extremity of his sufferings. By-and-by the 
struggle ceases, and sleep is no longer possible; the increasing shortness of breath will 
not allow the patient to forget himself for a moment ; he becomes wide awake, sits 
up in bed to lie down no more, throws himself forward, plants his elbows on his knees, 
and with fixed head and elevated shoulders labours for his breath like a dying man. 

When once the paroxysm is established, the asthmatic offers a very striking and 
very distressing spectacle. If he moves at all, it is with great difficulty, creeping by 
stages from one piece of furniture to another. But most commonly he sits fixed in 
a chair, immovable, unable to speak, or even perhaps to move his head, in answer to 
questions that may be put to him. His back is rounded, and his gait stooping ; 
indeed, his whole figure is deformed. His chest, back, and shoulders are fixed; 
he cannot even turn his head from side to side, so that when he looks from object 
to object he merely moves his eyes, like a person with a stiff neck ; his shoulders 
are raised to his ears, and his head thrown back and buried between them. In order 
the better to raise his shoulders, and at the same time to spare muscular effort in so 
doing, his elbows are fixed on the arms of his chair, or his hands planted on his 
knees ; or he leans forward on a table, or sits across a chair, and leans over the back 
of it ; or he stands grasping the back of a chair, and throwing his weight upon it ; 
or leaning against a chest of drawers, or some piece of furniture sufficiently high to 
rest his elbows on in a standing position. At every breath his head is thrown back, 
his shoulders still more raised, and his mouth a little opened, with a gasping move- 
ment ; his expression is anxious and distressed ; the eyes are wide open, sometimes 
strained, turgid, and suffused ; his face is pallid, and perhaps slightly blue ; the labour 
of breathing is such that beads of perspiration stand on his forehead, or even run 
in drops down his face. He is so engrossed with his sufferings and the labour of 
breathing, that he seems unconscious of what is going on around him ; or else he 
is impatient and intolerant of the assiduities of those who are in vain trying to give 
him some relief. 

During the attack, the heat of the body falls, and the extremities become cold, 
blue, and shrunken. At the same time, the perspiration produced by the violent 
efforts at respiration may b^> very profuse. It is this union of coldness and sweating, 
combined with the duskiness and pallor of the skin, that gives to the asthmatic so 
much the appearance of a dying man. The pulse during a severe attack is always 
gmall, and is sometimes eo feeble that it can hardly be felt. 



ASTHMA. 115 



The length of time required for an attack to attain its maximum intensity differs 
much in different cases. In some, within a quarter of an hour of the first seizure 
the patient seems almost at the point of death ; in others, the shortness of breath 
creeps slowly on, getting deeper and deeper for hours. The time that it lasts, too, 
varies greatly — from a few minutes to many days. It is very rarely that it remains 
long at its state of greatest intensity ; in an hour or two the severity of the paroxysm 
gives way, and, even should it not completely disappear, the patient experiences a 
sense of inexpressible relief. Sometimes the attacks come on quickly, and as quickly 
and completely subside, so that in half an hour the whole thing may be over, and the 
patient as well as ever. This, however, is rarely the case, except as the result of 
the immediate adoption of remedial measures, as when the patient, on finding the 
asthma on him, at once gets out of bed, and sits or stands, leaning against some 
piece of furniture, keeping himself thoroughly awake, or smokes till he feels sick, 
or takes an emetic, In many cases, the attack subsides soon after breakfast, 
or towards noon ; but the patient is fit for nothing for the rest of the day. 
In others it lasts the entire day, gradually abating towards evening, so that the 
patient has a good night, and awakes well the next morning. Again, it may get 
gradually worse as night comes on, so that the second night is worse than the first. 
In some cases, the onset and departure are alike sudden ; in others they are both 
gradual. There is generally some particular time at which the spasm yields, and the 
patient passes from a state of agony to a condition of very endurable suffering ; 
he generally knows when this has taken place, and feels that the crisis is over. 
In some cases, the spasm remains at an unvarying standard, and the sufferer grinds 
en all day without respite. More commonly, however, he experiences aggravations 
and abatements, for half an hour or so breathing perhaps as if each breath would be 
his last, then getting an hour or two's comparative ease, then getting worse again ; 
then better, and so on throughout the day. These aggravations are frequently due 
to some exciting cause, such as taking food, laughing, or yielding to sleep, against 
which therefore, as long as his attack lasts, the asthmatic is obliged most scrupulously 
to guard himself. Nothing is so certain as food to induce these exacerbations ; 
and, since asthma in no degree interferes with appetite, the enforced starvation 
to which the patient is reduced becomes an additional source of suffering ; fainting 
with hunger, he dare not let a particle of food pass his lips; and as long as his 
paroxysm continues, so long must he starve. 

When the spasm finally subsides it generally does so coincidently with the first 
appearance of expectoration. Up to this time the wheezing has been dry, and there 
has been no coug^, or, if any, a short single dry one ; the first appearance of loose 
cough is the harbinger of relief. The expectoration is very often of the consistence 
of jelly, or thick like arrowroot, of a pale grey colour, occurring in distinct pellets, 
about the size of a pea. 

It is a curious thing that in asthma the paroxysms occur at regular and definite 
periods. In many instances, this periodicity is most marked ; as the period charac- 
teristic of the particular case recurs, the attack is predicted with the greatest 
certainty, and never fails to appear at the right time. Asthma is essentially an 
angagement-keeping complaint In the length of the intervals, although in each 



116 THE TREATMENT OF DISEASES. 

case it is constant and characteristic, there is the greatest variety. Many of the 
intervals appear to be arbitrary, and one cannot account for them in any way; 
but many of them are natural, corresponding to the period of recurrence of certain 
conditions, either in the external world or within the body. Thus, with many people, 
an attack of asthma occurs regularly at intervals of a day, a week, a month, or a year. 
When the asthma is dependent upon the state of digestion, it is coram on for 
the attack to appear daily, the patient usually having his fit every afternoon 
after dinner. "When the attack is diurnal, it nearly always depends on some 
daily-recurring exciting cause. Very often an attack occurs regularly once a 
week, at the same hour of the same day. The case is recorded of an asthmatic 
boy, who for years had an attack every Monday morning. On every other day in 
the week he awoke well ; but as sure as Monday morning came round, so surely did 
his asthma appear. A suspicion arose on the part of his parents that he was 
shamming, or any rate making the most of his complaint, in order to escape school. 
It was not till this had been going on for a long time that the real cause was 
discovered. On Sunday evening he took supper, and on other evenings he did not ; 
and the Monday morning's asthma was caused by the supper over-night. On taking 
supper on other occasions, it was found that asthma invariably followed. He left off 
the suppers altogether, and the regular Monday morning's asthma at once disappeared. 
When the attack occurs at monthly intervals, it is usually associated with the men- 
strual periods, and is not a common form except in women. When asthma occurs 
at intervals of a year, it is probably either hay-asthma, of which we shall speak in 
detail in due time, or bronchitic asthma, — asthma that is dependent on an attack of 
bronchitis. 

It is a curious circumstance that each attack seems to impart for a time an 
immunity from a repetition of it. For some time after an attack — the time vary- 
ing according to the interval characteristic of that particular case — the patient may 
expose himself to the ordinary exciting causes of the paroxysms without the slightest 
fear of inducing one. As this period draws to a close, exposure to the provocations 
of the attack is attended with more or less risk, and when it has transpired the 
slightest imprudence is certain to bring on a fit. 

We must now consider certain points respecting the causes of the disease and 
its relation to age, sex, and so on. In the first place, is it hereditary 1 Of this 
there can be no doubt, and it is said that a disposition to it is transmitted in nearly 
half the cases. Asthma is a disorder which is incident to both sexes, but it occurs 
far more commonly in men than in women. The time of life of the first access is 
very variable. It may make its appearance at any time from the earliest infancy to 
old age^ A few days after birth the infant may give unmistakable signs of it, or 
the old man after spending a long life without an asthmatic symptom may suddenly 
become its victim. In cases in which the disease is hereditary it appears at an 
earlier age than when acquired, a circumstance quite in accordance with what occurs 
in gout, and many other transmissible diseases. 

An attack of asthma may be excited in many different ways. In some people, 
fog, or smoke, or the fumes of a lucifer match, or of a recently blown-out candle 
would be quite enough. Ipecacuanha has the curious power of producing an 



ASTHMA. 117 

asthmatic attack with some individuals. Then others, as we shall presently see, 
suffer from a form of asthma produced by the pollen of grasses, and known as " hay- 
fever." Certain kinds of air may act as the exciting cause. For instance, a man may 
be perfectly well so long as he remains in town, but suffer from asthma imme- 
diately on going in the country. It is by no means uncommon to find that an 
asthmatic can breathe perfectly well in one place, while in another he would be 
almost suffocated. There is a special form of asthma, called " peptic asthma," which 
always supervenes on a full meal, and is produced by nothing else. Cases of asthma 
are often met with in which no exciting cause of the attacks can be detected. They 
come on at a certain time, but neither the patient nor any one else can tell why. 

When called to a patient suffering from an asthmatic attack, we are often asked, 
" Is there any danger V " Will he get over it 1 " and we can nearly always say 
positively that there is no danger to life, and the paroxysm, however severe it may 
be, will undoubtedly pass off in time. We never heard of any one really dying in 
a fit of asthma, unless there were heart disease, or some other complication. Directly 
faintness ensues, the spasm relaxes, and the danger is over. Then there is another 
question that is often asked, " Will he get rid of these attacks in time % " and that is 
a very much more difficult matter to solve. It depends on a good many different 
circumstances. In the first place, the age of the patient is not without its influence. 
In young asthmatics the tendency is almost invariably towards recovery, whereas in 
a person who is first attacked after the age of forty -five the tendency is just the 
other way. It is probable that there is no disease in which the question of age 
affects the prognosis more. To the young asthmatic under fifteen, whose lungs are 
sound, we can nearly always say, " You will grow out of it." To a person whose 
attacks have commenced between twenty and forty-five we cannot speak so hopefully, 
and can only say that by judicious treatment and management, there is a very fair 
chance of recovery. Above the age of forty-five, it is only under very favourable 
circumstances that the complaint gets well by itself. 

The length of the attacks has an important bearing on the prognosis. If they 
are short, lasting only a few minutes, or, at the most, an hour or two, we may hope 
for the best ; but if they are very long, lasting a couple of days — or even a week, as 
they do sometimes — the case is a severe one. The frequency of the attacks is 
another point that may enlighten us as to the future. The more frequent they are, 
the worse the omen. Then again, the completeness of the recovery between the 
attacks is an important point. If the patient in the intervals is perfectly free from 
any shortness of breath, it is a favourable sign ; but if he is always more or less 
short of breath, we cannot look so hopefully to the future. When, in addition to 
the asthmatic attacks, there is constant expectoration, the patient always spitting a 
little, it is a bad sign, for it shows a tendency to bronchitis. A cough has much the 
same meaning, and is also unfavourable. One often derives valuable information 
concerning the future from the course or direction the disease is apparently taking. 
Are the attacks becoming more severe and more frequent, or milder and more 
distant ? The loss and the acquisition of the asthmatic tendency is generally a 
gradual process, and the future of a case is often but a reflection of its past history. 
If you feel that your attacks have mitigated in severity, and are getting less 



118 THE TREATMENT OF DISEASES. 

frequent, you have, especially if young, one of the most hopeful auguries of ultimate 
recovery. If, on the other liand, the disease is gaining on you, it must he regarded 
as a bad sign. If you can detect the exciting cause of your attacks, it will materially 
affect the prognosis.- If the exciting cause is clear, single, and such as may be pre- 
vented, nothing can be happier. You hold in your hands the key, as it were, of 
the disease, and by shutting off the exciting cause, you may indefinitely postpone a 
repetition of the attacks. If the attacks never occur but as the consequence of this 
exciting cause, and its recurrence is permanently prevented, this preventive treat- 
ment amounts to an absolute and final cure. If, for instance, as is not uncommon, 
there is some particular locality where the asthma is sure to come on, and no other, 
all you have to do is to stay away from that place ; or if, as is still more common, 
there is only one place where asthma does not come on, all you have to do is to go 
and live there, and never leave it. If an attack comes on only after some indis- 
cretion in eating or drinking, diet yourself strictly, and you are safe. 

We now pass on to the consideration of the treatment of asthma, and about this 
we shall have a good deal to say. Asthma is a very uncertain complaint, and not 
uncommonly displays most astonishing vagaries. A remedy which succeeds 
admirably in one person may utterly fail in another, even when, so far as one can 
judge, the cases are identical. And more than that, a remedy may on one occasion cut 
short a paroxysm instantly, whilst in the same individual a few weeks later it may 
prove inoperative. Hence the large number of drugs that are employed in the 
treatment of asthma. "We cannot lay down any positive rule for the treatment 
of your symptoms. We cannot say, " Take this, it will just suit your case." 
All we can say is, " Here are the different remedies for asthma ; this one generally 
succeeds, try it first ; if it fail go on to the next, and then the next, till you have 
tried them all, and found out which suits your case." A patient who has long 
suffered from asthma generally knows what will do him good better than any doctor 
can tell him. It is only after all his usual remedies and appliances have failed him, 
or in very severe attacks, that the asthmatic finds it necessary to send for medical 
aid. We will now proceed to the consideration of the remedies in detail. 

Tobacco. — Most asthmatics are smokers, and by the use of the pipe or cigar often 
succeed in warding off their attacks. For a man who has never learnt to smoke, 
tobacco will prove very useful in arresting a paroxysm. The case is recorded of an 
asthmatic, who fortunately had never established a tolerance of tobacco, and who 
could at any time cut short the most violent paroxysm by twenty whiffs of a pipe, 
or half a cigar. Sometimes he would begin to smoke when his breathing was so 
difficult that he could hardly smoke a pipe ; he would draw a feeble whiff or two, 
and then stop to recover his breath, then another whiff, and so on. By-and-by 
he would lay down his pipe, with a look of intelligence at his attendant, as much as 
to say, " It's all right now ; " his face would become pallid, and damp with perspira- 
tion, his limbs relaxed, his breathing long and sighing ; but his asthma was gone. 
His object was to smoke just so much as to produce this condition, and no more, 
so that the moment he felt the sensation coming on he stopped. In the case of 
non-smokers, tobacco is a valuable remedy. Its advantages are that it is always 
at hand, and is very speedy in its action ; but it has the great disadvantage that so 



ASTHMA. 119 



many people habitually smoke, that they find a difficulty in getting themselves 
thoroughly under its influence. It is probably not a matter of any great importance 
in what form the tobacco is used, but on the whole we should recommend the pipe 
in preference to a cigar. A pipe has the advantage of being of more certain and 
uniform strength, Bird's-eye is very commonly used, as being a mild tobacco, and 
one but little likely to produce collapse. Shag and other strong tobaccos should bo 
used by non-smokers with a certain amount of caution, as they are apt to cause very 
great prostration. In the case of ladies or children, a few whiffs at a mild cigarette 
will often succeed admirably. 

Stramonium or thorn-apple often answers well when tobacco has proved useless, 
and it is regarded by many as one of the best remedies for asthma. The dried 
leaves are broken up, and either made into cigarettes or smoked in a pipe. Very 
often it calms the paroxysm like magic. One man, who had been a sufferer from 
asthma for many years, declared that since he had used stramonium his attacks had 
lost half their terror, for he knew he could always cut them short in a minute. 
People often say that stramonium is very uncertain in its action, but in the majority 
of cases it will be found to succeed if attention be paid to two or three little matters 
of detail. In the first place, you must have your leaves good ; those you buy at the 
shops have often lost half their virtues. If you live in the country, you should grow 
your own stramonium, or, if a town-dweller, get some country friend to undertake 
this kind office for you. One patient stated that, while he received great benefit 
from stramonium grown and dried by a relative of his, that which he obtained 
at the shops did him no good whatever. Grow your own stramonium by all means, 
if you possibly can. It will grow almost anywhere, and without the slightest 
trouble. Then there is another point — stramonium will cut short an incipient 
attack, whilst it has comparatively little power over one that has been thoroughly 
established. The great thing is to resort to it in time; and, as the patient 
is generally awoke from his sleep by the paroxysm, he should put his pipe, already 
filled, with the means of lighting it, by his bedside over-night, so that when the time 
comes for using it not a moment may be lost. In many cases, it is a good plan 
to smoke a pipe of stramonium at bedtime, with the view of warding off an attack. 
Many people think that it does even more in the way of prevention than cure, 
and obtain greater benefit from the long-continued practice of smoking a pipe of 
it the last thing at night, whether an attack is threatening or not, than by waiting 
until a paroxysm comes on. 

Some people derive considerable benefit from inhaling stramonium smoke. They 
do not simply take the smoke into the mouth and puff it out again in the ordinary 
way, but draw it well into the lungs. Many people who cannot inhale the hot 
smoke, manage to take it when cold without the slightest difficulty. They smoke 
the stramonium like tobacco, puff the smoke into a tumbler, and then inhale it. 
The seeds of the stramonium are much more powerful than the leaves ; and many 
people who have found the latter almost worthless, have come to regard the former 
as a most efficient and powerful remedy. The effects of the seeds are so marked, 
that a certain amount of care is necessary in using them, and they should be smoked 
in very small and gradually-increasing quantities. In some cases, benefit might be 



120 THE TREATMENT OP DISEASES. 

obtained by steeping the leaves in a decoction of the seeds, and then drying and 
smoking them. Often enough when the ordinary stramonium [Datura stramonium) 
has failed, the stronger species (Datura tatula) will succeed admirably. There h 
one point in connection with stramonium-smoking that cannot be dismissed without 
a word of notice, and that is that in a very bad asthmatic attack the patient may be 
really so ill that he cannot smoke. He makes one or two ineffectual attempts at a 
whiff, but he is so short of breath that he cannot draw sufficient air into his mouth 
t© keep it alight, and finally has to give it up as a bad job. 

The Cigares anti-asthmatiques de Joy, a French preparation, often prove useful. 
They are said to contain arsenic of some form or other. They are sold now by most 
chemists. 

Coffee is a very excellent remedy for asthma. If you don't know how to cut 
short your attacks, and have not tried coffee, do so by all means. It often suc- 
ceeds admirably, when almost everything else has failed. There are one or two 
little points to be attended to in taking coffee for asthma. In the first place, it 
should be very strong — in fact, perfectly black. Weak coffee does more harm than 
good. If made very strong you need not take much of it ; a large quantity is a 
positive disadvantage, for it is less rapidly absorbed, and only distends the stomach* 
Then it should be given without sugar or milk — pure cafe noir. It should be given 
on an empty stomach, for when taken on a full stomach it often does harm, by 
putting a stop to the process of digestion. There is no doubt that with some people 
coffee taken at meal-times — especially late in the day — is very apt to produce 
asthma. Finally, it should be given very hot. 

Nitre-papers. — Of nitre-papers we can speak in the very highest terms in the treat- 
ment of asthma. It is an old-fashioned remedy, but it is one of the best. A London 
physician has a son who almost from his infancy has been very subject to asthma, which, 
however, is readily controlled by the fumes of smouldering nitre-paper. They sleep 
in adjoining rooms. At that time in the early morning when the attack is wont to 
come on, the wakeful, anxious father listens for and hears in his son's altered manner 
of breathing the earliest intimation of the coming trouble ; he rises immediately, and 
lights his nitre-paper in the son's chamber, and in five or ten minutes the threatened 
or incipient paroxysm is extinguished, the sleeper sleeping on in blissful ignorance 
of what has happened. This is by no means an isolated case. A lady obtained so 
much relief from this mode of treatment that she never went anywhere without 
taking some nitre-paper with her in her pocket. If an attack came on at any 
time she would at once resort to it. Sometimes, when making a morning call, she 
would find her asthma coming on ; she would put up with the inconvenience as 
long as she could, and then when she could bear it no longer, she would ask to 
be allowed to retire to some room to use her remedy, and in ten minutes wou!4 
return to her friends as well as ever. Many asthmatics habitually burn nitre- 
paper in their rooms before retiring to rest, and by this means invariably insure 
a good night's rest. Every one should make his own nitre-paper — the home- 
made is always the best. The best paper to use is ordinary blotting-paper, it 
must not be very thin, or it will not take up sufiicient nitre, nor yet too thick, or 
it will make the fumes too carbonaceous ; but it must be moderately thick and very 



ASTHMA. 121 

parous and loose in texture, so as to soak up plenty of the solution There is no 
difficulty in making the solution, for all you have to do is to put in just as much 
nitre as the water will take up. Nitre-paper will keep for any length of time, 
and will be none the worse for it. If it get damp, all you have to do is to put 
it before the fire and dry it, and it will be ready for use in a few minutes. 

When nitre-paper prepared in the ordinary way fails, another kind of nitre-paper 
will often succeed. This is very much stronger, and we have known cases in 
which its action was truly wonderful "We don't know that you can buy it any- 
where, so that you will have to make it yourself. We have made it dozens of 
times, and it is really very little trouble. In the first place, you get half-a-dozen 
sheets of ordinary red blotting-paper, and you cut this with a paper-knife into pieces 
about six inches square. Then you take these pieces and make a number of little 
piles of six of them, one on the top of the other, all over the table. You next take 
a good-sized saucepan, half fill it with water, and put it on the fire to boil. You 
must now get some saltpetre and chlorate of potash, and throw them into the boiling 
water — an equal quantity of each, till it will not take up any more. There is no 
occasion to measure how much you put in. "We usually throw in a big spoonful 
of each alternately, giving it a stir if it does not seem inclined to dissolve. When 
the water is saturated with the salts take the saucepan off the fire, put it on the 
hob, and then take one of your piles of blotting-paper — all six pieces — and dip it in. 
Directly it is wet through throw it on an old tray, or better still, on a piece of board 
with holes in it, so that it may drain. You must treat all your piles of paper in 
fche same way. You will have to be rather quick in pulling them out of the hot 
salt solution, or you will scald your fingers. You may, perhaps, find it convenient 
to use a small pair of tongs. The best way of drying the paper is to put it out 
in the sun for an hour or two. In the absence of sun the kitchen fire forms a 
very effectual substitute, only you must take care that a spark does not fiy out and 
set the whole of it on fire. Before the pieces of paper are quite dry, it is a good 
plan to sprinkle them lightly with a little aromatic of some kind or other. We 
generally use tincture of sumbul or spirits of camphor, but you can flavour to your 
taste. Hie addition of the aromatic, we are inclined to think, is not a mere matter 
of fancy, but really adds to the efficacy of the preparation. The nitre-paper so 
prepared is as thick as cardboard. It of course consists of the six pieces of 
Dlotting-paper, closely adherent, and covered all over with crystals of saltpetre and 
chlorate of potash. For the sake of distinction we often speak of these thick 
pieces of nitre-paper as " nitre-tablets." The way you use them is this : — You 
take a nitre-tablet and fold it across the middle so as to make it like a tent, or the 
cover of a book. You then put it standing up in the fender, or on a piece of metal 
ef some kind or other, and light it at each end of the fold. It burns very quickly, 
almost like a firework, forming a great deal of very dense smoke. In its com- 
■^astion it often shoots out a flame, some six or eight inches long, from each end, 
tso that you must be careful not to put it near the bed or the curtains, or anything 
that would catch fire. It is not a good plan to put it on a plate, for it may crack 
fi The smoke often causes great drowsiness, and the patient goes to sleep almost 
immediately, and nearly always passes the whole night without interruption. We 



122 THE TREATMENT OP DISEASES. 

have obtained some most excellent results with these tablets, and they often succeed 
when ordinary nitre-paper fails. Country asthmatics, who never suffer from their 
complaint whilst in town, may prepare a more congenial atmosphere by this means. 

Chloroform is a very good remedy for asthma, but it should be given with caution. 
It i3 never safe to use it for yourself, but if there is any one to do it for you, well 
and good. As an illustration of the danger of the self -administration of chloroform, 
we may mention a sad accident that resulted from its use. A person who was in 
the habit of curing his attacks of asthma by inhaling chloroform, when administering 
it to himself one day, and when in a state of half-subjection to its influence, in order 
to produce the full effect placed his handkerchief on the table, and buried his mouth 
in it. His insensibility became deeper and deeper, till at last he was too far gone 
to raise his head. He continued inspiring it, his coma became more and more 
profound, and a short time after he was found in that position quite dead. It is 
never necessary to produce insensibility with chloroform for the relief of asthma — 
at all events, this should never be done except by a medical man. The best way 
is to get some one to put a few drops of choloroform on a pocket-handkerchief, 
and give it you as inhalation at the first sign of an attack coming on. If employed 
in this way it proves extremely useful, but when the paroxysm is thoroughly 
established it is a far more difficult matter to stop it. 

Chloral given in a twenty-grain dose during a paroxysm will often succeed III 
arresting it. 

Nitrite of amyl used as an inhalation often proves very useful in asthma, cutting 
short the attack almost immediately. Four or five drops may be poured into tb 
palm of the hand and slowly inhaled, or what is better, a good sniff or two may be 
taken from the bottle. The full effect of the drug has not been obtained until it 
causes flushing of the face and a sense of pulsation about the head It can be used 
in the manner we have indicated with perfect safety. 

Ipecacuanha is a remedy very commonly used for asthma. The case is related 
of an asthmatic youth whose attacks generally awoke him about four or five in the 
morning, and soon compelled him to sit up in bed and wheeze, or get up and lean 
against the furniture for support. In two or three hours he would be able to dress 
himself, and perhaps in the forenoon he would obtain a little relief. Towards 
evening, however, he would get worse, and at bed-time there seemed to be no 
chance of the paroxysm passing off. He would then take twenty grains of 
ipecacuanha powder in a little water, would be sick, take a light supper, go to bed, 
sleep like a child, and wake quite well in the morning. There is very little doubt 
that if the ipecacuanha had been taken earlier it would have proved equally 
efficacious in cutting short the attacks, and would have saved some hours of acute 
suffering. Remedies such as ipecacuanha, which act as depressants, should be given 
as early as possible ; it is essentially bad policy waiting till the paroxysm has got 
a firm hold before attacking it. Treatment is often powerless after the dyspnoea 
lias continued for some hours which would not have failed if resorted to quite at 
the beginning. Moreover, even if the spasm does yield in spite of having been 
some time established, the recovery is not so complete as if the remedy had been 
applied immfediately on its appearance. 



ASTHMA. 123 

Tartar emetic is sometimes used to cut short an attack. It acts in the same 
way as ipecacuanha, to which we are inclined to think it is inferior. 

Lobelia inflata, the Indian tobacco, is one of our most valuable remedies for 
asthma. It does well in the form of asthma associated with indigestion, but proves 
especially efficacious when in addition to asthma there is bronchitis. It is less 
useful when the attacks como on periodically, at intervals varying from three weeks 
to a month. It may indeed for several days postpone or partly suppress the 
paroxysm, but after a time it usually breaks out, the lobelia being apparently 
unable to prevent the attack. The lobelia is taken internally in the form of the 
tincture. Ten drops of the simple tincture are to be taken in water every ten 
minutes or a quarter of an hour, until the shortness of breath gives way. The 
only drawback to this medicine is that it is somewhat uncertain in its action, some 
people being made sick and faint by doses which others can take with impunity. 
Those who are in the habit of taking lobelia soon learn what dose suits them best. 
Even should sickness and faintness appear they soon pass off, and never become 
serious. The relief obtained from lobelia is often very striking. 

There is another remedy for asthma which we cannot pass by without notice, 
although we have some hesitation in recommending it, and that is Alcohol. It may 
be taken either in the form of whisky, brandy, or gin. It is essential that it should 
be taken very hot and very strong. The mixture should consist of two-thirds spirit 
and one third water, and it should be so hot as that it is only just possible to drink 
it- The objection to this remedy is that it grows on one. You begin to take it, and 
often find it a difficult matter to leave it off. A gentleman who became acquainted 
with this method of cutting short his attacks was so pleased with it that he drank a 
^aart of brandy in the first twenty-four hours. He went on with this treatment 
for two months, and in that time took twelve gallons of spirits. The great thing in 
favour of the alcohol is that it is always at hand, and often succeeds where the 
more orthodox remedies have failed. 

Iodide of potassium is an excellent remedy for asthma. Asthmatics should take 
five grains of iodide of potassium — or its equivalent, two table-spoonfuls of the 
iodide of potassium mixture (Pr. 32) — three times a day, for a fortnight or longer. 
Should this fail to afford relief the dose should be increased to ten grains three 
times a day. Some people never have an attack so long as they take the medicine ; 
and then it is a good plan to continue it. Should it cause much depression, as it 
does occasionally, ten drops of sal volatile may be added to each dose. 

There is a remedy for asthma which has been quite recently introduced — in fact, 
within the last year — and we cannot refrain from just mentioning it. It is the 
Grindelia robusta. It is a Californian plant belonging to the natural order Com- 
positse — the daisy family. It is said somewhat to resemble the sunflower, only 
smaller. The best preparation is the liquid extract of grindelia, and of this twenty 
or thirty drops are given in a wine-glassful of water three or four times a day, an 
extra dose or two being taken at the onset of the paroxysm. "We have given it in 
about a dozen cases, and have obtained some very good results. In the case of a man 
who had had an asthmatic attack every night for years, it afforded complete relief 
in less than a week. It will not succeed in every case, and we have had several 



124 THE TREATMENT OP DISEASES. 



failures ; but it is .well worth trying. We have never known it produce any un- 
pleasant symptoms. It is a remedy as yet not at all generally known, but it may be 
obtained through any of the leading London or provincial chemists. 

Having considered in detail the different remedies used in the treatment of 
asthma, we will now pause for a moment, and just think over what you should do if 
suddenly seized with an attack. In the first place, can you account for it in any 
way 1 Do you know of anything that could have brought it on % Are your bowels 
confined ? or have you been taking anything indigestible 1 If your bowels are at 
fault get them cleared out at once. Take a seidlitz powder, or use an injection. The 
latter is preferable, because it is so speedy in its action. If the stomach is overloaded, 
yon must relieve yourself by an emetic : a table-spoonful of ipecacuanha wine, aided 
by a draught or two of warm water, will answer your purpose. If neither your 
bowels nor your stomach is at fault, is there anything in the air that is answerable 
for it 1 Has anybody been burning sulphur matches, or anything of that kind ] Do 
you smell anything wrong ? Is there any hay-making going on % Can it be that 1 
Has anybody been having anything to do with ipecacuanha powder % It is very 
important to find out the exciting cause ; for if this continues in operation, no amount 
of treatment will do any good. Do you think it is a question of locality ? Do you 
always have an attack when you come here 1 ? If it is a question of locality, or if 
there is something acting as an exciting cause that cannot be removed — as, for 
example, a hay-field — the sooner you get away from it the better : order a cab, or 
your carriage, or whatever it may be; make them carry you down-stairs if necessary, 
but get away without a moment's delay. It is very likely you will get all right 
before you have gone a couple of miles, always supposing that it is a local cause that 
has originated it. 

It is a great thing to place yourself in as good a position as possible dining an 
attack. If in bed get up, bolster yourself up in an arm-chair in front of a table of a 
convenient height, with a pillow on it, on which you may rest your elbows and 
throw yourself forward. It is really astonishing how much comfort this will often 
give; it not only actually relieves the breathing, but disposes the spasm to yield. 
If the breathing is really so bad that it is impossible for you to sit down, the only 
thing is to make the same arrangements adapted to a standing posture. 

If, however, the spasm still persist, the only thing is to have recourse to one of 
the remedies we have mentioned, or to try several of them in succession. In the 
choice of a remedy you will be more or less influenced by your former experience. 
You probably know bstter than anybody what will suit your attack and what will not. 
Few asthmatics suffer long from their complaint without discovering what particular 
remedy is most efficacious in their case, and in this respect asthma displays such 
caprice that there is no better guide than' the patient's own experience. 

We must now say a word or two respecting the dietetic treatment of asthma, 
Most asthmatics are more or less dyspeptic, and, as has been very truly said, in no 
direction is asthma more accessible than through the stomach. Even when, as in 
many cases, the asthmatic does not suffer from the severer forms of dyspepsia, it will 
be found that the stomach is irritable and the digestion capricious and irregular. 
"?&d presence of food in the stomach at bed-time is a potent exciter of the paroxysm 



ASTHMA. 125 

of asthma. It is a good practical rule, that any one subject to asthma should not take 
solid food for five or six hours before retiring to rest. If a man goes to bed at 
twelve, he should take nothing to eat after six o'clock. He should at all times 
carefully abstain from taking anything commonly reputed to be indigestible. All 
preserved things are to be avoided. Potted meats, dried tongue, sausages, stuffing 
and seasoning, preserved ginger, candied' orange-peel, dried figs, almonds and raisins, 
everything of this kind is to be regarded with suspicion. Cheese is bad, esj)ecially if 
old; and it has been said that there is "as much asthma in a mouthful of decayed 
Stilton as in a whole dinner." Kuts are especially likely to excite asthma. Meat- 
pies are very " asthmatic," so, in a peculiar degree, for some reason or other, are 
beef -steak and kidney puddings. As we have already seen, coffee taken as a beverage 
with meals is particularly likely to bring on asthma. The after-dinner cup of coffee 
is seldom admissible. For breakfast, it will usually be found that tea is better than 
coffee, cocoa better than tea, and milk and water better than either. Heavy malt 
liquors, especially those containing much carbonic acid gas, as bottled stout and 
Scotch ale, are, of all drinks, the worst for asthma. 

Over-distension of the stomach is very apt to bring on asthma. An asthmatic's 
meals should always be small in quantity, as nutritious as possible, and of easy 
digestion. The tendency of eating to induce asthma is in direct proportion to the 
lateness of the horn- at which the meal is taken : it is slight after luncheon, worse 
after a late dinner, worst of all after supper; whilst breakfast is entirely free from it. 
As breakfast is the least likely of all meals to do harm, the sufferer from asthma 
need not hesitate to take advantage of the fact, and should make a good one. In 
fact, in the case of people whose time is practically their own, there is no reason why 
the first meal of the day should not be to all intents and purposes dinner, the usual 
order of the meals being reversed. 

Curiously enough, many asthmatics never suffer from their complaint in certain 
localities. In some cases the foul and murky atmosphere of a crowded city proves more 
beneficent than the clear and purer air of the country. People tormented at home 
and coming to the city for medical advice, often find themselves on their arrival 
suddenly and thoroughly freed from their accustomed malady ; and are sometimes 
vexed that, however long they may wait, they get no opportunity of letting their 
chosen physician witness an attack. On their return to the country their complaint 
quickly resumes its habitual tyranny. In these cases, the densest, lowest, and most 
foggy parts of the city usually furnish the surest defence against the assaults of the 
disease. The history is related of a great sufferer from asthma, who was accidentally 
detained one night in the foulest region of London. He felt persuaded that he 
could not possibly survive till morning, so great was his dread of the close atmo- 
sphere. He not only lived through the night, however, but enjoyed the first uninter- 
rupted sleep he had known for months. He took the hint, removed to Seven Dials, 
for the benefit of the air, and from that time never suffered another attack. We 
hear of many agencies still more slight and subtle that are. enough to set the springs 
of the seizure in motion ; the mere absence of light, for instance. Laennec 
speaks of a man who invariably was roused from his sleep by a paroxysm of 
asthma if his lamp was extinguished, or if his chamber-door was shut. The 



126 THE TREATMENT OF DISEASES. 

eonsciousness that the customary preventive remedy was not at hand has Apparently 
brought on a fit. As a rule, the worse the air is for the general health the better it is 
for asthma. To this there are some exceptions, and some asthmatics are always 
safer in pure inland air, and a few find a specific remedy for their complaint in the 
air of the sea-coast. It is probable that every case of asthma is curable by the air of 
some place or places, and nothing but actual trial will discover what that is. 



ASTHMA FROM ANIMAL EMANATIONS. 

Cat Asthma, &c. — Cat asthma is an uncommon but very curious complaint, 
related in its general features to hay fever. The cause of the asthma is, as the name 
indicates, the proximity of a common domestic cat One would hardly believe that 
such a thing could be possible, were not its reality placed beyond doubt. It is a 
fact; and there is neither invention, nor imagination, nor exaggeration, about it. 
We recently had a case under our care, and can vouch for the reality of the suffering. 
The symptoms very closely resemble those of the hay fever, but they are usually 
shorter in duration, and, perhaps, more severe whilst they last. The asthmatic 
spasm, which is immediate and violent, is accompanied by sneezing, and burning and 
a watery condition of the eyes and nose. The eyes are injected, and instinctively 
avoid the light. Sometimes there is excessive itching of the chin, which may also 
extend to the chest, and, perhaps to between the shoulders. Some shortness of 
breath is usually produced in susceptible people, even when they are sitting by the 
fire and the cat is lying quietly on the hearth-rug ; but the effect is much greater 
when the animal is at the distance of only a foot or two, and it is still further 
increased by stroking the cat, especially when it is in the lap just under the face. 
The exciting influence is said to be greater in kittens than in full-grown cats. After 
the removal of the animal the symptoms begin to subside almost immediately, and if 
the paroxysm is not very severe, a cure is effected in from ten minutes to a quarter 
of an hour. 

Many people, even when they do not actually suffer from cat asthma, are strangely 
and unpleasantly affected by the presence of cats. "With them, the effect on the eye 
of rubbing it just after touching a cat is to produce a hot stinging irritation, a pro- 
fuse flow of tears, and an intolerance of light. The result of touching the lip is to 
produce a swelling, with a feeling of heat and irritation. If the cat happen to rub 
against the face, the cheek immediately becomes hot and swollen, and a kind of 
nettle-rash makes its appearance. 

In some people asthmatic symptoms are produced not only by cats, but by other 
animals. The case is related of a lady who could never visit the Zoological Gardens 
without being rendered asthmatic. In another instance a gentleman found that he 
could never go near horses without suffering from shortness of breath, nor did he 
dare stay in the room with any one who had been riding. He was a country 
gentleman, and it was frequently desirable that he should attend agricultural meetings, 
but he was unable to do so from this circumstance. We are told of a clergyman 
who was always rendered asthmatic by a hare or a hare-skin. If he met any of his 
parishioners who had been poaching and had their booty about them, he could 



BILIOUSNESS. 127 

always detect them. When he was a boy studying with a private tutor, a friend, as 
a practical joke, put a hare under a sofa in the room in which he was sitting, and the 
result was an immediate and very serious attack of asthma. A lady who was subject 
not only to cat-asthma, but to hare-asthma, tells us that on one occasion she was 
seized with a terrible attack whilst on, a railway journey. She was unable to account 
for it in any way, until a gentleman getting out of the carriage took a hare from 
beneath the seat. This same lady was unable to wear a cloak made of certain skins, 
from the shortness of breath it produced. 

Respecting the treatment of these cases, we have nothing to add to what we have 
already said when speaking of asthma. When once the exciting sause is known it 
is easily avoided 



BILIOUSNESS — CONGESTION OF THE LIVER LIVER DERANGEMENT — 

LIVER OUT OF ORDER. 

Nothing is more common than to hear people say that they are bilious, and that 
then- liver is out of order. No one supposes that it is a serious complaint, but it 
is uncommonly disagreeable while it lasts. There can be no doubt that the liver 
is often credited with symptoms with which it has little or no concern, and on the 
other hand symptoms are often referred to other organs which undoubtedly have 
their origin in the liver. 

We will, in the first place, consider what are the causes of derangement of the 
liver, and how it is that it so often goes wrong. We fear that errors in diet have 
a great deal to do with it. There can be no doubt that the present system of living, 
and especially the consumption of even what are regarded as average quantities of 
rich food and stimulating drinks, have much to answer for. It will be generally 
admitted, and it would not be difficult to prove, that most people eat more than is 
good for them — more than suffices to maintain the nutrition of the body. Of course, 
we do not mean that you individually take too much; but still, if you look round 
at your neighbours you will at once perceive that the amount of food they take is 
positively disgusting. Much of this excess is passed off by the bowels, but a great 
deal of it is taken up by the blood, and accumulates in the system, upsetting the 
liver. With regard to different kinds of food, we know that the liver is most apt 
to be deranged by sweet or fatty substances. Derangement of the liver is in many 
people more likely to be induced by even small quantities of these substances than 
by a moderate excess of meat. Rich sauces and sweets are very apt to disagree. 
There are also certain peculiarities with regard to many articles of diet, which always 
derange the liver in certain individuals, though they are comparatively harmless to 
others. 

But above all, alcoholic drinks are the most likely to cause liver derangement. 
They act injuriously in two ways. In the first place, even small quantities of 
alcohol in healthy people produce a temporary congestion of the liver ; and if the 
alcohol be taken in excess, or too frequently, the congestion becomes permanent, 
and the functions of the organ are deranged. But wines, and in fact most alcoholic 
drinks, contain large quantities of sugar ; and this, as we have seen, proves especially 



128 THE TREATMENT OF DISEASES. 

injurious to those who are prone to liver disturbance. It has been found -that the 
injurious efFeet of alcoholic beverages upon the liver increases in a direct ratio to 
the amount of sugar and spirit they contain It would seem, indeed, that a mixture 
of spirit and sugar produces injurious results, which would not be caused by taking 
a much larger quantity of spirit or sugar alone. Practically, we know that the 
alcoholic drinks which are most apt to disagree with the liver are malt liquors 
of all sorts, but especially stout and the stronger forms of mild ale, port wine, 
madeira, tokay, malaga, sweet champagne, dark sherries, liqueurs, and brandy; 
whilst those least likely to derange the functions of that organ are claret, hock, 
moselle, dry sherry, and gin or whisky, largely diluted. 

Derangements of the liver from excessive eating, or from any other error in diet, 
usually first show themselves in middle life — from thirty-five to fo ty-five. Young 
people who take much exercise, and who are still growing, can eat more than they 
actually require with comparative impunity. But by the age of fo A ty the body is 
fully developed, and most persons take less exercise than before, while at the same 
time they often indulge more freely in the pleasures of the table. 

Insufficient muscular exercise in the open air may derange the functions of the 
liver. It is well known that sedentary habits, and living in badly-ventilated rooms, 
act on the body injuriously, and more especially on the liver. It is a common 
observation that people who eat and drink too freely do not suffer from their livers 
so long as they lead an active life in the open air ; but as soon as from change of 
occupation or other causes they take to sedentary habits, without any corresponding 
change in diet, derangement of the liver ensue3. Every sportsman who has suffered 
from biliousness knows the effect of a day's hunting or shooting in clearing his 
complexion and relieving his symptoms. 
• A high atmospheric temperature is especially favourable to the production of 
disorders of the liver. We all know how frequently they occur in India and other 
tropical climates, and in our own the liver more often becomes disordered in summer 
than in winter. The draught, which is suitable in a cold or temperate climate, 
produces in the tropics liver derangement. 

It is probable that many cases of liver disturbance are nervous in their origin. 
We know that sudden fear, and other forms of severe mental emotion, may arrest 
the secretion of the milk, and that, from the cessation of the secretion of saliva, the 
tongue cleaves to the roof of the mouth. Prolonged mental anxiety, worry, and 
incessant mental toil, interfere with the secretion of bile, and produce that chain 
of symptoms to which we shall presently refer. Such results are all the more 
likely to ensue if the diet has been such as to favour liver disturbance-— ff, 
for example, to drown grief the sufferer has indulged in stimulants. 

In considering the causes of derangement of the liver, it must not be forgotten 
that there are constitutional peculiarities — inherited or acquired — in virtue of which 
the liver is upset by things which, under ordinary circumstances, would be harmless. 
Some people are more prone to suffer from their livers than are others. An innate 
weakness of the liver is often inherited. If an individual with this predisposition 
take spirits, even in comparatively moderate quantities, he usually suffers very 
quickly and also severely. Some people are always drinking, and apparently 



BILIOUSNESS. 120 



but little from it, whilst others have only to take a glass or two of champagne to be 
most frightfully upset. 

We must now consider the symptoms which we recognise as indicating that the 
liver is out of order. In the first place, the tongue is usually covered with a thick 
fur, sometimes whitish, but occasionally of a yellowish or brownish tint. It is 
commonly large, pale, and flabby, and indented by the teeth. Nevertheless, it is 
well to remember that there may be considerable derangement of the functions of 
the liver, and yet the tongue may be perfectly clean, or at most only slightly coated 
in the morning. 

When the flow of bile is deficient, the appetite is often very bad, and there may 
be a loathing of fat and of greasy articles of diet. Sometimes there is a loathing 
of everything except alcohol, indulgence in which intensifies the mischief. In 
exceptional cases the appetite may be excellent, even when the liver is performing 
its work very badly, and the patient is often tempted to eat what he knows from 
experience disagrees with him. Liver disturbance is often accompanied by a bitter 
or metallic taste in the mouth, especially in the morning. " Hot coppers " is a 
frequent complaint of those who have indulged too freely over-night. 

Flatulence, or wind, is another common symptom. It is one of the most frequent 
results of a deficient flow of bile. From the absence of bile in the intestines, the 
food undergoes fermentation, and a large quantity of gas is generated. Acidity is 
another frequent source of trouble. Many articles of diet habitually disagree with 
people who suffer from their livers, so that they get bilious. They awake in the 
morning with a dry or clammy tongue, a bitter taste in the mouth, dull heavy 
headache, giddiness, and cramps or pains in the knuckles. 

Functional derangement of the liver generally gives rise to disturbance of the 
bowels in some form or other. Most commonly there is constipation. The bile acts 
as a kind of natural purgative, and when it is secreted in diminished quantity there 
is nothing to stimulate the bowels to action. The motions are either unusually pale, 
or from long detention in the bowel become black and lumpy. The latter condition 
is often associated with great depression of spirits — the origin of the term melancholy. 
Very often, instead of constipation, there is diarrhoea, or the two conditions may 
alternate. It is probable that the retention of undigested food in the bowel, by 
setting up irritation, is the cause of the diarrhoea. It may be taken as a rule, 
that when little bile is secreted the stools are pale and unusually offensive, unless 
they be long retained in the bowel, when they may be dark and lumpy ; and that 
when there is an excessive secretion of bile — an overflow of bile — the motions are 
relaxed and liquid. 

In exceptional cases, bleeding from the bowel occurs as the result of simple 
derangement of the liver, without the existence of any actual permanent disease 
pf that organ. It is not common, but is most frequently met with in people beyond 
the middle age. The attack is usually preceded by a feeling of oppression and 
heaviness, by pain in the right shoulder, loss of appetite, nausea, and furred tongue. 
It is often followed by a subsidence or cessation of the symptoms. Great relief is 
usually afforded by a good purge, such as a calomel, or blue, pill, and a saline 
aperient. 

a 



130 THE TREATMENT OF DISEASES. 



Many people who suffer from liver complaint are subject to piles.. In fact, 
some doctors have gone so far as to say that, if a person complains of piles, it should 
mike you suspect that his liver is out of order. The two conditions are undoubtedly 
v~vy frequently associated. 

Often enough there is considerable derangement of the liver — it performing its 
f motions very imperfectly — without any pain over the region of that organ. In 
many cases, however, there is a sensation of weight, fulness, tightness, or even 
burning, just below the ribs on the left side. When the bowels are neglected, 
or if the patient continue to indulge in rich food and alcoholic stimulants, 
the pain may become very severe. It is usually increased after meals, and by 
lying on the left side. 

Aching pains in the limbs, and lassitude coming on about an hour after a full 
meal, sometimes associated with an irresistible tendency to drowsiness, are symptoms 
often resulting from the liver being out of order. Sometimes complaint is made of 
a dull heavy aching in the right or, more rarely, the left shoulder, or under the 
shoulder-blade. Burning or scalding of the palms of the hands and soles of the 
feet— a complaint very common with those who indulge largely in alcohol — is often 
an accompaniment of liver disorder. This curious sensation may be persistent, 
but far more frequently it is transient, coming and going by fits and starts. Cramps 
in the calves of the legs, the abdomen, and other parts are not uncommon, and are 
often very distressing. They usually come on during the night, occurring most 
commonly in cold or damp weather. They seem, in some instances, to be associated 
with a tendency to gout. 

People whose livers act badly often suffer from headache. It usually takes the 
form of a dull heavy pain, either in the forehead or more frequently at the back of 
the head. It is experienced chiefly on awaking in the morning, and may either 
speedily pass off or last the whole day, or even for several days. This form of 
headache may in susceptible persons be produced by constipation, or by any little 
indiscretion in diet. Megrim, or sick head, is not always caused by liver derangement, 
but it is sometimes. 

Giddiness, dimness of sight, double vision, and many other similar curious symp- 
toms, are undoubtedly dependent in many instances on congestion of the liver and 
a deficient flow of bile. An attack may often be excited by certain articles, such as 
fat and sugar, which, as we have seen, are especially likely to disagree with bilious 
people. A good purge to rouse up the liver often succeeds in effecting a cure more 
quickly than anything. The case is recorded of a gentleman who was seized with 
dimness of sight and giddiness every night while writing. He took iron, quinine, 
and other tonics, but got worse instead of better. He was told that he must give 
up his profession for a time, and try the effect of change of scene and air ; but before 
taking so serious a step, he took a few doses of blue-pill, and the symptoms at once 
and permanently disappeared. 

People are often met with who complain of numbness, tingling and pricking 
sensations, as if the part were asleep, or a feeling of coldness or creeping in the 
arms or legs of one or both sides. These disagreeable sensations often last for 
months or years, and may be associated with headache, nausea, and depression of 



BILIOUSNESS. 131 



spirits. They often cause needless alarm by exciting the suspicion tkafc paralysis is 
imminent. They are frequently associated with, or dependent on, liver c&sturbance, 
and disappear under the use of calomel pill, salines, and a restricted diet 

Sleeplessness sometimes arises from derangement of the liver, and may then be 
speedily relieved by treatment directed to that organ. 

The influence of the liver upon the animal spirits has long been recognised. 
There can be no doubt that in many cases depression of spirits, inaptitude for work, 
and general listlessness, are aggravated by torpidity of the liver. Many people with 
structural or functional disease of the liver are subject to fits of depression, and- often 
suffer from groundless fears of impending danger, which cease when the liver is 
restored to its normal condition. Irritability of temper often arises from the liver. 
A man who has previously borne the crosses of life with equanimity, and has been 
amiable to those about him, gradually becomes disconcerted by trifles, his mind 
broods upon them, and he makes all around him unhappy, and himself the most 
miserable of all. His friends and relatives, failing to recognise the true nature 
of the case, too often put down his ebullitions of temper to something mentally 
or morally wrong, and he comes to be regarded as a most disagreeable fellow. 
Remedial measures calculated to restore the liver to healthy action, if resorted to 
in time, will often remove the irritability, and reinstate the patient in the good graces 
of his friends. 

"We must now proceed to the consideration of the treatment of these cases 
of liver disorder of which we have been speaking. In the first place, it must 
be borne in mind that regulating the diet will do you more good than any amount 
of physic. If you are not prepared to put yourself to a little inconvenience in 
the matter, and give up some of your accustomed luxuries for the sake of getting 
well, it is no good going to the doctor — you had better try the undertaker. You 
should never forget that that which may ultimately destroy life too often enters by 
the same portal as that which is intended to support it. For the maintenance 
of health it is necessary for most people to put a curb upon their appetites. It is 
all very well to go after rank, and reputation, and wealth ; but they are very little 
good to you if your bile duct gets blocked up. What is the good of a baronetcy, for 
example, if you have to stay at home and live on blue-pills 1 If your liver shows 
any signs of performing its work badly, you had better take it in time, and cut off 
supplies. You will have to give up entrees, and shun all highly-seasoned dishes as 
you would the plague. Some people may get on very well with them, but they are 
poison to you. You had better label them mentally with a skull and erossbones. 
It is a shame for people to tempt you with them, but they will ; and you will have 
to make a determined stand against them. It is a difficult matter sometimes; 
people are so persevering — especially women — and they never display their 
perseverance more persistently than in persuading you to eat or drink what you 
know is not good for you. This faculty is commonly called " hospitality." If you 
are really very bad, you will have to give up not only your entrees, and sugar, and 
alcohol, but even potatoes, rice, sago, and fruit. It may be that your trouble is 
simply due to some one simple article of diet. You had better look out for that, 
and if so, cut it off at once. With many people, a diet consisting chiefly of stale 



132 THE TREATMENT OF DISEASES. 

bread, plainly-cooked mutton, white fish, poultry, game, eggs, a moderate amount of 
vegetables, weak tea, cocoa, or coffee, answers better than anything. It is not 
very pleasant at first if you have been accustomed to gratify your appetite ; but 
it is nothing when you get used to it. In time you will learn to laugh at people who 
eat anything that is put before them, without regard to their internal economy. 
You simply pick what experience has' shown you is best for you ; and who can 
blame you 1 If you did otherwise, people would only laugh at you behind your back, 
and think you stupid. If your liver is weaker than other people's perhaps your 
headpiece is stronger, so they have not much to boast about after all. At all events, 
it is a great thing to be able to talk rationally after dinner, and not to be reduced 
to a condition of semi-torpidity. Sometimes it is necessary to cut down the actual 
quantity of food taken; but this is not usually the case. In obstinate cases it 
sometimes proves beneficial to take the principal meal of the day the first thing in 
the morning, when the digestive powers are strongest. 

As a rule, the very strictest caution has to be observed with regard to drinkables. 
Malt liquors, port, champagne, Madeira, Burgundy, have all to be given up, and 
must be reserved strictly for the use of your friends. Claret or a small quantity of 
spirits largely diluted will probably suit you better than anything ; but sometimes, 
alas ! even these may have to be given up. A man need never despair as long 
as his doctor leaves him gin and seltzer,^ only it must be a large quantity of seltzer 
to very little gin. The gin is useful in this way, that it carries off a great deal by 
the kidneys, and serves to rid the blood of much effete matter, which might other- 
wise prove injurious. Most people get on well without any stimulant at all; 
and it is the opinion of many who speak from personal experience that those who 
have much : brain- work to do would be better if they did altogether without 
alcohol, or, at all events, took it in the very strictest moderation. Even for persons 
who for years have been indulging largely, there is very little risk in abandoning 
stimulants. Unless there is a weak heart, the only inconvenience experienced 
is a sinking at the pit of the stomach and a craving for alcohol, which a repetition 
of the stimulant has only temporarily relieved and has rendered more persistent. 

Plenty of fresh air is very essential in every case in which there is anything 
wrong with the liver. An excess of fresh air will indeed often counteract the bad 
effects of too large a quantity of food. Out-door exercise quickens the flow of blood 
through the liver, and prevents the accumulation in the system of materials which 
would probably prove injurious. Sea air is especially efficacious in this respect, and 
many sufferers from liver derive immense benefit from residence at the sea-side and 
from sea-bathing, although, unfortunately, the good effects of sea air are often more 
than counterbalanced by unhealthy lodgings and badly-cooked food. 

The free use of soda and seltzer water is useful in helping to eliminate morbid 
materials from the system. Many people derive considerable benefit from drinking 
a tumbler of cold water while dressing in the morning, and before going to bed at 
night. The action of the skin should be maintained by frequently bathing the 
entire body with tepid water. 

In most cases of functional derangement of the liver, great advantage is derived 
from the frequent use of aperient medicines, whether there be & tendency to 



BILIOUSNESS. 133 

constipation or not. Aperients bring away not only bile, but waste material from 
the blood. Saline aperients, from the promptness of their action and the larg« 
watery motions they induce, are among the best for the purpose. Recourse is 
usually had to Epsom salts (sulphate of magnesia), Glauber's salts (sulphate of soda), 
Rochelle salts (tartrate of potash and soda), or the phosphate of soda, or to various 
combinations of these salts with common salt (chloride of sodium), carbonate of 
soda, and other alkaline salts, such as are found in the waters of Carlsbad, Freidrich- 
shall, Piillna, Harrogate, or Cheltenham, or in the recently-discovered Hungarian 
spring, Hunjadi Janos. The salts derived from most of these springs can be 
obtained from any chemist, and they are best taken with warm water, and in the 
morning fasting. 

One of the most valuable remedies in cases in which the liver is out of order is 
Blue-pill. Of late years an attempt has been made by physiologists to show that 
mercury has no action at all on the liver in increasing the flow of bile. We do not 
know how that may be ; but we do know that if you are bilious you cannot do better 
then take a dose or two of blue-pill. Everybody who suffers from biliousness knows 
what a great deal of good blue-pill will do him. He knows that there is nothing else 
like it. If anybody does not believe in medicine let him get right-down bilious, and 
then take a blue-pilL We believe that even the most sceptical would admit that 
there was something in it. Even supposing we agree to believe the physiologist, and 
admit that mercury is incapable of increasing the flow of bile in health, it by no 
means follows that it is inoperative when the liver is out of order. It is quite con- 
ceivable that mercury may remove certain unhealthy conditions of the liver which 
prevented the secretion of the bile. Surely it is far better to endeavor to restore the 
liver to its natural condition than to give an unhealthy liver a drug to r^ake it work. 
Putting theory on one side, we all of us know practically that blue-pill removes what 
we call biliousness, and nobody in the world can deny that. The pill, taken at bed- 
time, may be followed by a saline aperient (Pr. 25), or black draught, in the morning. 
In many instances one of the sugar and grey powders (Pr. 71) given frequently will do 
almost as well as a large dose of blue-pill. These powders are especially indicated 
when there is a dull oppressive pain over the liver, preventing the patient from lying 
long on the right side ; when the whites of the eyes are tinged with yellow ; when 
the skin is sallow, when there is shivering followed by profuse clammy perspiration ; 
when there is loss of appetite, a nasty taste in the mouth, and constipatidH, with pale- 
coloured motions. 

Podophyllin is a very good substitute for mercury in some cases, when the la&ter 
cannot be used. It is, on the whole, less certain in its action than mercury, and more 
likely to cause griping. A dose that will purge one person violently often proves in- 
operative in another. Individual differences occur, it is true, with other purgatives, but 
podophyllin is unusually uncertain in its action. The time it take3 to act also varies 
very much. It purges some people in an hour or two, whilst others have to wait 
about all day. Sometimes, instead of doing its work straight off and have done with 
it, it makes a number of ineffectual attempts, and is a long time before it succeeds. 
The following is a good formula for its administration, the henbane being supposed 
to reduce its tendency to cause griping : — 



134 THE TREATMENT OF DISEASES. 

PODOPHYLLIN PlLLB. 

Resin of podophyllin, half a gram. 
Powdered rhubarb, three grains, 
Extract of hyoscyamus, three grain*. 
Make two pills. To be taken every night at bed -time. 

In many cases very much smaller doses of podophyllin may be employed. The 
podophyllin solution (Pr. 51) may be used with advantage. It is a small dose, but 
it is of no use taking more than is really sufficient to do you good. Podophyllin 
succeeds best when nausea and giddiness, bitter taste in the mouth, risings, tendency 
to bilious vomiting, and purging, and dark urine, are the prominent symptoms. 
When there is dull pain over the liver, when the bowels are costive and the motions 
pale, when there is loss of appetite and depression of spirits, it does not do so well. 
Mercury, in either large or small doses, should then be tried. 

Colocynth, Aloes, Rhubarb, Jalap, and Senna are all useful aperients in deranged 
liver resulting in constipation and deficient excretion of bile. Pr. 60 is a good 
purgative pill. 

Dandelion has been in use for years as a popular remedy for liver. It is pro- 
bable that most of the so-called dandelion pills that are so constantly advertised con- 
tain either mercury or podophyllin. Dandelion itself has little if any action on the 
liver, either in health or disease, and at the best it can but act as a mild aperient. 
Colchicum may be given with advantage to gouty persons suffering from liver, but 
in other cases it is not the best mode of treatment. 

Chloride of ammonium (sal ammoniac) has been found of service in congestion of 
the liver, both in this country and in India. It should be given in water, in doses oi 
twenty grains, two or three times a day. It is not by any means nice, the solution in 
water tasting uncommonly like brine, but it does good. If a difficulty is experienced 
in taking it, it may be adminstered in milk. It often induces perspiration, increases 
the flow of urine, diminishes the congestion of the liver, and removes the pain in that 
organ. 

In many of the severer forms of congestion of the liver, especially such as occur 
in tropical climates, ipecacuanha may be given It should be administered in the 
manner which will be recommended when speaking of its use in dysentery. • This is 
not a mode of treatment which is required in ordinary liver derangement in this 
country. 

Nux vomica often proves useful in the simple case of liver derangement result- 
ing from the use of intoxicating drinks, excessive or stimulating food, sedentary habit 
or nervous exhaustion. It is also indicated when there is constipation with deep red 
urine. It is best given in the form of the nux vomica mixture (Pr. 44). 

Bryony is indicated when there is enlargement and hardness of the liver, with 
shooting, stinging, or burning pain, increased on pressure, and constipation without 
inclination to go to stool. It should be given according to Pr. 49. It often acts 
admirably when given alternately with mercury. 

Chamomile is useful in bilious attacks occurring in women and children from 
exposure to cold. It is indicated when there is nausea or vomiting of bile, yellow- 
coated tongue, and bilious diarrhoea. 



BILIOUSNESS. 135 



Aconite is useful in sudden acute bilious attacks following chills, with high 
temperature, and slight jaundice. It may be given alternately with mercury. 

The Iris versicolor, or blue flag, is a drug which in America has obtained a very 
high reputation in the treatment of liver complaint. In many of its properties 
it resembles mercury to a remarkable degree. Nearly all the conditions for which it 
is applicable are characterised by unusual lassitude, prostration, and lowness of 
spirits. It is indicated when pain over the liver, increased by moving, is a pro- 
minent symptom. It may be given in the form of the tincture, a drop every quarter 
of an hour for the first hour, and subsequently hourly in water. Its active principle 
Iridin has also been obtained, and may in some cases be preferable. 

The Euonymus atropupureus, burning bush, Indian arrow- wood, spindle tree, or 
mahoo, is said to have similar properties, but it has been very little used in this 
country. In obstinate cases, where ordinary modes of treatment have failed, it 
may be tried with advantage. 

The Sanguinarea Canadensis, or blood-root, is better known, and has obtained 
some reputation in the treatment of these cases. It is given in the form of the 
tincture, a drop every quarter of an hour for the first hour, and subsequently 
hourly. 

Alkalies are very useful in the treatment of functional diseases of the liver. The 
greatest benefit is often derived from a course of alkalies, such as carbonate of potash, 
or soda, or lithia. Sometimes it is better to give the alkaline mineral waters, such 
as those of Yals, Vichy, or Ems. It is well to suspend their use occasionally, as 
they are apt, when long continued, to upset the stomach, but in cases in which 
they are indicated they are usually well borne. When there is much sleeplessness, 
a dose of bromide of potassium — fifteen or twenty grains — may be added to the 
water taken at bed-time. Should the waters in any case appear to be too weak, 
twenty grains of chloride of ammonia may be added to each dose for a few days. 

Mineral acids are often employed in derangements of the liver. Nitric acid 
especially has been thought to have the power of augmenting the flow of bile, but 
this is very doubtful. The acids may be of use when there is debility and want of 
tone, but the chief good which they effect is probably by improving digestion. 
Sometimes both acids and alkalies may be given, not mixed, but the alkalies 
before meals and the acids after. 

Tonics, as a rule, do no good in liver complaints, for they are apt to disagree. 
People often improve at once on substituting abstinence from alcohol with aperients, 
blue-pill, carbonate of soda, and careful regulation of the diet, for quinine, iron, the 
mineral acids, and stimulants. Opium is usually to be avoided when the liver is out 
of order — it increases the torpidity, both of liver and bowels. 

When a patient has had a very bad attack of liver, and the more urgent symptoms 
have passed off, he will still have to be very careful of himself. The acid and 
gentian mixture (Pr. 15), with or without the addition of five drops of tincture of 
mix vomica to each dose, taken three times a day, often proves very useful at this 
stage. The diet may be rather more generous, particularly if the patient is much 
pulled down, although the greatest care must be taken to avoid everything likely to 
produce a relapse. Fermented liquors are still interdicted ; and if wine be allowed 



136 THE TREATMENT OP DISEASES. 

at all it should be given in small quantities, and well diluted. Hock, claret, and dry 
sherry are the best. You want your wines light, but you want them good. Regular 
exercise in the open air is enjoined, and if there is much debility, horse exercise 
is the thing. The bowels will require careful attention, and benefit will often be 
derived from waters which are not only purgative, but contain iron, such, for 
example, as the springs of Crab Orchard, Ky., Saratoga, N.Y., Bedford, Va., 
Addison County, Vt. 

When on the high road to recovery, the sufferer from liver disorder will often 
derive benefit from the use of the nitro-muriatic acid bath. This is prepared by 
adding two ounces of strong hydrochloric and one ounce of strong nitric acid to 
two gallons of water, at a temperature of 96 or 98 degrees. Both feet are to 
be placed in the bath, while the legs and thighs, the region over the liver, and 
both arms, are sponged alternately, or the abdomen may be swathed in flannel 
soaked in the water. The process is to be continued for half an hour night and 
morning. It is absolutely necessary that a wooden tub should bo used, as the 
acid very soon destroys any ordinary metal bath. The sponges and towels should 
be placed in cold water after use, or they too will soon be destroyed- It is not 
absolutely necessary to prepare a fresh bath on every occasion, and the same may 
be kept in use for several days. All you have to do is to add one drachm of 
hydrochloric and half a drachm of nitric acid with a pint of water, to make up 
for waste, and then to heat about a quarter of the fluid in an earthen pipkin, 
and so bring the whole up to the required temperature. 

In many liver complaints the abdominal compress will be found useful. It 
consists of two or three thicknesses of linen rung out of cold water, placed over 
the seat of pain, and covered with a rather larger piece of oiled silk. The whole 
is kept in position by a flannel or linen roller passing round the body. It may 
be worn several nights in succession, the parts being well sponged with cold water 
and rubbed with a coarse towel on removing it in the morning. 

In the treatment of functional diseases of the liver, rest and change are most 
valuable, both as means of cure and prevention. The worry of business and 
the burden of domestic cares should be removed for a time, and the monotonous 
scenes of every-day life exchanged for the hill-top or the bold bluff. Should 
this be impossible, the long hours of mental and physical labour should be 
abridged, and more time given for the daily renewal of nervous energy. Man is a 
working animal, but it is very easy to do too much. 



BLEEDING FROM THE BOWELS. 

Blood in the motions is often due to piles. Ignorance of this fact sometimes gives 
rise to needless alarm. In every case in which the stools are found to be mixed 
with blood, the patient should be examined for piles, for often enough the blood 
does really come from the bowels. Haemorrhage from the intestines is not of un- 
frequent occurrence in typhoid fever and dysentery. When blood appears in the 
stools it has generally undergone much alteration in character, the amount of change 
depending on the quantity and source, and also, to some extent, on the rapidity with 



BLEEDING FROM THE STOMACH. 137 

+ i — ■ — — — ■ — ' 

which it is poured out. When a little blood comes from the upper part of the 
bowels, and is slowly discharged, it is dark in colour, being sometimes quite black, 
and presenting a tarry or sooty aspect, so that its real nature may not at first sight 
be suspected. When the blood comes from the lower part of the bowel, near the 
extremity, it is often quite bright-red, and has undergone very little change. The 
quantity may vary from a mere streak to half a pint or more. It must be re- 
membered that many medicines, such as iron and lead, stain the motions black, and 
this, of course, must not be mistaken for altered blood. Many people get very 
anxious if they find that their motions are black, but it occurs naturally when taking 
certain metallic substances. 

The treatment of bleeding from the bowels does not differ essentially from that 
of bleeding from other parts of the body. In the first place the patient should be 
made to he down in a cool room, and should be kept as quiet as possible. Cold wet 
compresses should be applied to the abdomen, and if there is any one particular spot 
(rhere pain or tenderness is experienced, or from which there is reason to suppose 
Ehe haemorrhage proceeds, a bag or bladder of ice should be applied on that region. 
Some astringent medicine must be given internally, and one of the best for this 
purpose is the acetate of lead mixture (Pr. 30), a dose every four hours. Should 
this not be at hand, perchloride of iron (Pr. 1 or 2) or gallic acid (Pr. 29) may be used. 
'.Thirty drops of turpentine taken in milk will often succeed better than anything ; 
it should be repeated every three hours until the bleeding ceases. A very simple 
and efficacious plan is to inject ice-cold water into the bowel. In these cases, too, 
the tincture of hamamelis virginica often succeeds admirably. A drop should be 
given in a tea-spoonful of water every quarter of an hour for the first hour, and 
then two drops every second or third hour. It is most likely to do good when the 
blood is dark, in colour. The energy with whicli the treatment should be pursued, 
and the question as to whether a doctor should be called in or not, must obviously 
depend on the amount of bleeding. As a rule, everything should be taken cold 
until the bleeding has ceased, and no stimulants should be allowed except in 
cases of alarming prostration. 



BLEEDING PROM THE STOMACH— HjEMATEMESI8. 

Haematemesis, or haemorrhage from the stomach, must be regarded simply as a 
symptom of disease, and not as a disease itself. It occurs in the course of many 
morbid conditions of the stomach and other organs. As a primary or idiopathic 
condition it is practically unknown ; we never meet with bleeding from the stomach 
analogous to the bleeding from the nose which is of such frequent occurrence in 
children and young people. 

But haemorrhage from the stomach, occurring in connection with other con- 
stitutional haemorrhages, or in their stead, is by no means uncommon. Not in- 
frequently haamatemesis is vicarious of menstruation, replacing the periods month 
after month with the greatest regularity. The case is recorded of a young woman 
who became the subject of hsematemesis recurring at the monthly periods about the 



138 THE TREATMENT OF DISEASES. 

age of fourteen. She had never menstruated in the usual way. This occurred until 
Bhe married, and in due time became pregnant, whereupon the haematemesis ceased. 
She brought forth her infant, but during the period of suckling the tsemorrhage did 
not recur. It came on again soon after she ceased to nurse the child No regular 
menstruation from the womb ever happened. This form of haemorrhage is not, as 
a rule, dangerous, and has little tendency to shorten the life of those who are 
afflicted with it. Sometimes, however, it does prove dangerous, the exhaustion 
from the mere loss of blood causing considerable alarm for ^he patient's safety. 
Two instances are recorded of suppressed menstruation being followed by copious 
haemorrhages from the stomach, which ultimately proved fatal. In neither of these 
cases was the health seriously deranged, nor previously to the onset of bleeding 
was there any debility or constitutional disturbance which could have afforded the 
slightest suspicion as to the unfortunate termination of the illness. 

In the majority of cases haematemesis is dependent on some injury to, or disease 
of, the stomach. The affections of the stomach in which it is most likely to arise are 
ulcer and cancer. It is sometimes a consequence of swallowing irritant poisons. 
Haemorrhages from the stomach may be the result of congestion of the stomach, 
arising from disease of the heart, or liver, or spleen. People who have injured 
their livers by excessive drinking often bring up blood from the stomach. 
Haematemesis may also occur in the course of yellow fever, sea-scurvy, and some 
other diseases. 

Vomiting of blood is more common in women than in men. It is usually pre- 
ceded by a sensation of weight and uneasiness at the pit of the stomach, and by 
nausea. It may also be ushered in by paleness of tlie face, dimness of vision, and a 
feeling of faintness. The haemorrhage commonly produces great depression, owing 
nartly to the alarm which, naturally enough, is always engendered by " spitting 
blood," and partly from the quantity of blood actually lost. In bleeding from the 
lungs, as we shall see presently, the blood is brought up by coughing, in mouthfuls 
at a time, is of a florid red colour, is frothy, and is frequently mixed with sputa. 
Moreover, bleeding from the lungs is usually preceded by cough, shortness of breath, 
with palpitation, tickling in the throat, and a peculiar sensation in the chest. We 
shall have more to say on the mode of distinguishing bleeding from the stomach from 
bleeding from the lungs, when speaking of the latter complaint. A difficulty in 
making the diagnosis may arise either when the blood is vomited immediately after 
its effusion into the stomach, so as to escape the action of the gastric juice, or when 
that proceeding from the lungs has been swallowed and subsequently vomited in an 
altered condition. Haemorrhage from the stomach is seldom, if ever, the firs^ 
symptom of disease of that organ. The patient has usually for some time been com- 
plaining of dyspeptic symptoms, and has suffered from pain in the stomach, nausea, 
or vomiting. 

When a large quantity of blood is poured out into the stomach, it appears 
to have a nauseating and emetic effect, and is soon rejected by vomiting. The 
dark colour which it presents is due to the action of the gastric juice, and the 
degree of blackness will be in proportion to the relative quantity of the acid 
which it meets in the stomach, and the intimacy of the admixture. Sometimes 



BLEEDING FROM THE STOMACH. 139 

the blood is clotted and not much altered in colour, and sometimes it is brown, 
of a chocolate tint, or like coffee-grounds. Sometimes, when the quantity of blood 
poured out into the stomach is small, it may pass into the intestines and be 
roided with the motions. In this way it may escape recognition either from the 
stools not being examined or from the changes in appearance it has undergone 
in its passage through the alimentary canal. 

Even when it can be shown that the blood has been vomited it is not a 
proof that there is disease of the stomach. The blood may have proceeded from 
the mouth or nose, and have been involuntarily and unconsciously swallowed. 
This is very likely to happen during sleep, especially to young children, and as 
the blood when subsequently vomited is coagulated and mixed with food, it is 
scarcely possible to say from its mere appearance that it has not arisen from 
bleeding from the stomach. We may in these doubtful and difficult cases succeed 
in arriving at a correct conclusioD by a careful inquiry into all the circumstances 
of the case, and an examination of the mouth and nose. Hseniatemesis is a 
complaint which is not infrequently feigned, either for the sake of avoiding some 
punishment, or with the view of exciting compassion. A young girl who was 
anxious to avoid the constraints of a convent, pretended that she was suffering 
from severe hsematemesis. In fact, on several occasions, she vomited large 
quantities of blood in the presence of the physicians who had been summoned 
to her assistance. It was not till long after, that it transpired that she had 
swallowed the blood, which had been conveyed to her secretly from the neighbouring 
shambles. 

Severe haemorrhages from the stomach are occasionally directly fatal ; and this 
is more likely to occur when the bleeding results from cirrhosis of the liver — 
the form of liver disease caused by drink — than when it originates in ulcer or 
cancer of the stomach. In the last-named disorders haemorrhage is often dangerous 
from the exhaustion and anaemia it produces. At the same time a very large 
number of patients with hsematemesis recover from the most hopelessly anaemic 
states; and we should never despair of saving the patient until life is actually 
extinct. 

Next, as to the treatment of hsematemesis. What should you do in the case 
of a person vomiting blood ? In the first place, keep your head steady. No noise, 
no hurry, no talking. Stand back, please, and give him plenty of air. Make 
him lie down, undo his clothes, open the windows, and you, sir, go and get some 
ice, as sharp as you like. When the ice comes, break it up, give him little pieces 
to swallow — ice pills — and rub a great lump all over his stomach outside. If you 
have an astringent or astringent mixture in the house, give him a dose; you can be 
doing this whilst they are gone for the ice. If you have either the acetate of lead 
mixture (Pr. 30), the perchloride of iron mixture (Pr. 1), or the gallic acid 
mixture (Pr. 29), give three table-spoonfuls at once ; or, if you have any tincture of 
steel, give a tea-spoonful of this in a glass of water; or, if you have liquid extract of 
ergot, give a tea-spoonful of this in water ; or, if you have oil of turpentine, give a 
tea-spoonful of this in water or milk ; or, if you have gallic acid or tannic acid, give 
one of these in water The dose of either gallic or tannic acid is fifteen grains, 



140 THE TREATMENT OF DISEASES. 

but if there is much bleeding do not stop to weigh it, throw a little into a tumbler 
of water, stir it up, and make him toss it ofE If you have nothing but alum, 
this must do ; dissolve some in water, and make him take that, and give him some 
pieces to suck as well. Should faintness occur, it need excite no alarm, as it 
favours the coagulation of the blood, and may tend to arrest the bleeding. Should 
the faintness persist, iced champagne is an excellent restorative, and is not likely 
to excite vomiting. 

After the first sharp bout is over, and all immediate danger is passed, abstinence 
from solid food should be enjoined, with perfect rest in the horizontal position. The 
room should be kept cool, and iced acidulated drinks should be taken at intervals. 
It may be necessary to continue the use of one of the astringent mixtures. Probably 
the best is the acetate of lead (Pr. 30), two table-spoonfuls being taken either 
eveiy three or four hours, according to the condition of the patient. After a 
severe attack it may be necessary to abstain from giving any solid food by the mouth 
for some days, the strength being supported by nutritive injections. If anything is 
given by the mouth it had better be milk or beef-tea ; but these must be.eold, and 
nothing hot is to be taken. When there is much prostration it may be necessary to 
resort to the use of beef-tea enemata, containing a little brandy and twenty drops 
of laudanum. The laudanum allays the excitement, but should not be given oftener 
than three times a day, and its use should be discontinued as soon as possible. We 
have recommended the addition of brandy where there is much exhaustion, but 
stimulants should not be given unless there is some absolute necessity for them, as 
they are very apt to excite the bleeding. In some cases it may be necessary to give 
cream, raw eggs, essence of beef — Valentine's is good — various broths, and perhaps 
even cod-liver oil. When the bleeding is known to be dependent on liver disease, 
a good purge, say a compound jalap powder, or a three-grain calomel pill (Pr. 61), 
at bedtime, and a black draught in the morning, will do good by getting rid of 
the congestion, but this treatment would be hurtful in either ulcer or cancer of 
the stomach. When the complaint becomes chronic, and there is only a little 
spitting of blood occasionally, the gentian and acid mixture (Pr. 15) will often 
answer well, and the quinine mixture (Pr. 9) also proves valuable in many 
instances. 

We have by no means exhausted all our remedies for hsematemesis. We have 
already had occasion to refer to the employment of hamamelis virginica in different 
kinds of bleeding, and it succeeds capitally in haemorrhage from the stomach. The 
tincture should be given in drop doses in water every ten minutes, until the bleeding 
is arrested. By many people it is considered to be the best remedy in these cases, 
and undoubtedly it often acts admirably. When the haemorrhage is accompanied or 
preceded by flushed face, shiverings, and quick pulse, aconite should be given accord- 
ing to Pr. 38. When the blood is bright red, and the face is pale, ipecacuanha 
should be tried (Pr. 50). It is often used after or in alternation with aconite. 
Ipecacuanha is especially indicated in haematemesis vicarious of menstruation. In 
these cases, when the catemenia desert their natural channel and seek an outlet 
through the stomach, it will be well, while means are taken to discourage the 
haematerp*^, to endeavour to solicit tLe discharge in the right direction. And we 



BLOOD-SPITTING*. 141 



often succeed in this object by placing leeches upon the groins of these patients 
immediately before the period when the vicarious menstruation is expected, and by 
putting their feet at the same time into hot water, or even by laying the patient in 
a warm ba &. 

In all cases of bleeding from the stomach the attendance of a medical man is 
necessary. 

BLOOD-SPITTING. 

If a person spit up more than a few drops of blood, we should advise him to 
see his doctor and have his chest examined. Quite a large quantity of blood may 
be spat up, and nothing come of it; but still it is well to be cautious, and in such a 
case as this it is really absolutely necessary that the matter should be thoroughly 
investigated. The most common cause of blood-spitting is consumption ; but there 
are other causes, and it does not absolutely follow because a man spits blood that he 
is consumptive. Sometimes the blood comes up without any warning ; but people 
who are subject to haemoptysis — as spitting of blood is technically called — often 
know by experienco what is about to happen. It is generally coughed up a 
mouthful at a time, but sometimes we have seen it come up in gushes — nay, almost 
in torrents. The quantity may vary from a mere streak to a pint or more. The 
blood is generally bright red and frothy; but occasionally, especially when it is 
discharged suddenly, it is dark in colour. There may be clots, but usually it 
is entirely liquid. The attack varies much in duration : it may be all over in a 
minute or two, or the expectoration may be tinged with blood for days 
together. 

In a person disposed to bleeding from the lungs, the onset of an attack may be 
determined by a variety of causes. Anything which hurries the circulation will 
have a tendency to excite the haemorrhage — straining of any kind, great bodily 
efforts, active exercise, much talking, and more especially public speaking or 
singing, or playing on wind instruments. 

When a man brings up blood we must try and find out where it comes from — 
does it come from the lungs or from the stomach 1 Sometimes this problem is easy 
enough to solve; at others it is most difficult. If a man is known to be consumptive, 
we suppose that the blood comes from his lungs ; and if a young woman has long 
suffered from symptoms of ulcer of the stomach, we naturally enough conclude that 
the haemorrhage is gastric in origin. Even when we know nothing about the 
previous history of the patient, the circumstances of the attack may serve to throw 
some light on the subject. In bleeding from the lungs the blood is generally 
coughed up in mouthf uls ; but in bleeding from the stomach it is vomited profusely. 
When the blood comes from the lungs it is frothy, and of a florid red colour; when 
from the stomach it is not frothy, and is dark in colour. When the blood comes 
from the lungs, it is mingled with phlegm ; when from the stomach, it is mixed with 
food. After bleeding from the stomach, the motions are often black or contain 
blood ; but in bleeding from the lungs this symptom is absent. For convenience 
of reference and comparison we have arranged these symptoms in parallej 
columns: — 



142 



THE TREATMENT OF DISEASES. 



In Bleeding from the Lungs — 

The patient has previously suffered from 
cough., shortness of breath, or other chest 
symptoms. 

The blood is coughed up in mouthfuls. 

The Mood is frothy, and of a florid red 
colour. 

The blood is mingled with phlegm. 

The bleeding is not followed by blood in 
the motions. 



In Bleeding from the Stomach — 

The patient has previously suffered from 
loss of appetite, vomiting, or e^her stomach 
symptoms. 

The blood is vomited up profusely. 

The blood is not frothy, and is dark- 
coloured. 

The blood is mixed with food. 

The bleeding is often followed by black 
motions, or they may contain blood. 



These are the rules, but there are many exceptions. On paper, it looks a 
very easy matter to distinguish between these two different kinds of bleeding ; but 
practically there is often a difficulty. For instance, a man who is spitting blood 
from his lungs may accidentally swallow some of it, and then that may give rise 
to nausea and vomiting ; or, on the other hand, a man who is vomiting blood may in 
his hurry and excitement draw some into his chest, and then it would set up cough- 
ing, and might be expelled again, mixed with phlegm. These rules will help 
you in making the diagnosis; but your own common sense will do more for you than 
anything. 

Sometimes bleeding from the nose is mistaken for spitting of blood. When 
a person is lying down, blood from the nose readily passes backwards into the 
throat, and when spat up might excite unnecessary alarm. Bleeding from the 
gums has, in some cases, been mistaken for something more serious; but an 
examination of the mouth will at once show the real nature of the case. 

What is to be done when any one is spitting blood ? In the first place send for 
the doctor ; and if it is coming up quickly, remember that there is no time to be lost. 
If you have any gallic acid or tannic acid in the house, put half a tea-spoonful into 
a little water, and make your patient drink it off at once ; or if you have the 
perchloride of iron mixture (Pr. 1), or the acetate of lead mixture (Pr. 30), give two 
table-spoonfuls of either, the latter by preference. If you have nothing else, give 
some pounded alum and water, or even salt and water. Half a tea-spoonful of 
common salt put on the tongue dry, and gradually swallowed, is by no means a bad 
remedy. Send for some ice, and give the patient some to suck, directing him to 
swallow the small pieces. If the bleeding is not arrested, put some ice on his 
chest or laack next to the skin ; you may wrap it up in a towel or handkerchief, 
if necessary. If you can get no ice, and the bleeding is very bad, you may throw 
some cold water over the chest and back, or use a towel wrung out of cold water. 
A very good remedy, and one that is easily obtained, is turpentine. Put some on 
a handkerchief, or into the palm of your hand, and hold it under the patient's nose, 
directing him to inhale the vapour. This will often succeed when everything else 
has failed, and it is a method of treatment which is available even when the patient 
cannot swallow. 

The energetic treatment we have advised is necessary only in bad cases — where 
the blood Is really Goming up in gushes, and life is endangered. When the blood is 



BLOOD-SPITTING. 1 43 



spat up only a little at a time, we may proceed more leisurely in the administration 
of our remedies. The patient should be put to bed in a cool well-ventilated room. 
He should have plenty of ice broken into small pieces to suck and swallow, and he 
should take the acetate of lead or gallic acid mixture every four hours. Everything 
should be taken quite cold. His fears should be calmed, and he should be kept as 
quiet as possible both mentally and bodily. If the cough is very troublesome, 
a tea-spoonful of the morphia linctus (Pr. 56), or a dose of the ordinary cough 
medicine, should be taken when necessary. It is very important to keep the 
cough quiet, or it may start fresh bleeding. If the bowels are confined, a pur- 
gative should be given at once, and one or two loose motions will do good. No 
stimulants of any kind should be given : this is very important. A glass of hot 
brandy-and-water given to a man spitting blood might kill him, so that you must 
be very particular on this point. If he complain of thirst, you may give him as 
much iced water or iced milk as you like, but nothing in the shape of stimulants. 

There are several other remedies for spitting of blood which may have to be 
employed in obstinate cases. 

The liquid extract of ergot, given in half tea-spoonful doses in water every three 
or four hours, often succeeds admirably. In very severe cases it may even be given 
hourly for the first three or four hours. The addition of ten drops of laudanum to 
each dose increases its efficacy, but the laudanum should not be given oftener than 
every four hours. In apparently hopeless cases the injection under the skin of a 
concentrated extract of ergot — known as ergotine — has often saved life; but this 
is a mode of treatment which can be resorted to only by a medical man. 

We have already spoken of the inhalation of turpentine as a valuable means of 
arresting bleeding from the lungs. Not uncommonly it is also given internally. 
Thirty drops of oil of turpentine are dropped into a wine-glassful of water, and 
taken every three hours. Not infrequently the turpentine, ergot, and laudanum 
are given together. 

Ipecacuanha has obtained a high reputation in the treatment of the less severe 
forms of hsemoptysis. Three drops of ipecacuanha wine may be taken in a tea- 
spoonful of water every ten minutes for the first hour, and subsequently five drops 
may be taken hourly, or the ipecacuanha mixture (Pr. 50) may be used. 

The tincture of hamamelis virginica often proves useful in spitting of blood. 
It is recommended chiefly in cases where the blood is dark in colour, and the flow 
is not very rapid. The dose is one or two drops in water every two or three 
hours. 

Aconite often succeeds admirably in checking spitting of blood. The great 
indication for its use is elevation of temperature. It may be given in the form 
of the aconite mixture (Pr. 38), as directed. 

Tincture of arnica is the remedy to employ when the bleeding has resulted from 
mechanical violence, as a blow on the chest. It is to be taken internally — a drop 
in a tea-spoonful of water every ten minutes for the first hour, and subsequently 
hourly. In many cases, dry cupping over the back or chest arrests the bleeding 
more quickly than anything. Good results are said to follow the application of the 
hot-water bag to the upper part of the spine. 



144 THE TREATMENT OF DISEASES. 



BOILS. 

We feel that it -would be superfluous to attempt to define a boiL Most people 
have a pretty clear idea of what they are like. A man who has once had a boil is 
not likely to forget it. It is a kind of thing that impresses itself on the memory. 
It makes, if not a favourable, at all events a lasting, impression. 

Boils are not particular where they come. As a rule, they prefer the posterior 
region, and then a chair becomes a useless article of furniture. They are not averse 
to making their appearance on the back of the neck, just where the edge of the 
collar catches you. Sometimes they come on the back, just under the braces, 
and a favourite spot for them is on the forehead, where it is rubbed by the rim 
of the hat. Although often out of sight, they are seldom out of mind. Sometimes 
they come singly, but, on the whole, they prefer to come in crops, or in a series of 
crops, one after another. Some people are very susceptible to them, and generally 
have one or two about them somewhere. In these peculiarly gifted individuals 
they come out on the very slightest provocation. You put a poultice on to cure 
one, and half-a-dozen others, flattered by the attention, make their appearance. 
Occasionally a blister is followed by a crop of boils, and an ordinary plaster has been 
known to bring them out. 

A boil is of no practical value. It is said that everything has its use, but this 
certainly does not apply to boils. They are of no use ; and few people consider them 
ornamental. They do not improve your personal appearance, and they do not add to 
your comfort. We are told, on good authority, that in many cases they must be 
looked upon as salutary, as being the means adopted by Nature to rid the system of 
morbid matters that irritate the constitutiim. This may be, but a boil is a violent 
remedy. Most people, if they had the choice, would prefer a less energetic means 
of having the system cleared out. Scientific doctors usually call them fwrunculi, 
but even then they are rather painful 

It is very difficult to say what boils are due to. They are generally ascribed to 
a " disordered condition of the blood," or to " atmospheric causes," or to " depressing 
influences." As a rule, they come in spring ; but they appear to have no particular 
objection to summer, autumn, or winter. They are far more prevalent some years 
than others : 1857 and 1858 were good boil years. They usually make their ap- 
pearance at especially inconvenient times, and they commonly pay a pretty long visit. 
As a rule, they prefer stout, full-bodied people ; but in default of better material, 
they will attack the ansemic and debilitated. They take an interest in athletic sports, 
and those who are in training often make their acquaintance. They are often to 
be found in company with the now almost extinct animal — the prize-fighter. They 
seem to be favourably disposed to good living, for they often put in an appearance 
when people take to living on a more liberal scale. When a young woman 
"goes to service" for the first time, she often develops boils. She has probably 
been living in the country all her life, and has had plenty of out-door exercise and 
not too much to eat When she finds a place in town she seldom gets out till after 
dark, and eats meat three times a day, and the result is — boils. The subjects of 
saccharine diabetes often suffer frightfully from boils, and in them they are by no 



soiia 145 

* n * — ■ 

means easy to cure. It is stated that boils and carbuncles often come from eating 
tiie flesh of animals who have died of the disease called pleuro-pneumonia. 

As a rule, boils display a particular affection for young people. They are fond 
<& children. They often come out during convalescence from fevers and other 
exhausting diseases. They sometimes result from over-suckling. 

There are two forms of boils. They are so closely related, that if one had one's 
choice it would be difficult to know which to prefer. The ordinary boil is lumpy, 
definite in extent, and prominent on the surface, whilst the flat or blind boil is less 
definite in its outline. The common boil usually begins as a little lump beneath the 
skin. At first it is not very painful, but subsequently it makes up for any deficiency 
on this score. As it increases in size it seems to irritate the surrounding tissue, 
which presents an angry appearance. After a time the external swelling becomes 
more pointedly conical, and acquires a bright-red blush on the surface. The pain is 
usually of a piercing, throbbing character, sometimes varied, by way of a change, by 
a distressing sensation of tension and weight at the part affected, the surface of 
which becomes exquisitely sensitive to the slightest irritation. In from four to 
eight days the boil bursts and lets out a little matter, disclosing a little opening 
leading straight down to the greenish-yellow core beneath. A day or two later 
this core comes away, leaving a large hole. The trouble is now nearly over. The 
subsequent progress towards recovery is rapid. For a day or two longer a little thin 
matter is discharged, and then the hole gradually fills up, leaving behind nothing 
but a small, depressed, and slightly-discoloured spot. 

The flat or blind boil generally commences in a small inflamed pimple, sur- 
rounded by a red and exquisitely tender ring, ill-defined in its margin. The pain is 
from the first of a throbbing character, keeping time with the beating of the heart, 
and is greatly increased by anything that quickens the circulation. The boil, when 
it bursts, discharges a little matter, but the core is usually far smaller than in a 
common boil. 

Boils, as a rule, give no notice of their coming ; yet not infrequently individuals 
who have had much personal experience of boils can anticipate the appearance of each 
fresh visitor by the occurrence of a certain feeling of general discomfort and chilliness, 
while in others the eruption is preceded by a transient irritability and querulousness 
of temper. 

What is the best remedy for boils 1 Sulphide of calcium, undoubtedly. A tenth 
of a grain should be taken hourly, or every two or three hours, or Pr. 78 may be 
employed. It lessens the inflammation, and reduces the area of the boil. Moreover, 
it liquefies the core, so that it separates more speedily, and the troublesome little visitor 
is induced to take its departure. When the skin is not yet broken, and the slowly 
separating core not exposed, this medicine often converts the boil into a little abscess, 
which soon bursts, and the whole thing is over. If the sulphide is taken sufficiently 
early, the boil often dries up, the inflammation subsides, and a hard knot is left which 
disappears in a few clays without the formation of a core, and without any discharge. 
The sulphide exerts a marked influence on the general health, removing the debility 
and malaise so frequently associated with these eruptions. Not only will the 
sulphide of calcium, taken in the manner we have indicated, cure existing boils, but 
10 



146 THE TREATMENT OF DISEASES. 

it will often prevent the formation of fresh ones. There are certain local measures 
which may be advantageously adopted, in addition to taking the sulphide of calcium. 
When you send to the chemist for your powders, tell him to forward you a bottle 
of liniment composed of equal parts of belladonna liniment and glycerine. At the 
same time order a piece of belladonna plaster, three inches square : the best is that 
spread on leather. Now cut a hole in the middle of your plaster about the size of 
the boil, and apply it so that the boil protrudes through the aperture. You will find 
no difficulty in making your plaster stick if you warm it for a little time before the 
fire. Next, daub the b#il gently but thoroughly with the liniment. Lastly, put a 
small linseed-meal poultice over the whole, taking care that it does not extend beyond 
the plaster. Change the poultice as often as it gets cold, and each time apply fresh 
liniment freely to the boil. The belladonna liniment helps to reduce the inflamma- 
tion and allay the pain. We have already mentioned that a poultice applied to the 
skin in the neighbourhood of boils often brings out a fresh crop. The object of the 
plaster is to protect the healthy skin from the direct contact of the poultice. 
This is the best treatment of boils with which we are acquainted. We have had 
considerable experience of it, and we are enabled to speak of it most favourably. 
Of course, when a tendency to boils is known to depend on any particular cause, 
that cause should as far as possible be removed. We must mention that sulphide 
of calcium occasionally fails, and in the deep-seated boils resulting from diabetes 
it usually does no good. 

The sulphurous waters of Blue Lick are often resorted to for the cure of 
boils. They contain sulphuretted hydrogen; the gas into which the sulphide of 
calcium is converted when taken into the system. The milder springs, such as 
those of A. von or Sharon, usually prove most efficacious. 

Belladonna, which is so serviceable when applied locally, often does good when 
taken internally. Of course the belladonna liniment is not intended for internal 
administration. The tincture of belladonna is for this purpose the right preparation. 
.The dose is two drops every two hours in a little water. This is equivalent to two 
tea-spoonfuls of the belladonna mixture (Pr. 39). It does most good when ad- 
ministered in the early stages, before matter has formed. When there is matter the 
sulphide of calcium is much to be preferred. 

A very good local treatment for boils consists in the application of flexible 
collodion, which should be painted over the part with a brush. This is applicable 
only to boils which have not yet burst. It is desirable to apply fresh coatings of 
collodion over the old ones, allowing them to remain until the boil has dried up 
and the sore place completely disappeared. This treatment has also the advan- 
tage of allaying the great irritation which often accompanies the early stage of 
boils. 

We are told on good authority that, in a certain limited number of cases, yeast 
taken fasting in table-spoonful doses three times a day does good. It is added that 
its use need not be continued longer than a fortnight or three weeks. We have had 
no experience of this method of treatment, but if we could not cure the boil with 
sulphide of calcium in a very much shorter time than that, we should be ashamed of 
ourselves. In some very obstinate cases it might be worth trying. 



BRAIN — DISEASES OF THE BRAIN. 147 

It is said that in the earlier stages boils may be cut short by rubbing in first 
tincture of camphor, and then olive oil, three times a day. 

A good remedy for preventing the recurrence of boils is sulphur. A few grains 
should be taken three or four times a day. Ten-drop doses of dilute sulphuric acid 
taken twice a day before meals will prove equally serviceable. 

Sufferers from boils require " feeding up." " A low diet " is seldom called for. 
Attention to diet, cleanliness, and healthy out-door exercise and recreation, will do 
much towards eradicating a predisposition to boils ; but when they do come, sulphide 
of calcium is the remedy. 

BRAIN — DISEASES OF THE BRAIN. 

The brain, like every organ in the body, is liable to many diseases, and sometimes, 
it must be confessed, it is not easy to detect their nature. We do not know as yet 
quite as much about the healthy brain as perhaps we ought to; we know that it is a 
complicated organ, but physiologists are not agreed about the function of each part. 
Encased as it is in a bony covering, it is not very easy to get at. We can ascertain 
the condition of most of the internal organs by different modes of examination with 
almost as much certainty as if we could see them. If we want to find out if there is 
anything the matter with the heart or lungs, we sound the chest and listen to it, and 
the problem is at once solved. Or if we want to know anything about the stomach, 
we look at the tongue ; or if about the kidneys, we examine the urine. In brain 
diseases we can employ none of these methods of examination ; and, moreover, the 
intellect is often interfered with, so that we are cut off from the information we 
might derive from the statements of the sufferer. We have the ophthalmoscope, it- 
is true, by which the eyes can be examined and some information obtained about the 
condition of the brain, but it wants special skill and experience to use that instrument, 
and its teachings are often far from reliable. 

There is one thing — disease of the brain is not likely to be overlooked or mistaken 
for anything else. A man has an apoplectic seizure, for instance, or becomes maniacal, 
and you can make no mistake about that. No, you are far more likely to suppose 
that you have to deal with some very serious disease of the brain, when in reality it 
is nothing but dyspepsia, or the liver is a little bit out of order. People who live in 
large towns often get very much worried and bothered about their work, their 
business, or whatever it may be. They get anxious and despondent, and very often 
think they have some disease of the brain, or that they are going mad. This is 
simply the result of over-work, and nine times out of ten it means nothing serious. 
The best remedy for it is bromide of potassium, fifteen grains, dissolved in a little 
water, three times a day, or it may be given in the form of the bromide of potassium 
mixture (Pr. 31) ; this, combined with rest and change of air and scene, will usually 
make these so-called brain symptoms disappear like magic. After a time phosphorus 
(Prs. 53 and 54), or the hypophosphites (Pr. 55), will do good. Phosphorus is a 
brain food, and is an excellent remedy in all disorders of that organ. 

Many people whose blood is poor suffer from a deficient supply of that fluid 
to the brain ; this gives rise to many disagreeable symptoms, but more especially to 



148 THE TREATMENT OF DISEASES. 

headache. The pain is usually felt in the temples and at the top of the head. It is 
not very severe, but is just as if something were pressing down and out from the 
inside. It is increased by abstinence from food and by the erect posture, and is often 
removed by lying down. It is intensified, too, by thinking, reading, writing, &c. It 
usually comes on in the morning, during dressing, goes off after breakfast, comes on 
again before luncheon, and so on. The pain is often throbbing in character, and is 
accompanied by a feeling of fulness and weight, so that people often think there is 
determination of blood to the head. In addition to the headache there may be noises 
in the ears and a general sense of pulsation all over. The noise is heard on both 
sides, and is rumbling and low-pitched, like distant cart-wheels. All these symptoms 
soon pass off when a little attention is paid to the general health. The great thing 
is to take plenty of good nourishing food, and to remove the ansemia, or poorness 
of blood, by iron and the other remedies recommended when speaking of that 
complaint. 

The reverse condition — congestion of the brain — is not of infrequent occurrence. 
It may be met with in the course of different fevers, when it is often the cau.se of 
delirium, or it may occur quite independently of any other disease. Old people whose 
tissues and blood-vessels are decaying not unfrequently suffer from this condition. 
They find it comes on when they are weak or cold, or when they have been over- 
exerting themselves, as in straining at stool or going up-stairs. Congestion of the 
brain is undoubtedly in many cases due to a tight cravat or shirt-collar, and 
people who have a tendency to apoplexy should look to this. It is a good rule to 
have the collar so big that you can get both hands in between it and the neck. A 
patient who suffers from congestion of the brain gets dull at times, and confused with 
regard to the use of words. He cannot remember the names of people or things, 
nor can he remember events that happened long ago. He exhibits a tendency to 
fall asleep after meals, and gets habitually stupid. All his sensations are more or less 
obtuse, his hearing is not good, and even when he does hear a thing you have to 
repeat it three or four times before you can get him to understand it. He often com- 
plains of numbness and giddiness, and sometimes says he sees things floating about 
before his eyes, or hears rumbling noises in his ears. These symptoms are always 
worse after lying down, and are increased by a meal, and more especially by over- 
loading the stomach. Often enough there is a sense of general weakness and weight 
in the limbs, which seem dead and heavy. There is never any actual loss of power in 
the limbs, but every movement is attended with a sense of weariness or disgust. 
Sometimes the forehead is hotter than the cheeks, and the lips and ears and the 
loose tissue under the eyes are dusky red. The tongue is usually furred; there is 
indigestion ; the bowels are sluggish, and often there is a tendency to shortness 
of the breath. One always fears in these cases that if the case be not taken in time, 
a fit may ensue. The great thing in the way of treatment is to pay attention to 
the general health, and see that the secretions are free. The bowels should be kept 
perfectly regular ; and should there be a deficiency of urine, the amount should be 
increased by taking some simple saline mixture or mineral water. The mind should 
be kept as quiet as possible ; and it is a good thing to sleep with the head well 
raised. Should the rest be disturbed, three table-spoonfuls of the bromide of potassium 



bright's disease. 149 



mixture (Pr. 31) should be taken every night at bed-time. Such medicines as iron, 
quinine, quassia, and gentian, should be taken occasionally, with the view of main- 
taining the general condition of the health. Mixtures Prs. 1, 2, 3, 6, 9, 11, and 15 
will be found useful for this purpose. Phosphorus and the hypophosphites (Prs. 
53, 54, and 55) are especially indicated. Parrish's Chemical Food often does good. 

Softening of the brain most frequently occurs in those whose health has been for 
soine time below the average, or in people who are the subjects of some chronic and 
exhausting disease. It occurs most commonly in those over the age of fifty. Usually 
there is more or less severe and persistent pain in the head, with attacks of giddiness 
coming on suddenly and soon passing off. There is a diminution of intellectual 
power, an embarrassment in answering questions, depression of spirits, and an 
inclination to shed tears on the slightest provocation. There are commonly prickings 
and twitchings of the limbs, and sometimes pain or numbness. There is often a 
tendency to stupor, especially after meals; and, more or less, impairment of vision or 
hearing is not uncommon. Softening of the brain is a complaint in which the 
attendance of a doctor is absolutely necessary. In any case in which a tendency to 
softening is suspected, attention to the following points will prove of value: — 
1. The body should be maintained at an even temperature; the feet and hands 
when chilly and blue should be put in hot water, or wrapped in and rubbed with 
warm flannels ; and the head should lie low. 2. Long intervals between the meals 
should be avoided; food easy of digestion should be given frequently; and the 
patient, if old, should not be allowed to pass the night without nourishment. 
3. When there is a tendency to faintness, some gentle stimulus, such as a glass 
of wine or a little sal volatile, should be given. 4. The mind should be easily 
and pleasantly occupied — lazy inaction being avoided on the one hand, and violent 
excitement on the other. 5. The bowels should be carefully attended to; con- 
stipation and straining at stool should be avoided, and so should the production 
by medicines of anything like active purgation. 

In cases where there is paralysis, convulsions, insensibility, delirium, or any of 
the more serious symptoms of brain disorder, it will of course be necessary to obtain 
medical aid. In many brain diseases, iodide of potassium given in large doses, 
gradually increasing from five grains up to ten, twenty, or even thirty, three times a 
day, will do good even when everything else has failed ; but this is a point on which 
you must be guided by your doctor. The iodide of potassium mixture (Pr. 32) 
contains five grains in the ounce ; but when it is desired to give a larger dose, the 
solution can be made twice or three times as strong. It is in cases in which there 
is reason to suspect a syphilitic taint that iodide of potassium proves so eminently 
serviceable. 

bright's disease. 

This disease, which was named after the eminent physician who in 1837 first 
described it, is regarded by some as a disease of the kidneys, and by others as 
a general constitutional disease in which the kidney is affected. What should be 
it3 exact place in the classification of diseases is a matter which in reality concerns 
ua but little. We can consider its symptoms and discuss its treatment equally well, 



150 THE TREATMENT OF DISEASES. 

whether we regard it as a purely local disease, like stone in the bladder, or as a 
disease of the whole system, like gout or rheumatism. 

It is a recogiiised fact that there are several different though closely-allied 
diseases included under the general name of Bright's. They have, however, one 
symptom in common, and that is that the urine contains albumen. Albumen is the 
substance which we know" familiarly as " white of egg," and, normally, in a state of 
health it is not found in the urine. It is impossible to tell simply by looking at the 
urine whether it contains albumen or not. White of egg before it is boiled is a 
clear glairy-looking fluid, and if we were to mix a little of it with urine it would 
produce no change in its appearance. To ascertain the presence of albumen in 
the urine, we must submit it to examination. If we take a fresh egg, and break it, 
we obtain the yolk and the white. If we mix a little of the white with water, and 
put it in what chemists call a test-tube, and boil it over the gas, or a spirit-lamp, it 
coagulates, and forms a thick white deposit. When we wish to examine urine for 
albumen, we submit it to a similar procedure. We take a test-tube, half fill it with 
the urine, and then boil it. If we obtain a deposit we may suspect the presence of 
albumen, but cannot be positive about it, because naturally the urine contains 
certain salts called phosphates, which if present in large quantities are precipitated 
on boiling. The presence of phosphates in the urine is of not the slightest con- 
sequence, but the presence of albumen is a serious matter ; hence the importance of 
distinguishing between these two bodies. This is easily done by adding a couple of 
drops of strong nitric acid (aquafortis) to the boiled urine. If the deposit is due to 
phosphates it will at once disappear on the addition of the acid ; but if it is owing to 
the presence of albumen it will remain unaltered. The quantity of albumen in the 
urine in Bright's disease varies very much. We have examined urine which became 
instantly and absolutely solid on boiling, so that the test-tube could be inverted. 
As a rule, however, the quantity is much smaller, and sometimes it amounts to little 
more than a distinct cloudiness. If on boiling a little of your urine in a test-tube, 
and then adding a few drops of nitric acid, you get no deposit, you may feel pretty 
sure that you are not suffering from Bright's disease. As a rule, albumen in the 
urine is of no moment unless it be in some quantity, or is detected on several 
different occasions. From the almost constant presence of albumen in the urine in 
Bright's disease, this complaint is often known as " albuminuria." 

Even if you find albumen in the urine it does not mean of necessity that the 
kidneys are diseased, or that the person is suffering from Bright's. Albumen appears 
temporarily in the urine in the course of many fevers, disappearing as soon as the 
temperature returns to the normal. In women it frequently occurs during the later 
months of pregnancy. It is caused partly by the altered condition of the blood, which 
is natural to the pregnant state, and partly by the pressure of the womb on the 
veins which carry the blood from the kidneys. It does not, as a rule, show itself 
until the seventh or eighth month, and often not until the approach of labour. It 
is generally attended with swelling of the lower extremities, and sometimes also of 
the face and upper parts of the body. Under these circumstances it is usually of 
little importance, for in the large majority of cases it all disappears in forty-eighty 
and sometimes in twenty-four, hours after delivery, 



bright's disease. 151 



Blight's disease may arise from many different causes, one of the most common 
being the somewhat complex process which is known as "catching cold." It is, of 
course, not every one who catches cold who has an attack of Bright's, but still on 
inquiry it will be found that the majority of people who are suffering or have 
suffered from this disease refer its origin to some exposure to wet or cold. Cold 
operating slowly and continuously is also a prolific source of Bright's disease. 
Persons whose occupations expose them to the inclemency of the season without 
adequate protection, those who work in hot workshops and are in the habit of 
going out to cool their heated bodies in the open air, the indigent classes who, 
insufficiently clad and ill-fed, dwell in damp cellars amidst dirt and squalor, 
furnish a large proportion of victims to this disease. The abuse of spirituous 
liquors also ranks high as a determining cause of Bright's. It is not the habitual 
drunkard only who exhibits this tendency to kidney disease, but the dram-drinker 
who is in the constant habit of using ardent spirits several times a day without 
becoming actually intoxicated. Malt liquors, though far less pernicious than spirits, 
are, when largely indulged in, not without their influence in producing Bright's 
disease. In the case of a journeyman baker, the complaint was clearly traced to the 
patient's habit of fuddling himself with beer from Saturday night to Monday 
morning, a practice which he had previously followed for many years. Yery 
frequently intemperate habits go hand-in-hand with exposed occupations, and it 
hardly excites our surprise to find that a large proportion of cases occurs among 
labourers, cabmen, carters, hawkers, glass-blowers, smelters, and puddlers. In 
many instances the disease is undoubtedly owing to some constitutional taint, such 
as scrofula ; and among the more opulent classes gout is a prominent antecedent. 

Bright's disease may occur either in an acute or in a chronic form. Acute 
Bright's disease may arise from any of the causes to which we have already referred, 
but in a large number of cases it follows an attack of scarlet fever. The functions 
of the skin are interfered with by the rash and the subsequent desquamation, or 
peeling, and an excessive pressure of work is consequently thrown on the kidneys. 
It is now well understood that kidney disease is not a necessary sequel of scarlet 
fever, and that the scarlatinal poison is, under favourable circumstances, eliminated 
entirely by the skin, so that it is only when the natural course of the disease is 
interfered with by some disturbing cause, such as exposure to cold, that it is diverted 
into other channels. The reason why dropsy so commonly follows a mild attack of 
scarlet fever is that little importance is attached to the disease, and no care is taken 
to protect the patient from the injurious effects of cold. 

There can be little difficulty in recognising the onset of an attack of acute 
Bright's disease. A boy, we will suppose, has just recovered from scarlatina, and 
his friends, thinking that an airing will hasten convalescence, take h\m down the 
river on the steamboat for a good blow. Towards evening he is very tired, says 
he feels chilly, and is perhaps sick. The next morning he is worse, and complains 
of a dull aching pain in the back and limbs. His countenance is pale and puffy, 
and wears a heavy stupid expression, and there is distinct swelling of the limbs 
and trunk. The thermometer shows that there is fever, the pulse is hard and full, 
there is no appetite, thirst is excessive, and the skin is hot and dry. The urine is 



152 THE TREATMENT OF DISEASES. 

passed in small quantities, and when the doctor examines it he finds that it contains 
s great deal of albumen ; there may even be some blood 

The attack may last for a period varying from a few days to some weeks. One 
of the earliest signs of a favourable termination is an increase in the amount of 
urine to three or four pints or more in the course of the twenty-four hours. At the 
same time the skin becomes moister, and the dropsy gradually decreases. An attack 
of Bright's disease, such as we have described, is a very serious matter, particularly 
from its tendency to give rise to lung complications; but nevertheless, in the majority 
of eases, a favourable termination may be expected. 

In every case of acute Bright's disease the doctor should be sent for without delay. 
As, however, medical assistance is not always at hand, we will indicate the general 
course of treatment to be adopted. The patient should be strictly confined to bed, 
should be wrapped up in flannels, and made to lie between the blankets. A large 
hot linseed-meal poultice should be applied to the loins, and changed every three 
hours, or oftener if necessary. A hot bath should be given every evening or every 
alternate evening, to promote the action of the skin; or, when appliances are at 
hand, a hot-air bath may be advantageously substituted. A " blanket bath " often 
proves useful. A large thick blanket is wrung as dry as possible out of boiling 
water, and as soon as it is cool enough to be borne it should be wrapped round the 
patient, who is then to be covered with bed-clothes, which are to be heaped up over 
him. In twenty minutes or half an hour the wet blanket should be removed, and 
the skin quickly dried with a warm soft towel. Respecting the general manage- 
ment of the patient there is little more to be said. The room should be well ventilated, 
and should be kept at a moderate and equable temperature. At the commencement 
of the attack there is little desire for food, but considerable thirst — two natural 
indications by which we may be safely guided. The diet should be composed chiefly 
of light farinaceous food, and milk should be administered freely. The action of the 
kidneys may be materially promoted by getting the patient to drink plenty of 
water or any simple fluid, care being taken, however, not to allow him to over- 
distend the stomach by taking too much at a tima 

Next, as to the medicinal treatment. If the complaint can be caught quite at 
its commencement, aconite is the best remedy. It should be administered in the 
form of the aconite mixture (Pr. 38) we have so frequently had occasion to use. 
The dose is a tea-spoonful every ten minutes for the first hour, and subsequently 
hourly. This treatment should be commenced immediately the nature of the 
complaint is suspected, and without losing time by waiting for the arrival of the 
doctor. Even if you are wrong in supposing that it is Bright's disease, no harm 
will have been done. You are nearly always safe in giving aconite when any one is 
feverish. 

Respecting the subsequent treatment we have little to add to what we have 
already said when speaking of the treatment of dropsy. The bowels should be freely 
opened by compound jalap and bitartrate of potash powder (Pr. 98), the dose of 
which must be regulated by the age of the patient. For, example, a boy of four 
would require only a quarter of the adult dose. Care should be taken to guard 
against excessive purging, as it is apt to prove very weakening. Mercury, or any 



WIGHT'S DISEASE. 153 



medicine containing that drug, should be avoided on account of the extreme 
susceptibility of people suffering from Bright's disease to its action. A very small 
dose of either blue pill or grey powder would suffice to produce profuse salivation, 
the occurrence of which would in all probability augment the severity of many of 
the symptoms, and possibly imperil the patient's chances of recovery. Digitalis or 
the resin of copaiba will be found useful in increasing the action of the kidneys and 
diminishing the dropsy. The indications for their employment will be subsequently 
given, (See Digitalis and Copaiba in the " Materia Medica.") When the fever has 
abated and the dropsy is yielding, the more active measures may be discontinued, 
or pursued less energetically; but the efforts to restore or maintain the action of the 
skin should be persevered in. When convalescence is fairly established — and not 
till then — iron may be given with advantage. It is best to begin with small doses, 
and if it agrees to gradually increase them. A table-spoonful, or even half a table- 
spoonful, of the mixture (Pr. 1) every four hours will be enough to commence with, 
the full dose being worked up to in time. The action of the iron is to diminish the 
quantity of albumen in the urine. 

When the patient has recovered from his attack, unusual care will have to be 
taken to guard against a relapse, to which there is always a tendency for a consider- 
able time. The slightest exposure to cold or wet is often sufficient to cause 
the re-appearance of tho albumen in the urine, with a repetition of all the old 
symptoms. When the patient is strong enough to be moved, and the urine has 
completely regained its normal character, a change of air to a warm sheltered 
locality is likely to prove highly beneficial, and to hasten the restoration of the 
impoverished blood. 

Sometimes acute Bright's disease, instead of taking its departure and leaving the 
patient to recover from the effects of the attack, assumes a chronic form. In the 
great majority of cases, however, chronic Bright's disease is not a sequel of an acute 
attack. On the contrary, it begins slowly, insidiously, and almost imperceptibly. 
In very many cases it is not detected, its existence is not even suspected, until it has 
existed for months, and perhaps for years. At length the patient is awakened to a 
sense of his condition by the gradual failure of his strength, the increasing pallor 
and sallowness of his complexion, and his disinclination or even inability for 
exertion. Perhaps his suspicions are awakened by a little puffiness under the eyes, 
a slight swelling of the ankles at night, or by unusual frequency of passing water. 
Sometimes the disease creeps on stealthily in the wake of some pre-existing disorder, 
such as consumption, gout, constitutional syphilis, or chronic alcoholism. It may 
remain long concealed, and then suddenly reveal itself in the guise of an acute 
attack after exposure to cold or a fit of intoxication. 

As we have already said, there are several different varieties of kidney disease 
included under the general term of Bright's, and it is only right we should state 
that when we speak of the symptoms of chronic Bright's disease we are speaking 
only in general terms, and that our statements, though in the main correct, may be 
found to be inapplicable to certain conditions. For example, as a rule, the urine con- 
tains albumen, but occasionally, even in confirmed and fatally-ending cases, only the 
minutest traces may be detected. Again, in the large majority of cases there is 



154 THE TREATMENT OP DISEASES. 

dropsy, but occasionally not a sign of effusion can be discovered. Speaking generally, 
then, we should say the symptoms of chronic Bright's disease were debility, general 
impairment of the health, pallor of the face, pain in the loins, a frequent desire to 
pass water (particularly at night), albuminous urine, and dropsy. It should be ■ 
distinctly understood that the presence of one or two of these symptoms would 
not justify us in assuming that the patient was suffering from Bright's. It is 
necessary for the establishment of the diagnosis that all, or at all events a large 
majority of them, should be present, the most important being dropsy and the 
existence of albumen in the urine. Delirium, convulsions, or coma, may sometimes 
occur in the course of Bright's disease, and these symptoms are of the very gravest 
importance, and require energetic treatment, the exact nature of which must depend 
on the condition of the patient. 

The tenure of life of a person suffering from Bright's disease is undoubtedly 
somewhat precarious ; but still, under favourable conditions and by the use of 
appropriate remedies, it may be prolonged for several years, the patient enjoying 
the pleasures and fulfilling the duties of existence very much as other people do. 
He will have to take the very greatest care of himself, and should always remember 
that any imprudent indulgence or exposure may quickly reduce him to a condition 
of the most imminent peril. As a matter of precaution against cold, he should 
be habitually clothed in flannel, and the activity of the skin should be encouraged 
by moderate walking or carriage exercise, and the occasional use of warm baths, 
with friction to the surface. The bowels should be opened once daily, and the diet 
should be light and nutritious. Milk nearly always agrees well, and should be 
taken habitually as an article of food. Two or three glasses of claret or hock daily, 
or a glass of beer, may be taken; but port and sherry and all kinds of spirits usually 
do harm, and should be strictly avoided. Iron in all forms proves beneficial, and 
should be taken at intervals. The tincture of steel, and the iron mixtures (Prs. 1 
and 2), are excellent preparations; but the less astringent forms, such as Prs. 3, 4, 
and 6, may be resorted to occasionally by way of change. The best methods of 
dealing with dropsy will be subsequently discussed. [See Dropsy.) 

BRONCHITIS. 

Bronchitis may occur either as an acute or as a chronic disease. In the former 
case there is a sharp attack lasting a few days, or at the outside a week or two, whilst 
in the latter the complaint comes on year after year, and may last the best part of the 
winter. We will first consider the former variety. 

Acute Bronchitis. — It may occur at any age, but is most commonly met with at 
the extremes of life. It is a frequent complaint amongst children, especially when 
they are cutting their first set of teeth, and old people are also very prone to suffer 
from it. It occurs both in men and women, the former, from their frequent exposures 
to wet and cold, being more subject to it than the latter. Any constitutional weak- 
ness or debility, arising from over-work, under-feeding, or neglect of the natural laws 
of health, greatly increases the liability to it. It frequently attacks those who are 
suffering from some chronic illness, such as gout, or diabetes, or Bright's disease. It is 



BRONCHITIS. 155 



a very common cause of death amongst rickety children. One attack of acute 
bronchitis favours the occurrence of another. The occupations which beget a liability 
to bronchitis are those which involve much exposure to wet and cold or sudden and 
marked changes of temperature. Employments which necessitate the inhalation of 
irritating particles floating in the air, such as cotton, steel, or charcoal, favour its occur- 
rence. It naturally follows that the complaint is commoner amongst those who earn 
their bread by the sweat of the brow than with the rich and well-to-do. By far the 
largest number of cases is met with in the autumn and winter months. In summer 
it is comparatively rare, but from November to March or April it is very common. 
A sudden change in the weather, or a north-east or east wind, will be sure to 
bring with it bronchitis. 

The immediate cause of bronchitis is, nine times out of ten, cold in some form or 
other. It acts in many ways — you may get hot running to the station to catch a train, 
and then sit in a draught from the window ; or you may get hot dancing, and then 
go and cool yourself on the balcony ; or you may get wet through, and neglect to 
change your clothes, or have no opportunity of sc doing. Boots that let in the wet 
are a fruitful source of bronchitis. Many people get an attack from neglecting to 
wear flannels or a sufficient amount of warm clothing in the winter ; sleeping in damp 
sheets has caused many a man's death from bronchitis. If you are subject to this 
complaint, you cannot be too particular in keeping out cold, although you must be 
careful not to keep out fresh air as well. Living in a close stuffy room soon weakens 
and makes any person more than ever susceptible to bronchitis. Children who 
drivel much, and whose garments covering the chest are constantly moist, are very 
likely to have bronchitis, so that the greatest care should be taken to keep them dry 
and clean. Grit and dust have the credit of being able to excite bronchitis, and with 
many people they undoubtedly produce great irritation of the bronchial tubes. 

Bronchitis varies very much in its severity — sometimes it is little more than a 
common cold, at others it is so severe as to endanger the patient's life. Usually, to begin 
•with, there is an irritating watery flow from the nose and eyes, and a feeling of fulness, 
heat, and soreness in these parts, with frequent attacks of sneezing. Very often there 
is also tension or fulness over the forehead. The throat feels sore and rough ; and the 
patient has to keep on hawking to clear it. The voice is usually affected, and becomes 
hoarse and husky, so that it seems quite an effort to talk. The patient feels hot and 
feverish and out of sorts, but the temperature is usually but slightly elevated. The 
pulse is a little quicker than natural Sometimes the limbs ache, and the patient seems 
to have a cold all over. There is loss of appetite, the tongue is furred, and the bowels 
are confined. There is a sense of heat or rawness in the chest, particularly beneath 
the upper part of the breast-bone. Sometimes there is a feeling of tickling which 
is peculiarly distressing. Cough soon sets in, and usually comes on in fits, either 
spontaneously or from a draught of cold air, or some other source of irritation. They 
increase in frequency and severity as the disease progresses, and they are usually worse 
on first lying down at night or getting up in the morning. There is usually no 
expectoration to begin with, but this soon sets in ; at first it is very slight, and thin 
and watery in appearance, but after a time it gets thicker and more copious, and 
assumes a yellow colour. Sometimes it is so thick that the greatest difficulty s§ 



156 THE TREATMENT OF DISEASES. 

experienced in getting rid of it. It sticks about the throat and the back of the mouth 
in the most distressing manner. Sometimes there are little streaks of blood in it, 
but that arises from the violence of the cough, and too much importance must not be 
attached to it. In favourable cases, and when energetic treatment is resorted to, the 
attack runs it3 course in from three to five days; but if the patient keeps about in the 
cold air, and takes no care of himself, it may last two or three weeks or even longer. 
There is usually no cause for anxiety ; but in rickety children, and in those who are 
ill-nourished, or the subject of some constitutional disease, it often proves dangerous, 
and a fatal result may ensue. Sometimes the inflammation extends to the smaller 
bronchial tubes, and it then constitutes a very serious condition. This complication 
is more likely to occur in children than in adults. The onset of the bronchitis of the 
smaller tubes, or " capillary " bronchitis, as it is called, is often ushered in by well- 
marked rigors, severe headache, and sickness. Shortness of the breath is always a 
prominent symptom. It may be limited to quickened and somewhat laborious 
breathing, with a feeling of constriction and oppression across the chest, or the respira- 
tions may be extremely frequent and hurried, attended with violent efforts during 
inspiration and an urgent craving for air. Sometimes there is very great wheezing, 
which may be heard at some distance from the bed. The cough is almost continuous, 
but it also comes on in extremely violent, prolonged, and distressing paroxysms, during 
which the face becomes swollen, red or purple, and the veins swell and the arteries 
throb and throb again. There is a great deal of expectoration, which is coughed up 
with the greatest difficulty. There is an exception to this in the case of children, 
who do not expectorate, or rather swallow what they bring up. 

In capillary bronchitis the constitutional symptoms are always very severe. 
The temperature may rise to 103° Fahr. or more, and the pulse is quick and full. 
The symptoms may gradually subside, but very often the lips and face, and even the 
hands and feet, become blue and cold and livid, as the result of the interference 
with the breathing, and then there is the greatest danger. Cold clammy sweats 
break out about the face and upper part of the body, and the exhaustion becomes 
extreme. It is a pitiable sight to see a little child in this condition. Often enough 
there is intense thirst and craving for water, and soon the mind begins to wander. The 
cough ceases, the patient is too weak to expectorate, or too ill to feel the necessity 
for so doing, and gradually the chest becomes blocked up with the phlegm, and then 
recovery is almost hopeless. Fortunately, capillary bronchitis occurs in only a small 
number of cases, and ordinarily the symptoms are far less serious. 

In the milder forms of bronchitis the patient is usually convalescent in from 
nine to twelve days; but in severe cases of capillary bronchitis it may be three 
weeks before convalescence is established. There is evidence to show that bronchitis 
may lay the foundation of consumption. 

Bronchitis, however slight, should never be. neglected, because a little care 
and appropriate treatment may put an end to an attack which might otherwise 
become very serious, or even lead to a fatal result. A neglected cold may lay 
the foundation of an incurable disease. The treatment will vary somewhat, accord- 
ing to the severity of the attack ; but if you err at all be sure that you err on 
the side of over-care. In the first place, it is absolutely necessary to stay in-doors. 



BRONCHITIS. 157 



It is very hard sometimes to have to do so, but there is no help for it. It is economy 
of time in the long-run, and the sooner you recognise that fact, the better your 
chances of a speedy recovery. Your room should be kept warm with a good fire if 
the weather is at all unfavourable. It is a good thing to try to get yourself into a 
profuse perspiration, and you had better do this on the first night of your illness. 
Have a good fire lighted in your bedroom a couple of hours or more before you go 
to bed. Have an extra supply of bed-clothing, and sleep between the blankets. 
Have your bed well warmed with the warming-pan, and take a couple of hot- water 
bottles to bed with you. These hot-water bottles should be placed in a flannel bag, 
and then you can put them against your legs or body without any fear of being 
burnt. The water should be as hot as possible, and the bottles should be rinsed out 
with hot water to warm them before being used. You should either have a hot bath 
just before getting into bed, or you should put your feet in hot water with some salt 
and mustard in it. Then you should put a good large hot mustard poultice over 
your chest, and keep it on as long as you can conveniently bear it. If you are 
a bachelor, and have a difficulty in getting any one to make a poultice for you, 
a couple of mustard-leaves will do almost equally well, and they are very much less 
trouble. Then you will want a night-cap — something hot and strong. It does not 
matter very much what form this takes, but the following is as good as any: — 
" Beat up an egg with a wine-glassful of sherry, and add it to a basin of hot gruel. 
Flavour with nutmeg, sugar, and lemon-peel." If you cannot have gruel you can 
always get spirits and water, and a good stiff glass of gin, brandy, or rum and water, 
with plenty of sugar, is not to be sneezed at. Directly you have taken it, you should 
cover yourself up, and try to go to sleep. If you take a book and read, it will not do 
70U half so much good, for you will have to keep your arms out to hold the book, 
and you will never get into a perspiration ; so we say cover yourself up, and try to 
get to sleep. You will probably find it very hot, and be tempted to throw off some 
of the bed-clothes ; but you are not to do that on any account, or you will assuredly 
defeat your object. Many people employ a kind of domestic Turkish bath when 
they wish to get into a perspiration, and nothing could be better, provided you have 
the apparatus and know how to use it. Others prefer the wet pack for this purpose, 
and we have nothing to say against it, for it often answers admirably. These 
methods may be used in conjunction with some of the other measures we have 
recommended. If taken quite at the beginning, aconite (Pr. 38) will often succeed 
better than anything. This mode of treatment will be discussed more fully when 
speaking of " cold." In a severe case of bronchitis this simple treatment may fail 
to effect a cure, although it will be sure to do some good. If you are very bad you 
had better keep in bed for a day or two, but if not you may get up and go into 
your sitting-room. You will find it a good plan to keep a linseed-meal poultice 
constantly on your chest. It should be put on as hot as you can bear it, and as soon 
as it gets cold it should be changed for another. In the case of children it is best to 
hai^e a jacket poultice — that is, a poultice big enough to go over both chest and 
back. Children should be kept in bed, for they are then more easily managed, and 
if it does nothing else it keeps them out of colds and draughts. For adults, 
inhalations are very useful. The simplest way of inhaling is to get a jugful of hot 



158 THE TREATMENT OF DISEASES. 

water, put jour mouth over it, and breathe the steam. You should put a towel 
round the top of the jug, and then you will have something to rest your face on, 
and you will not burn yourself. Sometimes, when the cough is very irritable, it 
is a good plan to put a couple of tea-spoonfuls of chloric ether in the water, or 
a little chloroform or ether. The air of the room may be kept moist by a kettle of 
water on the fire, and it may be advisable to put the chloroform or ether in this, so 
that it gradually becomes diffused. 

Respecting diet. If there is much constitutional disturbance, or if the cough is 
very troublesome, solid food is inadmissible. You should have plenty of good strong 
beef tea, and, above all, plenty of milk. The milk may be taken cold or tepid, alone 
or mixed with water or soda,- water, as taste dictates. When it forms the staple article 
of diet, three or four pints will have to be taken in the course of a day. It must be 
remembered that it is a food, and should be taken at regular intervals, say every two 
or three hours, and not at any time when you are thirsty or happen to fancy it. 
What about stimulants ? It is difficult to lay down any positive rules on this point, 
as so much will depend on the actual condition of the patient. As a rule, you will 
do better without anything ; when there is much prostration you will want three or 
four ounces of brandy in the twenty-four hours, or perhaps more. The brandy may 
be given in water or mixed with the milk. 

In the early stage of bronchitis it is advisable to give a sedative and expectorant 
mixture such as the following :— 

Be Sweet spirits of nitre, four drachms. 

Solution of acetate of ammonia, one ounce and a half. 
Ipecacuanha wine, two drachms. 
Paregoric, two drachms. 
Camphor julep, to make up eight ounces. 
Two table-spoonfuls to be taken every four hours. 

When the more acute symptoms have passed away, and the disease shows a 
tendency to lapse into a chronic condition, more benefit will be derived from the 
carbonate of ammonia and senega mixture (Pr. 22) than from anything else. It is 
very nasty to take, but it does good, and that is the great thing. Throughout the 
whole course of the treatment the bowels should be kept moderately open, though 
diarrhoea should be avoided. When there is constipation, it is a good plan to lead off 
with a calomel pill (Pr. 61) at bed-time, followed by a saline draught in the morning. 
In capillary bronchitis stimulating treatment is absolutely necessary, and anything 
that tends to lower the system must be scrupulously avoided. A very good mixture 
is the effervescing ammonia mixture (Pr. 99) taken every four hours. Children may 
take the carbonate of ammonia alone, simply dissolved in water and not in a state of 
effervescence ; the dose will vary from one to three grains every four hours according 
to age. Chlorate of potash lozenges are often serviceable. The application of mustard 
poultices or turpentine stupes to the chest must not be neglected. A few drops 
of chloroform, from ten to twenty poured on the hand and gently inhaled as it 
evaporates, will do much to relax spasm and facilitate expectoration, but it should 
never be carried to the extent of producing stupor. In the case of children tartar 
emetic in small doses often succeeds admirably. The following is a very useful formula : 



BRONCHITIS. 159 



— Take of tartar emetic one grain, water half a pint; dissolve. Of this a tea-spoonful 
is to be given every quarter of an hour for the first hour, and then hourly. Should 
it produce vomiting — as it often does — the dose must be reduced. It is especially 
useful when the child suffers from much wheezing and difficulty in breathing. 

When bronchitis occurs in a gouty subject, some colchicum wine should be added 
to the cough medicine — say fifteen drops to each dose. During convalescence tonics, 
such as quinine (Pr. 9), iron (Pr. 1), acid and gentian (Pr. 15), and cod-liver oil, 
should be given. The clothing should be warm, and a good stout plaster should be 
worn over the front of the chest. 

Those who are subject to attacks of bronchitis will have to take great care to 
avoid cold and wet in every shape and form. If possible, a change to a warm climate 
during the winter months should be enjoined. Cold sponging is useful, especially in 
the case of children. 

We now pass on to the consideration of 

Chronic Bronchitis. — This is usually the result of the acute affection, remaining 
sometimes even after a single attack, but in the majority of cases occurring after 
several repeated attacks. It is frightfully common, both in the city and in the 
country. It is most frequently met with in those who are exposed to the inclemency 
of the season. One man, a hospital patient who was under our care, was a peddler, 
and, in addition to being out in all weathers, had to use his voice in crying his 
wares. Another was a street ballad-singer. A third was a mason's labourer, who, 
in addition to often getting wet through without any opportunity of changing his 
clothes, was not unfrequently engaged in demolishing old houses and walls, so that 
he had to inhale the irritating dust from the dry mortar. It is not confined to men, 
but may be almost as commonly met with in women. Laundresses are frequent 
sufferers. They work in hot damp rooms, without very much clothes on, and find it 
difficult to resist the temptation to go out in the yard or stand at the door to try 
and get cool. Women who keep open grocery stores suffer in the same way. 
"We might give many other examples of those in whom it occurs ; but these will 
suffice to show that wet and cold are powerful predisposing causes. The complaint 
is met with most commonly in middle-aged people. 

Now. as to the symptoms. In the first place the patient has probably been 
troubled with cough for many years. During the summer he is pretty well ; but 
during the winter months — from October to March, or even May — he suffers greatly, 
sometimes without any intermission, occasionally getting a little better and then 
catching cold, or perhaps he may lose his cough for a few weeks, and then have 
a return of it from some slight exposure. The cough is very violent, frequent, and 
hacking, and it often comes on in fits. The paroxysms vary very much in their 
severity; they may last only a minute or two, or may continue almost without 
intermission for five, ten, or even twenty minutes. There may be only one or two 
attacks in the day, but sometimes the fit comes on two or three times in the course 
of an hour. The cough is generally brought on by exertion, and in bad cases so 
easily is it provoked that the patient is afraid to move or even speak. It is 
generally worse the first thing in the morning on getting out of bed. 

The cough is usually accompanied by expectoration, which is often very abundant. 



tso 



TSe treatment of diseases. 



Sometimes it is transparent and watery, but quite as frequently it is thick and 
yellow. It varies greatly in quantity, and is usually difficult to expel. Occasionally, 
after a violent bout of coughing, it is tinged with blood ; but there is never any 
real spitting of blood as there is in consumption. 

Shortness of breath is always a very prominent and distressing symptom. 
So short is the breath that often the patient can walk only a few yards, especially 
in the cold air. He finds it very hard work to get up-stairs, and is usually quite 
unfitted for an active life. The breathing grows worse at night, so that he cannot 
sleep unless with the head propped up with several pillows. He is troubled, too, 
with bad fits of shortness of breath, which generally come on at night, last several 
hours, and constrain him to sit up in bed. Sometimes the breathing is difficult only 
on exertion, but it — like the cough — is in most cases made much worse by fogs, 
east winds, or damp. 

Wasting is not a prominent symptom as it is in consumption, but still there is 
nearly always some loss of flesh in winter, which is gradually regained as summer 
returns. In bad cases the legs may swell. The sufferer from chronic bronchitis 
usually leads a most miserable existence ; for nearly six months out of the twelve 
he is practically an invalid. 

The best method of treating chronic bronchitis is by means of a spray. By & 
very simple apparatus a liquid can be "atomised," or converted into fine vapour. 
This process is probably familiar to most of our readers, for it is often used for the 
diffusion of scent. By inhaling the spray, the drug can be brought into immediate 
contact with the lungs, the part on which it is required to act There are several 
kinds of spray apparatus sold by instrument makers, but " Richardson's " is the one 

most commonly used for this 
v purpose. It is very simple, 
and the accompanying figure 
requires but little explanation. 
The bottle is about two-thirds 
filled with the liquid it is 
desired to atomise, and on 
squeezing the india-rubber ball 
(a) several times in succession 
the spray issues from the 
nozzle (b). A small tap (c) 
is usually placed just behind 
the nozzle, and must of course 
be open. The second india- 
rubber ball (d) acts simply as 
a reservoir, and serves to make the jet uniform. The end of the tube (e) is covered 
with linen, or has a little piece of sponge attached, to filter off any particles that 
m<ay be floating about in the liquid and might block up the apparatus. The best 
substance for spraying in chronic bronchitis is ipecacuanha wine. It is too strong to 
be used alone, and it should be diluted with twice the quantity of water. It is as 
wall to use tepid water, as the spray is then pleasanter to inhale. At first the nozzU 




Fig. 1. — RICHARDSON S S.P11AY APPARATUS. 



BRONCHITIS. 161 



of the apparatus should be placed about a couple of feet from the patient, but it 
may be gradually brought nearer. If much fluid collect in the mouth, it should 
be spat out and not swallowed, or it may cause nausea or even vomiting. The 
duration of the inhalation will depend on the quantity of spray produced by each 
compression of the elastic ball, and to a certain extent on the susceptibility of the 
patient to the action of the drug. It is a good plan to begin with about twenty 
squeezes, and to gradually increase the number at each sitting. It is seldom neces- 
sary to give more than sixty or seventy squeezes at one time. After every three or 
four squeezes, especially at the commencement, it is advisable to pause for a while. 
It is necessary to see that the tongue is not arched up against the roof of the mouth, 
or it will hinder the passage of the spray into the lungs. The spray should be 
taken well into the chest, or it will not do much good. The best way is to take 
a good deep breath, so as to get as much of the vapour as possible. The inhala- 
tion should be used twice daily, night and morning, for the first week, then once 
a day for another week, and after that the intervals may be gradually extended 
as the patient gets better. 

The benefit derived from the use of the ipecacuanha spray in chronic bronchitis 
is very great. The shortness of breath is the first symptom relieved. The night 
after the first spraying the patient usually has a fair night's rest, although, for 
months before, sleep may have been broken by shortness of breath and coughing 
The difficulty of breathing on exertion also quickly abates, and in a few days the 
patient can get about with comparatively little difficulty. A marked improvement 
takes place after each inhalation, and, unless the patient is unfortunate enough 
to catch a fresh cold, he progresses steadily. Patients have told us that in a week's 
time they could walk two miles with less distress of breathing than they could have 
walked a hundred yards before the spray was employed. In some instances two or 
three days elapse before any noticeable improvement takes place — this comparatively 
slow effect being sometimes due to awkward inhalation, so that but little ipecacuanha 
passes into the bronchial tubes. The effect on the cough and expectoration is also 
very marked, these both greatly decreasing in a few days, though the improvement 
in these respects is rather slower than in the case of the breathing. Sometimes for 
the first few days the expectoration is rather increased, but it speedily alters in 
character, so that it is expelled much more readily, and thus the cough becomes 
easier even before the expectoration diminishes. The patient is soon enabled 
to sleep at night with his head lower, and in a week or ten days, and sometimes 
earlier, can do with only one pillow — an improvement which occurs in spite of fogs, 
damp, or east winds • even, indeed, whilst the weather gets daily worse, and when 
the patient is exposed to it the chief part of the day. 

Sometimes, just at "first, an inhalation may excite a fit of coughing, which 
generally soon subsides ; but should it continue, a weaker solution should be used. 
The patient soon becomes accustomed to it, and inhales the spray freely into the 
lungs. At first he often inhales the spray less adroitly than he learns to do 
afterwards, and he is apt to arch his tongue so that it touches the palate, and con- 
sequently less enters the chest than when the tongue is depressed. This difficulty 
may usually be overcome hy holding the nose whilst the spraying is in progress* 
11 



162 THE TREATMENT OP DISEASES. 



The spray may produce dryness or roughness of the throat, with a raw sore sensation 
behind the breast-bone ; but this is temporary, and soon passes off. Sometimes the 
Bpray produces a certain amount of discomfort ; but, on the other hand, many 
people who are hoarse recover the voice after the first inhalation. 

Sometimes Siegle's spray apparatus succeeds even better than Richardson's. The 
great advantage of this form is that it works by steam, and the trouble of squeezing 

mthe ball is avoided. For self-administration it is 
very convenient. The boiler is filled with hot 
water through the opening at A, and then closed 
by the cork ; the ipecacuanha wine, diluted with 
water, is put in the bottle at b, the lamp is lighted, 
and in a minute or two the spray is given off. 
Many people have a great objection to the smell 
of the spirit used in the lamp, but this can be 
removed by adding to it a few drops of scent. 
There is no danger of the boiler bursting, as 
should the pressure become too great, the cork 
would be blown out. After each inhalation a 
Kg. 2.— siegle's spbay appakatus. little clean water should be sprayed through the 

apparatus to clean it, and the boiler should always 
be emptied before it is put away. The quantity to be used with the Siegle is at each 
sitting from one to two of the little bottlef uls of the ipecacuanha wine and water — 
one part of the former to two of the latter. 

Although we have assigned to the ipecacuanha spray so prominent a place in the 
keatment of chronic bronchitis, it must not be supposed that it is the only remedy for 
that distressing complaint. Sometimes it may be inconvenient or impossible to use 
the spray ; then a mixture must be given. This often happens in the case of poor 
people who have not the means to purchase the spray apparatus. Very frequently 
carbonate of ammonia succeeds admirably, and it may be conveniently given in com- 
bination with senega, as in Pr. 22. This mixture is especially indicated in chronic 
bronchitis occurring in old people. When the secretion is thick and abundant, its 
efficacy may be increased by the addition of fifteen grains of chloride of ammonia to 
each dose, or Pr. 36 may be used. Sometimes a solution of chloride of ammonia 
is used for spraying, but it is decidedly inferior to the ipecacuanha. An old- 
fashioned though very serviceable remedy is Friar's balsam. It should be taken 
three times a day, in half tea-spoonful doses, either beaten up with the yolk of 
an egg or suspended in mucilage. It is very useful in old-standing cases. A 
tea-spoonful may be put in a jug of boiling water and the steam inhaled. Nearly 
all resinous bodies seem to be usefnl in chronic bronchitis. Ammoniacum often 
does good. There is an ammoniac mixture in the U.S. Dispensatory, and 
the dose of this is from half an ounce to an ounce every four hours. When 
in long-standing cases there is a great deal of expectoration, the compound mix- 
ture of iron, or Griffith's mixture, as it used to be called, may be used with 
advantage. One or two table-spoonfuls should be taken every four hours. It is 
supposed to owe much of its efficacy to the myrrh that it contains. Tar often does a 



BRONZED BKTS. 163 



great deal of good in this complaint, and on the Continent it is a very great favourite. 
There is not the slightest objection to using it in conjunction with the ipecacuanha 
spray. Most chemists keep tar-water, and this is not very disagreeable to take. Tar 
pills (Pr. 70) often succeed admirably. Creosote is another capital remedy; a 
linctus may be made by adding four drops of creosote and four drachms of glycerine 
to four ounces of water (Pr. 58). Two or three tea-spoonfuls of this may be taken 
several times a day. It speedily eases the cough, but has less influence on the 
breathing. The creosote and opium mixture (Pr. 23) is also useful. The occasional 
application of iodine to the chest, and especially to the back, does good by diminish- 
ing the cough and lessening expectoration. 

In the great majority of cases of chronic bronchitis a general tonic plan of 
treatment is necessary. In addition to the remedies directed to the relief of the cough, 
a course of quinine (Pr. 9), or of acid and gentian (Pr. 15), often proves of service. 
The quinine may sometimes be given in combination with iron (Pr. 11). The oxide 
of zinc pills (Pr. 66) are also useful in some cases. When there is a great deal of ex- 
pectoration, resulting in loss of flesh and strength, cod-liver oil is of essential service. 
Pancreatic emulsion is a useful remedy in chronic bronchitis, particularly when 
given in conjunction with cod-liver oil. A table-spoonful of cod-liver oil should be 
taken directly after breakfast, and a tea-spoonful of the emulsion in a tumbler of 
milk, with a table-spoonful of brandy, two hours after dinner. If cod-liver oil 
disagrees, the pancreatic emulsion may be given two hours after breakfast, and again 
two hours after dinner. A dash of rum may be added to the milk instead of the 
brandy if preferred, and a small plain biscuit should be taken after the dose. 

The general management of the health also requires careful attention. It is very 
important to avoid sudden changes of temperature — as in going from a warm room to 
one without a fire. The sufferer from chronic bronchitis should always wear a respirator 
out-doors if it is at all damp or foggy. On really bad days it is almost impossible to 
go out. Different forms of bronchitis require different climates, but in every case it 
is desirable to ensure a tolerably warm temperature, without sudden changes, a 
moderately high altitude, and protection from cold winds. When there is cough 
without much expectoration, a soft relaxing atmosphere with moderately high tem- 
perature is recommended. When the expectoration is abundant, the patient is advised 
to resort to a dry, hot, and more or less stimulating climate. In this country people 
with chronic bronchitis usually go to Florida, Colorado, Santa-Barbara, Cal., Bermuda 
and Bahama Islands. Abroad, the chief resorts are Mentone, San Remo, Pisa, 
Rome, Cannes, Algiers, and Corfu. Plenty of warm clothing will have to be worn, 
with flannel next to the skin. A warm bath or Turkish bath should be employed 
from time to time. When the wer.ther permits, moderate exercise is advisable. The 
diet should be at all times nutritious, especially if there is much emaciation. Th© 
bowels will have to be regulated if they fail to act naturally. 



BRONZED SKIN, OR ADDISON S DISEASE. 

This is a comparatively rare disease. The most prominent characteristics are 
marked bloodlessness, coming on without any apparent cause, excessive and pro- 



, 164 THE TREATMENT OP DISEASES. 

gressive weakness, a feeble and perhaps rapid pulse, faintness on the least exertion, 
pain in the region of the stomach shooting through to between the shoulders, a 
pearly aspect of the whites of the eyes, loss of appetite, sickness, flabbiness of the 
limbs, or perhaps loss of flesh, and a brownish or dingy discoloration of the whole 
surface of the body. The browning, or bronzing, is not diffused uniformly over the 
surface of the skin, nor have the darker parts any definite outline. It occupies 
principally the front of the body and of the limbs, and is usually most marked about 
the face, neck, arms, armpits, and around the naveL Spots that have been blistered 
become very dark, as do sometimes the rings made by the pressure of the garters. 
The colour varies considerably in intensity. Usually the skin assumes a dingy or 
smoky hue, somewhat like the stain produced by the juice of walnuts ; but in one 
instance we are told that the patient was so generally and deeply darkened that 
but for his features he might have been mistaken for a mulatto. 

This is often a serious complaint, and no time should be lost in consulting a 
doctor. You must be careful not to mistake a slight attack of jaundice for Addison's 
disease. In jaundice, the whites of the eyes have a yellow tinge, and the urine 
is distinctly light-coloured. Moreover, you must not confound it with a skin 
disease called chloasma, which forms light-brown spots on the surface of the body. 
The margins of these spots are well marked, whilst in Addison's disease the bronzing 
has no definite outline. 

We may take this opportunity of mentioning that in women a little darkening of 
the skin occasionally occurs as a temporary condition, and is of not the slightest 
importance. Some women always get a little darker at the menstrual periods or 
when in the family way. The case is recorded of a lady who began to get brown as 
soon as she became pregnant, and before the termination was as black as a negress. 
After delivery the colour gradually disappeared. Fortunately, such cases are rare, 
although a brown stain may often be noticed on the forehead in women who are 
pregnant, or who are suffering from some derangement of the womb. Every one 
must have noticed the dark rims under the eyes which many people present when 
they are a little out of health. Young ladies in their first season often exhibit this 
symptom, and it is not uncommonly a source of anxiety to mothers. It is, how- 
ever, easily got rid of. A gentle galvanic current passed through the part from 
a battery will in most cases remove it in a few minutes. 

BRUISES. 

A bruise, or contusion, is an injury inflicted by some blunt instrument without 
breaking the skin. Bruises vary much in severity, but it is only in the more serious 
forms that it is necessary to call in a doctor. Ordinarily, a little simple treatment 
will soon set things right again. Tincture of arnica is one of the very best remedies, 
and its use is indicated in all injuries arising from mechanical violence. It is not to 
be used undiluted, but a lotion should be made by mixing one part of the tincture 
with ten of warm water. It should be applied immediately by saturating a piece of 
lint with it, and then covering it with a rather larger piece of oiled silk to prevent 
evaporation An infusion or decoction of arnica, when it can be obtained, succeeds 
even better than the tincture. In addition to the external application, tincture of 



BUNIONS. 165 



arnica should be taken internally. A tea-spoonful of the tincture should be put in an 
eight-ounce bottle of water, and of this a tea-spoonful should be given every two or 
three hours. Arnica succeeds admirably in allaying the pain caused by getting the 
finger jammed in the door. The sooner it is used after the receipt of the injury, 
the more likely is it to do good. There is never any advantage in waiting till the 
discoloration of the skin makes its appearance. The part should be kept raised, 
and should of course not be used. The arnica lotion, if employed at once, will do 
much to ward off the occurrence of a black eye. For internal bruises, arnica is 
a most excellent remedy, speedily neutralising the ill-effects of blows, falls, and other 
mechanical injuries. In cases of shake, concussion, and shock, resulting from 
railway accidents, it is also very serviceable. 

In the case of people subject to erysipelas, HcvmameUs Virginia* may be used 
instead of arnica, though usually it proves less efficacious. A tea-spoonful of the 
tincture of hamamelis should be mixed with eight ounces of water, and of this three 
tea-spoonfuls should be taken every two or three hours. A hamamelis lotion may be 
made by adding two tea-spoonfuls of the tincture to half a pint of water. It is to 
be employed in the same way as the arnica lotion. This hamamelis lotion will do 
much in removing the discoloration of a black eye. 

When after a bruise the pain and tenderness have subsided, it is a good plan to 
apply a bandage to restore tone to the injured tissues. It often proves beneficial to 
use a cold douche, followed by warm friction. 

BUNIONS. 

Bunions are nearly always the result of badly-fitting boots. Rightly to under- 
stand their mode of production, it is necessary to revert for a moment to the natural 
form of the foot, uninfluenced by the distortion produced by modern boots and shoes. 
If you look at the foot of a street gam in or any little shoeless urchin you may 
come across, you will be surprised to find what a beautiful structure it is. You 
will see that the big toe is in a straight line with the inner side of the foot. 
There is a distinct interval between the big toe and the next, so that they dc 
not touch at alL There is a smaller though very appreciable interval between 
the second and third toes, and you will notice that when the weight of the 
body is thrown on the foot, the third and fourth toes are not in contact. 
Now compare this with the foot of any one who has been accustomed to wear 
tight-fitting boots all his life, and you will see what a difference there is. All the 
toes are screwed up together like a bunch of carrots, the second or third toe is 
sticking up over the others, whilst the little toe is pushed under, quite out of sight ; 
the big toe is no longer in a straight line with the inner margin of the foot, but 
forms a distinct angle with it. "We have seen people's feet that have really been 
quite painful to look at, from the distortion they have undergona We are fond of 
laughing at the Chinese for some of their customs, but we should do well to look at 
home before becoming too critical. It is a curious circumstance that we, wise people 
as we think ourselves, should consent to distort our feet and make ourselves 
miserable with corns and bunions just to please other people; but we do. We 
should never think of wearing tight uncomfortable boots, if it were not for " the 



166 THE TREATMENT OF DISEASES. 

look of the thing." The shape of modern boots is purely conventional, and is not at 
all adapted to the natural form of the foot. Boots to fit properly — we mean really 
properly — must have square toes, and should not be made to taper off to a point. 
There is no reason why a comfortable boot should be ugly, and some of the prettiest 
boots we have seen have been constructed with a due regard to the natural shape of 
the foot. 

In addition to the direct effect produced by the pressure of misshapen boots, the 
material of which they are made often exercises a predisposing influence on the 
formation of bunions. Patent leather, or any material like it which prevents the 
evaporation of the perspiration, must exert an injurious effect. 

There undoubtedly exists in many persons an hereditary tendency to the forma- 
tion of bunions, which nothing but the greatest attention to the shape and construc- 
tion of their boots will overcome. Though generally situated over the first joint of 
the great toe, bunions are not unfrequently developed over bony prominences, in 
other parts where the natural conformation of the foot fails to correspond with the 
artificial and arbitrary shape of the shoe. 

In its early formation a bunion generally attracts attention as a painful and 
tender spot, on some point exposed to pressure and irritation by distortion of the 
toes. By-and-by the part enlarges in consequence of an effusion of fluid, the design 
of which is obviously to protect the part from undue pressure. The irritation con- 
tinuing, inflammation is set up, causing progressive enlargement, with possibly the 
formation of matter. Sometimes this matter is discharged, leaving a nasty ulcer 
which is very difficult to heal. 

It is only in the early stage of a bunion that treatment is likely to effect a com- 
plete cure, though palliative measures are practicable at all times. The tender spot 
preceding the formation of a bunion should be covered at night with wet lint and 
oiled silk, whilst care should be taken to see that the boots are wide in the sole and 
not sloped off on the inner side towards the middle line of the foot. Should the 
part be very tender, it may be covered with soap plaster spread on kid or wash- 
leather. "When the formation of fluid has already occurred, steps should be taken, in 
addition to the above precaution, to procure its absorption by painting the part with 
tincture of iodine. As soon as one coat has cleared off, another should be applied. 
Sometimes it is advantageous to use the iodine liniment, which is stronger than the 
tincture, but it will have to be applied less frequently, and with greater caution. If 
there be inflammation of the part, a hot foot-bath, followed by linseed-meal poultices 
or water-dressing, will prove of service. Benefit is sometimes experienced from an 
arnica lotion made by mixing two drachms of tincture of arnica with eight ounces of 
water. It should be applied on lint, covered with oiled silk, and its use should be 
continued for three or four days. Tincture of Veratrum Viride, painted on inflamed 
bunions, often gives speedy and lasting relief. 

It is the custom with many people who suffer from bunions to wear boots made 
to fit accurately their distorted feet The wearing of a shoe so constructed as to aid 
in the restoration of the toes to the natural position is recommended; except in cases 
of very extreme distortion of the joints, the sole should be cut exactly as if the toe§ 
were in their natural position. 



CANCER. 167 



CANCER. 

Our remarks on this subject must necessarily be brief, not because cancer is a 
disease of little importance, but because, on the contrary, it is of so serious a nature 
that it is unsuited for domestic treatment. It may, however, be of interest to 
consider the circumstances which conduce to the development of this disease. As 
we all know, cancer, or carcinoma, as it is technically called, attacks many different 
parts of the body. At present, however, we shall not speak of cancer of any par- 
ticular organ, but of cancer in general, referring to the local manifestations only 
incidentally. There is scarcely an organ or tissue in the body which is not liable to be 
attacked by this terrible foe : it may be found in the brain, the eye, the lips and 
face, the lungs, the stomach, the bowels, the liver, the kidneys, the breast, the womb, 
the bones, and some other parts. The regions most frequently attacked are the 
womb, the stomach, and the female breast. 

There is a very prevalent opinion that cancer runs in families, and undoubtedly 
many cases occur which favour this view. Thus the first Napoleon died of cancer of 
the stomach, and so did his father and sister. When, however, the evidence as to 
cancer being hereditary is investigated on a large scale, there is found to be very 
little in it. Out of 278 cases of cancer, it was found that in one instance only had 
the patient's father or mother died of that disease. Many people seem to imagine 
that because one of their parents died from cancer, they are doomed to suffer the 
same fate — an opinion for which there is not the slightest foundation. 

Cancer is a disease which is common to all ranks of society, from the highest to 
the lowest. Not only are the richest and poorest alike subject to it, but so are the 
worst and best fed, those who are living under the most favourable atmospheric 
conditions and those who are immured in the worst, those who are cleanly and those 
who have a wholesome dread of soap and water, those of all temperaments and all 
occupations, those who are apparently healthy, and those who are never well. It may 
attack people of any age, from the baby at the breast to the nonagenarian. Speaking 
generally, however, cancer may be said to be a disease of middle and advanced life, 
for it comparatively rarely visits those who have any claim to be considered young. 
Cancer is more common in women than in men, and it is said to occur more 
frequently in those who are unmarried than in those who have taken upon themselves 
the cares and pleasures of matrimony. 

Depressing mental emotions are said to give rise to, or at all events favour the 
production of, cancer. It would seem that the body weakened and its vitality 
lowered by worry of mind falls an easy prey to the invading disease. An eminent 
surgeon recording his experience on this point says : — " I have seen so many cases of 
cancer, more particularly of the abdominal organs, in individuals who had suffered 
from grief, anxiety, harass of mind, for years before the development of the malignant 
disease, that although the doctrine is incapable of proof, I cannot but look upon it 
as probable that the cancer was the result of the antecedent, long-continued 
disquietude." The moral is " don't worry." 

Curiously enough, cancer appears to occur with very varying degrees of frequency 
in different parts of the world. It is certainly more common in Europe than in any 



168 THE TREATMENT OP DISEASES. 

other continent In some parts of North America and China it is also frequent, 
whilst in South America, in Africa (except Egypt), and the greater part of Asia it is 
not of frequent occurrence. In England, cancer is least common in the north-western 
and western parts of the kingdom, including Wales, but throughout the most 
elevated southern and middle districts it is common. It has been pointed out that 
the distribution of cancer follows the course of the great rivers after their formation, 
when they are passing through the low-lying valley lands liable to overflowing and 
its attendant dangers. There is no evidence to show that cancer is influenced by the 
density of the population, or that it is proportionately of more common occurrence 
in large towns than in country districts. There is reason for believing that its 
prevalence increases with the advance of civilisation. 

It is sometimes said that cancer may arise from a blow or kick ; but this is very 
doubtful At all events, in such cases the patient must have been very strongly pre- 
disposed to cancer. Many women are apt to attribute the origin of the complaint to 
a squeeze on the breast, and to reproach themselves on this score. "We must admit 
that we have some difficulty in believing that such a trivial cause could be in any 
way operative ; if it were, the disease would undoubtedly be more common. 

As a rule, there are no precursory symptoms of cancer, and in the majority of 
cases the first sign is the detection of some growth or tumour. After a time it is 
noticed that the patient is getting thinner, and day by day weaker and more 
deficient in muscular power. The appetite is generally bad, and often the patient 
takes scarcely anything to eat. The skin becomes loose, and acquires a peculiar 
lemon or straw colour, which can be distinguished from the yellowness of jaundice 
by not affecting the whites of the eyes. There is often great depression of the 
spirits, but the intellect remains unimpaired. 

And do these symptoms indicate the presence of cancer t Certainly not, for the 
majority of them are common to, we might almost say, dozens of complaints. We 
are seldom warranted in deciding that a case is cancer unless we can detect the 
presence of a tumour. And if, then, a tumour is found, is it cancer ? Again no ; 
decidedly not. There are many swellings and tumours which are of the most 
innocent description, and never do anybody harm. It is most likely that that 
lump you have been worrying yourself about, and thinking was a cancer, is of not 
the slightest importance, and will disappear in time. There are "fatty tumours," 
lumps of fat, and all kinds of things that anybody who is not a doctor might 
mistake for a coming cancer. But you have been losing flesh, have you ? Well, and 
what then 1 You cannot expect to be the same weight all your life. Your weight 
fluctuates more or less just as everything else does. Sometimes you gain a little, 
and sometimes you lose. We will be bound that if you got yourself weighed you 
would find that you had not lost a pound in a month. But your appetite has fallen 
off] Well, we do not wonder at it. The fact is that a change of air would do you 
more good than anything. A few days at Brighton or Long Branch would soon set 
you up again ; even Saturday to Monday is better than nothing. But you are look- 
ing yellow ] Dare say you are, as yellow as gold. It is just what we should expect 
when you are cooped up in-doors all day. But if you really feel anxious about the 
swelling, go and see a doctor by all means, and get him to examine it. Tell him 



CANCER OF THE STOMACH. 169 



jnst what you think about it, and in all probability he will be able to set your mind 
at rest on the subject. 

As to the treatment of cancer, that is a subject on which it is impossible for us 
to speak in detail. It would not benefit you in the least if we were to enter into a 
discussion as to what cases are benefited by an operation and what are not This 
is often one of the most difficult points which a surgeon has to decide, and he can 
arrive at a correct conclusion only by an attentive consideration of all the circum- 
stances of the case. "We may mention, however, that very frequently the pain may 
be temporarily relieved by the use of opium or morphia. Sometimes ten grains of 
chloral, or Pr. 37, taken three times a day, will succeed better than opium. The 
pain of cancer when the skin is broken so as to leave a painful irritable sore may be 
relieved by playing vapour of chloroform on the raw surface, the immunity from 
pain often lasting several hours. Of course it is understood that it is the vapour 
of the chloroform which is to come in contact with the sore, and not the liquid itself 
A starch poultice, from its soothing, unirritating properties, often relieves the pain 
when applied to an open cancer. When the disease attacks the bowels or the 
adjacent organs, the pain may be mitigated by the use of large injections of 
warm water, which also often prove successful in relieving the distressing straining 
and desire to evacuate the bowels, of such frequent occurrence under these 
circumstances. 

The tincture of Hydrastis Canadensis, or golden seal, has obtained a great reputa- 
tion in the treatment of some cases of cancer. It has been especially extolled in the 
treatment of cancerous tumours of the breast. It should not only be given internally, 
but should be used as a local application. A lotion may be made by mixing a drachm 
of the tincture with half an ounce of glycerine, and this should be applied or 
rubbed in in small quantities several times a day. A still better and more efficacious 
lotion is made by dissolving ten grains of chloride of hydrastia (hydrastia being the 
active principle of hydrastis) in eight ounces of water. 

In many cases the most satisfactory results have followed the long-continued 
administration of small doses of arsenic, as, for example, half a tea-spoonful of the 
arsenic mixture (Pr. 40) every four hours. It has been found to succeed admirably 
even in cases in which the general constitutional symptoms were far advanced. It 
is most suitable for cancer attacking the lip, tongue, or stomach. Its internal 
administration should be combined with the local application of a lotion made by 
adding six tea-spoonfuls of the mixture (Pr. 40) to half a pint of water. This should 
be applied on lint, covered with a piece of oil-silk, several times a day. 



CANCER OF THE STOMACH. 

We purpose entering very briefly into the consideration of this subject, not 
because it is of little importance or of infrequent occurrence, but because the patient 
must of necessity at some time or other in its progress come under the care of 
a medical man, and we feel assured that the earlier he seeks professional advice, the 
better it will be for his welfare. 

In the first place we must consider the predisposing causes of cancer of the 



170 • THE TREATMENT OP DISEASES. 



stomach. There is no doubt that it may be hereditary. In support of this statement 
the case is often quoted of the first Napoleon, who died of cancer of the stomach, as did 
his father and sister. It is a great mistake, however, for people who may have lost 
one or more near relatives from cancer to suppose that they are doomed to die of the 
same horrible disorder. It is nothing of the kind ; and it is the opinion of many of 
the most eminent physicians and surgeons of the day that cancer of the stomach is 
far less likely than any other form of cancer to be hereditary. Moreover, unless a 
post-mortem examination was made, it is very difficult to assert positively that the 
disease was actually cancer. There are several morbid growths which in the 
symptoms they produce are very like cancer, but a tendency to which it cannot be 
supposed for one moment is capable of transmission. "We recently saw in a hospital 
an old man who was supposed by everybody to be suffering from cancer of the 
stomach. He died ; and at the post-mortem examination we found that there 
was no cancer at all, and that death had resulted from a large ulcer. The poor 
fellow had no friends, but we can readily imagine that in many cases a knowledge 
of the fact that the sufferer had died of a non-hereditary complaint would be a great 
comfort to the survivors. We would earnestly impress upon you the necessity of 
not attaching too much importance to the existence of a cancerous taint in your 
family. 

Cancer of the stomach occurs with about equal frequency in men and women. 
It is very rare under the age of thirty, and the greatest predisposition to the disease 
is met with in people between the ages of sixty and seventy. Among the exciting 
causes of cancer of the stomach are usually mentioned errors of diet, brandy- 
drinking, and mental anxiety ; but their influence is, to say the least of it, very 
problematic. 

Patients suffering from cancer of the stomach often present a peculiar yellow 
colour, they become languid and weak, they emaciate, and exhibit other signs 
of profound constitutional disturbance. It must not be forgotten that these 
symptoms are common to many diseases, and that to the unpractised eye the 
pallor of anaemia is readily mistaken for the cachexia of cancer. Pain at the pit of 
the stomach is absent in very few cases. It is usually a very marked symptom, and 
is often lancinating in character, but there is nothing peculiar about it which would 
serve to distinguish it from the pain caused by indigestion or any other disorder. 
Loss of appetite and vomiting are of constant occurrence in cancer as in many other 
diseases of the stomach, and the vomited matter is frequently mixed with blood. 
None of these symptoms will serve to indicate positively the existence of cancer ; in 
fact, it is the rule with most medical men not to diagnose the existence of cancer of 
the stomach unless they can detect the presence of a tumour in the abdomen. 

As we have already pointed out, it is often a most difficult matter to distinguish 
between ulcer of the stomach and cancer. If the patient is under thirty years of 
age, if he is fairly healthy in aspect, if he is not wasted much after an illness of 
some duration, if there are marked variations in his condition, he is probably not 
suffering from cancer. Copious bleeding from the stomach is in favour of ulcer 
versus cancer. 

Cancer of the stomach is so essentially a disease which must come under the care 



CARBUNCLE. 171 



of a medical man, that it would be superfluous to enter into the subject of treatment. 
In any case in which cancer is suspected, the sooner the opinion of the doctor is 
taken the better. 

CARBUNCLE. 

A carbuncle is a far more serious matter than a boiL A boil is no joke, but still 
it is a very trivial matter compared to a carbuncle. A carbuncle is a large flat 
circumscribed, very hard, and very painful tumour, of a purplish-red colour, and 
attended with a sensation of burning heat. It may reach three or four inches in 
diameter, or even more. It usually gives rise to the formation of a deep slough, and 
the total destruction of the skin which is involved. It is evident that boils and 
carbuncles are closely allied, for they are usually prevalent at the same time. 
Moreover, occasionally a carbuncle results from the confluence of two or three boils 
which have arisen near each other. By many doctors a carbuncle is considered to be 
nothing more than a large boil, and there is undoubtedly much to favour this view. 
A carbuncle may be distinguished from an ordinary boil by being less clearly defined 
in its margin, by being less conical in the centre, and for its size, less prominent on 
the surface. Moreover, it perforates the skin by several apertures, and extends 
more deeply than a boil ; the redness of the skin is of a more livid hue, the pain is 
more severe, and it is accompanied by more constitutional disturbance. 

Carbuncle is often a very serious complaint. At first sight one would hardly 
feel inclined to credit the fact that every year in England alone between two and 
three hundred people die of carbuncle. How many here we have no means of knowing. 

Carbuncles occur more than twice as often in men as in women. They are met 
with chiefly in advanced life, in corpulent males, and in people who have lived 
freely. A carbuncle in a person under twenty is a rarity. The disease attacks all 
ranks of life, but the upper classes are more liable to it than the ill-fed and over- 
worked poor. Carbuncles are in the majority of cases of constitutional origin, and 
frequently the only cause that can be assigned is a condition, on the one hand, of 
general debility, or, on the other, of plethora. Some people exhibit a remarkable 
predisposition to this form of disease. By many it is supposed that carbuncles arise 
from eating the flesh of animals who have died of pleuro-pneurnonia, 

Carbuncles may appear in almost any situation, but they most commonly affect 
the hinder parts of the body, and more especially the nape of the neck, the shoulders, 
and the buttocks. A carbuncle is usually most dangerous when it appears on the 
scalp. 

A carbuncle usually begins as a painful inflammatory swelling, hard to the 
touch, red in colour, obtusely conical in shape, and ill-defined in its boundaries. It 
gradually increases in extent and hardness, and after a few days the colour becomes 
darker, the more prominent parts being of a livid red. Presently a little blister 
forms, and when this bursts, the skin beneath is seen to be perforated by several 
little apertures, from which a little thin matter oozes. After a time these separate 
holes merge into one large ragged-looking opening, at the bottom of which will 
be seen a large slimy-looking slough. When this is exposed, the pain usually 
somewhat abates, thick matter is formed, and the slough is slowly and painfully 



172 THE TREATMENT OP DISEASES. 

separated, leaving a cavity of very irregular shape, having usually deeply under- 
mined and jagged edges. After a time this hole is filled up, but it often leaves a 
permanent scar. The local mischief is usually productive of a considerable amount 
of fever and constitutional disturbance. 

We must now consider the treatment of carbuncles. Sulphide of calcium 
is every bit as useful in carbuncles as it is in boils. The mode of adminis- 
tration should be that indicated when speaking of the latter complaint. (See 
Boils, p. 144.) Or the Blue Lick waters may be taken. The belladonna plaster 
and the liniment with poulticing should be employed as already directed. When 
there is severe inflammation and high fever, as indicated by the thermometer, 
it may be necessary to give aconite. A tea-spoonful of the mixture (Pr. 38) 
should be given every ten minutes for the first hour, and subsequently hourly. 
It may, if necessary, be alternated with the sulphide of calcium : a dose of one 
one hour, and a dose of the other the next, and so on. The medicines are never to be 
mixed, and must not be given together. In the majority of cases we should prefer 
giving the sulphide of calcium only. When there is great prostration, the arsenic 
mixture (Pr. 40) may prove useful ; but usually it will be found to be inferior to the 
sulphide of calcium. The external application of an extract of opium of the con- 
sistence of treacle is sometimes used to ease the pain. It is to be thickly smeared 
three or four times a day over and around the swelling. The extension of the 
carbuncle may sometimes be limited by tightly strapping it with strips of adhesive 
plaster applied concentrically from the border, inwards, around, and over the 
swelling. The plaster should be removed daily, and any discharge that may have 
exuded sponged away with warm water. The enlargement of a carbuncle may 
be considerably curtailed by early strapping. 

It will be gathered from what we have said that in carbuncle the attendance of 
a doctor is desirable, and this is especially the case when the complaint makes its 
appearance on any part of the face or scalp. 

Respecting the general treatment, it may be said that it should be essentially of 
a sustaining character. The food should be given in as digestible a form as possible. 
The patient should have plenty of strong beef tea, chicken or mutton broth, eggs, 
milk, and other articles of diet of a similar nature. In the majority of cases 
stimulants are required. Brandy and egg may be given with advantage, or brandy 
or sherry and milk. 

CATALEPSY. 

Catalepsy is one of the strangest diseases possible. It is of rare occurrence, and 
some very sceptical people have even gone so far as to deny its existence. That is 
all nonsense, for catalepsy is just as much a reality as gout or bronchitis. 

A fit of catalepsy — for it is a paroxysmal disease — consists essentially in the 
sudden suspension of thought, feeling, and the power of moving. The patient 
remains in any position in which she — we say she, for it occurs mostly in women — 
happens to be at the moment of the seizure, and will moreover retain any posture 
in which she may be placed during the continuance of the fit. For example, you 
may stretch out the arms to their full length, and there they remain stretched out 



CATALEPSY, 173 

without showing the slightest tendency to drop. It does not matter how absurd 
or inconTenient or apparently fatiguing the position may be, it is maintained until 
altered by some one, or until the fit is over. In these attacks there are no con- 
vulsions, but on the contrary the patient remains perfectly immobile. She is just 
like a waxen figure, or an inanimate statue, or a frozen corpse. 

The following description of a case is nearly a hundred years old, but it presents 
a more graphic picture of the disease than any modern account with which we are 
acquainted : — 

"In the latter end of last year (1781), I was desired to visit a young lady 
who for nine months had been afllicted with that singular disorder termed catalepsy. 
Although she was prepared for my visit, she was seized with the disorder as soon as 
my arrival was announced. She was employed in netting, and was passing the 
needle through the mesh, in which position she immediately became rigid, exhibiting 
in a very pleasing form a figure of death-like sleep, beyond the power of art to 
imitate or the imagination to conceive. Her forehead was serene, her features 
perfectly composed. The paleness of her colour, her breathing at a distance being 
also scarce perceptible, operated in rendering the similitude to marble more exact 
and striking. The positions of her fingers, hands, and arms were altered with 
difficulty, but they preserved every form of flexure they acquired; nor were the 
muscles of the neck exempted from this law, her head maintaining every situation in 
which the nand could place it, as firmly as her limbs. About half an hour after my 
arrival, the rigidity of her limbs and statue-like appearance being yet unaltered, 
she sang three plaintive songs in a tone of voice so elegantly expressive, and with 
such affecting modulation, as evidently pointed out how much the most powerful 
passion of the mind was concerned in the production of her disorder, as indeed her 
history confirmed. In a few minutes afterwards she sighed deeply, and the spasm in 
her limbs was immediately relaxed. She complained that she could not open her 
eyes, her hands grew cold, a general tremor followed ; but in a few seconds, re- 
covering entirely her recollection and powers of motion, she entered into a detail of 
her symptoms and a history of her complaint." In this case we are told the fits 
occurred once or twice a day, and sometimes more frequently, but they never came 
on at night. They frequently occurred without warning, but were sometimes 
ushered in by a fluttering at the pit of the stomach, or by a fixed pain at the top of 
the head. The onset was usually very sudden, and on one occasion she was seized 
whilst carrying a cup of tea to her mouth, and remained rigidly fixed in that 
position. 

The most common cause of catalepsy is mental emotion. A young girl who 
was in the hospital recovering from typhoid fever was greatly frightened one night 
by the occurrence of a fire in an adjacent building. She was awoke by the blaze 
flashing in at the windows, and at once exclaimed that the day of judgment had 
come. She remained in an excited state all night, and the next morning grew 
gradually stiff like a corpse, whispering before she became insensible that she was 
dead. If her arm were raised, it remained extended in the position in which it was 
placed for several minutes, and then slowly fell. This strange condition gradually 
passed off in the course of the morning, and there was no return of it. 



174 THE TREATMENT OF DISEASES. 

The subjects of catalepsy are usually young women, but it is occasionally met 
with in men. In one case the patient was a man sixty years of age. He was 
engaged in plastering, when suddenly he became insensible, and his limbs and 
body were rigidly fixed in the position in which he was attacked. The fit lasted 
twenty-two hours, and then recovery gradually took place. It is supposed to 
have been induced by much mental suffering, owing to the sudden death of 
his wife. 

Cataleptic fits vary very much, not only in their frequency, but in their duration. 
Sometimes they are very short indeed, lasting only a few minutes. In one case, 
that of a young lady, they would sometimes come on when she was reading aloud. 
She would stop suddenly in the middle of a sentence, and a peculiar stiffness of the 
whole body would seize her, fixing the limbs immovably for several minutes. Then 
it would pass off, and the reading would be continued at the very word at which it 
had been interrupted, the patient being quite unconscious that anything had happened. 
But sometimes fits such as these may last for days and days together, and it seems 
not improbable that people may have been buried in this state in mistake for 
death. 

Catalepsy is in many cases associated with other diseases, and it sometimes ends 
in epilepsy. Curiously enough, some cataleptics are able voluntarily to induce the 
fits at almost any time. It has been supposed that absence of mind is in reality a 
slight form of catalepsy. When a man is in a " brown study," or reverie, the eyes 
are fixed by a muscular action similar to that which occurs in the cataleptic, and 
not the eye only, for a limb or the whole body will remain in the same position for 
many minutes, the senses themselves being in deep abstraction from surrounding 
objects. 

Catalepsy is by no means a dangerous disease, for recovery almost uniformly 
takes place. The best remedy is bromide of potassium. It should be given in two or 
three table-spoonful doses of the mixture (Pr. 31) three times a day. The oxide of 
zinc pills (Pr. 66) will in some cases be found useful. The administration of strychnia 
is often attended with benefit. Several cases have been treated successfully with 
small doses of tincture of Cannabis Indica y the Indian hemp. Only one of these 
drugs should be given at a time. It is very essential that the mind should be 
brought under proper discipline, and kept as far as possible from all causes calculated 
to promote emotional excitement. 

CHILBLAINS AND CHAPPED HANDS. 

A chilblain is a low form of inflammation of the skin, usually of the hands or 
feet, attended with itching, tingling, burning, and swelling of the part. It is chiefly 
a complaint of early life. Boys and girls at school are the chief sufferers. Men 
seldom suffer from them, but some women are subject to them all their lives. A 
tendency to chilblains often runs in families. They occur most frequently in people 
who have a weak circulation, as evinced by cold feet and hands, and occasional 
blueness of the lips and tips of the fingers during the winter months. Their appear- 
ance is generally ascribed to too suddenly warming the hands and feet after they 



CHILBLAINS AND CHAPPED HANDS. 175 

have been thoroughly chilled. In some constitutions, however, they are very readily 
produced. A sudden change in the weather, a rapid thaw, or an east wind, may act 
as an exciting cause. 

Chilblains appear most commonly on the hands, but sometimes on the feet, 
and more rarely on the lobe of the ear or the tip of the nose. Their course varies 
somewhat in different people. In some they itch very much, and this is a constant 
source of trouble, whilst in others this symptom is almost entirely absent. Some- 
times they break veiy easily, but frequently enough they exhibit no such tendency. 

Why do chilblains occur so frequently in school-girls 1 Simply because the mode 
of life adopted in many of our schools is eminently favourable to their production. 
Just talk the matter over with any school-girl you may happen to know, and you 
will soon see that this is the case. In the first place, you will find that even in the 
middle of the winter she has to turn out at six in the morning. " All in the dark? " 
" Oh, yes," she says ; " but we have a candle." " And there's no fire in the room? n 
" Oh, no, and sometimes it's so cold ; once, just before the holidays, the water was 
frozen in the jug quite hard, and we had to break it." " And what do you do then ?" 
" When we're dressed we go down in the school-room, and practise for an hour." 
" Of course it's warmer there ? " " Oh, no, it's very cold. Jane never lights the fire 
till past seven." "And what time do you get breakfast?" "Oh, not till eight 
o'clock ; sometimes it's twenty minutes past." We have no hesitation in saying that 
very frequently this is prejudicial to the health of a young growing girl. Many a 
big strong fellow of six feet two would suffer under such treatment. We do not say 
anything about the early hours, provided the children get to bed in good time, and 
get a good night's rest. But we do object, and that very strongly, to their having 
no hot water to wash in. When they get down-stairs they should find a good blazing 
fire in the school-room, and the first thing to be done should be to have a good hot 
breakfast. After that they may practise as much as you like, but they would 
not suffer from chilblains. We do not advocate " coddling " children ; but there is a 
medium in everything. 

Sufferers from chilblains should have a liberal diet, and a glass or two of wine 
added to the daily food will not do any harm. For grown-up people, a glass of rum 
and milk before getting up in the morning is a good thing. In the case of young 
people it is very important to see that they have plenty of good warm under-clothing. 
Flannels should be worn from head to foot, and we may be excused for saying that 
they should be changed with sufficient frequency. It is very necessary to protect 
the feet and hands from cold. There is nothing like having good roomy boots 
and good warm socks. People may make ill-natured remarks, and say something 
about "beetle-crushers" in connection with your feet, but never mind — wait till 
they get chilblains. Do not be afraid of wearing good big gloves lined with wool. 
Tight kid gloves are an abomination. They may be very pretty to look at, and no 
one can help admiring a nice little hand, but they prevent the free circulation of the 
blood, and make the fingers horribly cold. There is another thing ; do not wear 
elastic bracelets, and do not wear tight garters. If you want to get rid of your 
chilblains, you must take plenty of out-door exercise. Do not stay in day after day 
because it is wet. It is nearly always fine some time in the day. If it shows no 



176 THE TREATMENT OP DISEASES. 

signs of holding up, you had better wrap up well and go out for a good brisk walk 
all the same, only mind you change your things directly you come in. Never sit 
down for a minute in your wet boots. The skipping-rope is an excellent institution. 
If you hare chilblains, do not be in a hurry to give it up; you are to take it 
medicinally, and it will do you more good than cod-liver oil. 

And what about medicine t There are a good many applications which may be 
advantageously used for chilblains, especially before they are broken. One of the 
best is iodine ointment. Send to the chemist for some, and rub it well over the 
chilblains — always supposing the skin to be unbroken — two or three times a day. 
You may wear an old glove over it if you like, only it must not be tight. This is a 
most excellent mode of treatment, and will nearly always effect a cure in two or 
three days. 

There is another good method of treating chilblains which we can recommend. 
The only objection to it is that the application takes a little time and trouble to 
prepare. It is admirably adapted for people who habitually suffer from chilblains. 
It is as follows: — Make a strong tincture of capsicum-pods (chillies), by steeping them 
for several days in a warm place in twice their weight of rectified spirits of wine. 
Dissolve gum-arabic in water to about the consistency of treacle. Add to this an 
equal quantity of the tincture, stirring it together with a small brush, or a large 
camel's-hair pencil, until they are well incorporated. The mixture will be cloudy and 
opaque. Then take sheets of silk or tissue-paper, give them with the brush a coat of 
the mixture, let them dry, and then give another. Let that dry, and if the surface 
is shining there is enough of the peppered gum, if not, give a third coat. This paper, 
applied in the same way as court-plaster to chilblains that are not broken, speedily 
relieves the itching and the pain. It acts like a charm, and effects a rapid cure. We 
may mention incidentally that the same method of treatment proves very successful 
in burns that are not blistered, and in discoloured bruises. 

A solution of sulphurous acid, either applied in the liquid form, or used as a 
fumigation, by means of a spray apparatus or scent-diffuser, is very useful for 
chilblains. A good wash for the hands when affected with chilblains is sulphurous 
acid three parts, glycerine one part, and water one part. 

When chilblains are broken it is a good plan to poultice them. The application 
of glycerine of starch often gives relief. A coating of collodion will serve to 
protect them from injury. 

In connection with chilblains we will say a word on the subject of chapped 
hands. This affection consists of slight inflammation of the skin of the part which 
subsequently becomes cracked. It occurs most frequently in frosty weather, when it 
sometimes gives rise to much pain and inconvenience. 

The treatment is, on the whole, similar to that adopted in the case of chilblains. 
Glycerine, glycerine of starch, or one part of glycerine mixed with two parts of eau 
de Cologne, will form an excellent application. Either of these will remove the 
stinging, burning sensation, and make the parts soft and supple. When undiluted 
glycerine is applied to a delicate skin it is apt to produce smarting and irritation. 
Rose-water may, if preferred, be used in place of the eau de Cologne. 

Collodion is sometimes applied to chapped hands and chapped nipples, but 



CHOLERA. 177 



chapped hands and lips are better treated with glycerine of starch or the mixture of 
glycerine and eau de Cologne. Arnica ointment also frequently proves of service, as 
does the solution of sulphurous acid. 



CHOLERA. 

True Asiatic cholera is a disease which is always more or less prevalent in 
Calcutta and Bombay, and occasionally visits us also in the form of an epidemic. 
It is a disease we are not very likely to be called upon to treat, and it will 
consequently be our endeavour to make our remarks on this subject as concise as 
possible. 

The following are the dates of the epidemics which have occurred during the 
present century :— 1827, 1842, 1848-9, 1853-4, 1865-6. Since 1866 a few isolated 
cases have occurred, but there has been no epidemic. 

Cholera probably depends upon the entrance of some poison into the system. 
This has hitherto evaded chemical and microscopical research, and we know nothing 
respecting its origin or mode of propagation. 

Certain circumstances influence the spread and development of cholera. Great 
importance has been attached to meteorological conditions, but apparently without 
sufficient reason. It is but little influenced by ordinary atmospheric changes. The 
opposite conditions of heat and cold, of humidity and dryness, and of high and low 
barometric pressure have prevailed during different epidemics. It usually reaches 
its height during the hot months, but it is not exterminated by cold. A sudden 
change in the weather will often cause a considerable decline in the number of cases. 
Cholera is always more prevalent in low-lying districts than in elevated regions. I n 
the majority of instances, the disease attacked those predisposed to sickness. The 
robust and temperate escaped. 

There is strong evidence to show that impure water plays an important part in 
the propagation of the disease. In several cases violent attacks of cholera have been 
traced to the use of bad food, such as putrid Ash, pickled pork, and decayed cheese. 

Over-crowding, want, excessive fatigue, and depressing mental emotions, by 
lowering the general condition of the health, favour an attack. People who " are 
frightened out of their wits " about the cholera are for this reason very likely to 
suffer from it. 

Cholera attacks men and women indiscriminately, and people of all ages suffer. 
Both the strong and the weak fall victims to its deadly power, and it has been 
found in the army that the most robust are often the first to be stricken down. The 
previous habits of life exert but little influence, although in some epidemics it has 
been thought that the intemperate were more subject to attacks than the abstemious. 
Occupation produces no special liability, although those which expose the individual 
to unhealthy influences may increase the risk. In the army the privates always 
suffer more than the officers. 

The limitation of the area of the disease is often very abrupt. In some instances 
it has been strictly confined to one side of a street, camp, or town. 

Is cholera catching 1 There is considerable diversity of opinion respecting its 
12 



178 THE TREATMENT OP DISEASES. 



contagiousness, so that it is quite evident that it can't be very catching. The doctors, 
nurses, and others engaged in attending to the sick do not suffer from it more than 
other people. It would seem as if the poison affected places rather than individuals. 
It must, we think, be granted that the complaint, in every instance, was excited 
by the application of some noxious material to the body, some positive poison. 
It is certain, also, whatever hypothesis may be chosen, that more individuals were 
exposed to the agency of this poison than were injuriously affected by it. By many 
it is supposed that the disease is communicated only by the stools or vomited matter 
of the patient. Practically what it comes to is this : that if you want to nurse any 
one suffering from the disease you need not be deterred from so doing by fear of 
catching it. There is a little risk, but very little. 

One attack affords no protection from another. 

The disease often sets in with purging and vomiting, but in many cases the 
bowels are relaxed for some hours or days before the real attack begins. The bowels 
are opened three or four times in the twenty-four hours, perhaps with a little griping, 
and the motions are watery or semi-fluid. There may, in addition, be a little feeling 
of exhaustion. 

We have no intention of describing an attack of cholera in full, but shall content 
ourselves with little more than an enumeration of the leading symptoms. The attack 
begins with violent purging, usually painless, but sometimes attended with griping. 
At first the motions consist of the contents of the bowel, mixed with much fluid, 
but subsequently they assume the appearance of water in which rice has been boiled. 
They are shot out with considerable force, often in a full stream, and the quantity 
may be so great as to fill an ordinary-sized stool-pan in two or three hours. The 
evacuations are frequently repeated, the patient becomes exhausted, and is glad to 
remain in bed. With purging is generally combined vomiting, the fluid, which is 
clear and watery, being ejected with considerable force, often in quantities of a pint 
or more. Cramps in the limbs set in, the face becomes shrunken, the pulse feeble, 
and the patient passes into a state of collapse. In this condition there is the utmost 
depression possible with a capability of recovery. The surface is deadly cold, the 
tongue icy to the touch, the very breath a cold air stream, and the temperature in 
the mouth often as low as 80°. The patient may die in a few hours, or he may 
remain in this condition for a day, or even two days, and then recover. When 
reaction sets in recovery is generally very rapid. It is said that a woman has been 
standing at her door on Wednesday, who on Monday was in perfect collapse. 

The mortality in cholera is high. In some epidemics it is from 20 to 30 per 
cent., in others from 70 to 80. It is usually higher at the beginning of an epidemic 
than towards its termination. 

There is usually no difficulty in recognising a case of cholera. The purging, 
vomiting, anxious countenance, cramps, and the quick advent of collapse, indicate only 
too surely the nature of the complaint. The only other disease with which it is at 
all likely to be confounded is choleraic diarrhoea, or as it is sometimes called 
" cholerine." Should there be any doubt as to whether it is true cholera or only 
choleraic diarrhoea, act on the supposition that it is the more serious disease. 

How arc we to avoid cholera? This is a question which on© naturally asks 



CHOLERA. 179 



oneself during the prevalence of an epidemic. We trust the following rules will 
afford a satisfactory answer : — 

How to Avoid Cholera. 

1. If possible, remove from the affected locality. The higher you are above the sea-level 

the better. 

2. Avoid over-fatigue, and maintain a good condition of general health. 

3. Don't take purgatives, if you can avoid it. 

4. Avoid indigestible food, or food that is high or in a state of decomposition. 

5. Have your drinking-water boiled, or use a charcoal filter. 

6. Have your milk scalded. 

7. Never consider any attack of diarrhoea trivial, but at once take steps to check ife, 

The slight diarrhoea of early cholera is usually so painless that it is very apt to 
be overlooked. It is a standing order in the case of soldiers in India, that if any 
man goes twice to the closet in one day he should report himself, and non-com- 
missioned officers are usually stationed at the latrines to see that this salutary order 
is carried out. In some parts of Europe, a house-to-house visitation is usually 
established during the prevalence of an epidemic. 

There are certain precautions to be observed by those in attendance on the sick. 
Every discharge should be at once thoroughly disinfected by being mixed with a 
considerable quantity of strong carbolic acid, perchloride of iron, or chloride of zinc. 
In large towns, the stools must of necessity be emptied down the water-closets ; but 
in the country they should, after thorough disinfection, be buried deeply at a distance 
from the house, and especially from the source of water supply. The greatest care 
must be taken to thoroughly steep all linen in strong soda, or in Bromo-Chloralum, 
before washing it. Articles of clothing that cannot be washed had better be 
destroyed. Every one who has been in the sick-room should, before going to meals, 
carefully wash his hands in hot water, to which some carbolic acid has been added. 
The use of the nail-brush is also desirable. 

We must now consider the question of treatment. The first thing to be done 
in a case of cholera, or even of suspected cholera, is to send for the doctor, saying 
what is the matter. If, as is sometimes the case in the country, some hours must 
elapse before the arrival of medical aid, you must begin treatment yourself. Almost 
every minute is of importance, and a few hours' delay may make all the difference 
between life and death. The drug on which you must rely is camphor. You must 
give the strong solution, the essence of camphor, in four drop doses, every ten minutes 
for an hour, or until there is some improvement, and hourly afterwards. It is best 
given in about a tea-spoonful of milk. The great thing with this remedy is to give 
it eatly, to give it frequently, and to give it in sufficiently large doses. It checks 
the vomiting and diarrhoea almost immediately, wards off the cramp, and restores 
warmth to the extremities. Camphor is so speedy in its action, that by the time 
the doctor arrives he may find his patient on the high-road to recovery, and will have 
some difficulty in believing that he has been so seriously ill. If you haven't the 
essence of camphor, you can use the camphor pilules, which most chemists keep. 

In the latter stages of cholera, where there is much collapse, arsenic may advan- 
tageously replace camphor. You should give half a tea-spoonful of the arsenic 



180 TK5 T&KATMENT OF DISEASES. 

mixture (Pr. 40) every ten minutes for the first hour, and subsequently hourly for 
six hours, or until the symptoms abate. 



COLD. 

Catching cold is one of the most general and most prolific causes of disease. 
When we consider that such affections as bronchitis, pneumonia, consumption, quinsy, 
pleurisy, rheumatism, neuralgia, toothache, and a host of others, may have their 
origin in a cold, we must acknowledge that it is not easy to overrate its importance. 

We will in the first place consider what are the causes of cold, and under what 
circumstances it is likely to be produced. Insufficient clothing is undoubtedly a very 
frequent cause. The custom of leaving uncovered the thighs and legs of children, 
and the neck, chest, and arms of young girls, is a bad one, The importance of 
protecting these parts is recognised in the case of adults, but, curiously enough, in 
those of tender years they are unhesitatingly exposed to the inclemency of the 
season. The exposure may be only occasional, as when ladies wear low-bodied 
dresses at balls and evening parties, but it is none the less hurtful on that account. 
There can be no doubt that many cases of consumption have their origin in the 
custom of using insufficient clothing at evening entertainments. Evening dress is 
usually very much lighter than that worn during the day, and it often affords very 
little protection against cold and draught. Moreover, the heated impure air in 
places of public assembly promotes perspiration, and thus renders the body more 
susceptible to cold on going into the cooler outer air. After dancing, especially, 
one shoidd be very careful in passing along cool corridors or passages. The great 
thing is to keep moving, and to cover the shoulders with an opera-cloak or cloud, 
or something of the kind. Many people have caught a severe cold while waiting 
for the carriage, or in walking home in their thin boots and upper clothing. Men 
naturally suffer less in this way than do women. Neglecting to wear flannels in the 
winter is a prolific source of cold. Those who are at all weak on the chest should 
wear flannels night and day, summer and winter. The flannels should be changed 
at least once a week, and the same flannel should never be worn night and day. 
This is a point which is constantly neglected, even by those who in other respects 
are scrupulously cleanly in their habits. 

The origin of a cold may in many instances be traced to getting wet through. 
Clothes when dry are imperfect conductors of heat, and retain the natural warmth 
of the body. When they are wet, evaporation takes place, much heat is consumed 
in the process, and the body becomes chilled. If, however, the heat thus lost is 
continually renewed by exercise, a cold is not taken. If you get wet through, it is 
better to keep in motion till you have an opportunity of changing your wet things 
than to stand still. It is better for you to walk home than to ride. If you keep on 
the move, probably no harm will come of your wetting. Sitting on a wet seat, or on 
the damp grass, often gives rise to cold. The heat of the body passes off rapidly, 
and there is no increased production to compensate for it, Another very common 
cause of cold is sitting in a draught. It is pleasant enough to sit in a current of 
cool air when the bodv is heated by exercise, but it is a dangerous practice, and a 






COLO. 181 

luxury that should never be indulged in. Even when there is no draught, cold air 
may be the starting-point of a cold. Many people have a great dislike to " begin 
fires," and leave it till quite late in the autumn, no matter how cold it may be, 
before they will consent to have one lighted. This, to say the least of it, is false 
economy. It is curious how frequently, in making formal morning calls, one is 
shown into a large, cold, damp drawing-room. The fact is, the ♦family habitually 
live in the dining or breakfast-room, and seldom have a fire in the other apartments, 
unless they expect visitors. A call made under these circumstances often results in 
a cold ; and if the slightest feeling of chilliness is experienced, the sooner a move 
is made the better. Going up to bed in a very cold room may lay the foundation of 
all kinds of mischief. The only thing is to undress as fast as you can, and jump into 
bed. Passing rapidly through the air, as when you are riding in an open or partially 
opened carriage, or when sitting in a train next to the window, may give rise to cold. 
All danger may usually be avoided by putting on your overcoat, or covering yourself 
up with your rugs. 

Damp often gives rise to cold. A damp house or room, or a house with a damp 
cellar, is an abomination. How often do we hear the exclamation, "This is a 
wretchedly damp house ; I am never well in it." When such is really the case, 
the sooner a move is made the better. If a house is damp, it is almost impossible 
to keep it warm. Then, again, many people move into new houses almost before 
they are finished. This practice is by no means confined to the poor, and many a 
rich man has dated not only the spotting of his mirrors and the tumbling to pieces 
of his furniture from this injudicious procedure, but also his rheumatism or bronchitis, 
or whatever it may be. A new house should be allowed plenty of time to dry before 
it is inhabited. When people have been away from home for even a week or two, 
fires should be lighted in all the rooms the day before their expected return. When 
the house is left in charge of the servants, they should receive orders to have a fire 
in each of the rooms in turn, or they will assuredly get damp and stuffy. 

Nothing can be more prejudicial to a person's bodily welfare than sleeping in a 
damp bed. The unsuspecting sleeper not only parts with the heat of his body in 
drying the damp sheets, but does so at a time when his vital functions are at their 
lowest ebb. A thoughtful hostess will always see that her guest's sheets are properly 
aired. It may seem a small matter, but its neglect has cost many a man his life. 

Prolonged bathing often gives rise to cold. In a healthy person the chill which 
results from the first plunge is at once followed by a reaction, which is salutary. In 
a man with a sound heart and good lungs, this reaction is maintained for some time, 
but in people of feeble constitution it is transitory. Directly you begin to feel cold 
and chilly in the water it is time to come out. Have a rub down with a good rough 
towel, put on your flannels, and run about till you feel warm, and then dress as 
quickly as you can. The practice of idling about on the bank in a state of nudity, 
either before or after bathing, is very dangerous. Cold bathing is the best tonic in 
the world, especially for young people, but if you remain in the water after you feel 
chilly you are almost sure to catch cold. 

A general state of debility powerfully predisposes to the occurrence of cold. A 
person who is constitutionally weak catches cold from an exposure that would prove 



182 THE TREATMENT OF DISEASES. 

innocuous in the case of a strong, healthy man. The very young, the very old, the 
anaemic, the cachetic, the convalescent, and the licentious, are all more prone to catch 
cold than others. Whatever lowers the general tone of the system predisposes to the 
occurrence of this, the commonest of all disorders. Drunkards suffer greatly from 
colds and their consequences. Many people when exposed to cold, take wine or 
brandy, or spirit in some form or other, with the view of keeping out the cold. This 
is an injudicious measure, for as soon as the primary stimulating action is over, there 
is a reaction, with increased depression, and the person is more than ever likely to 
suffer from exposure. It has been shown experimentally that alcohol depresses the 
temperature of the body, and so, far from keeping out cold, it lets it in. There is no 
objection to taking a moderate allowance of alcohol when the exposure is over, for 
the stimulating effect may be beneficial, and by the time the reaction sets in, the 
patient will have changed his things, and will be warm and dry, and not likely to 
suffer in any way, Practically, what it comes to is this, that if you have to take a 
long walk in the rain, you should not stop half way to have a glass of grog, but there 
is no objection to your having something to drink when you arrive at your 
destination. Puddlers, and other workers in iron-furnaces, find that they can work 
better, and that they suffer less from colds and their consequences, if they dispense 
entirely with alcohol. The Arctic voyager knows, too, that he can withstand the 
rigours of the climate better without his grog than with it. 

A cold is called in scientific language a catarrh. It consists essentially of 
inflammation of the mucous membrane of some portion of the air-passages. When 
it is confined to the mucou3 membrane of the nose, it is spoken of as a cold in the 
head. When it is attended with much watery discharge from the nose, the complaint 
is called " coryza," and when with much pain over the forehead " gravedo." If the 
disorder should extend into the lungs, the patient is said to have a " cold on his chest," 
or from one of its most prominent symptoms, u a cough," or in other words a " slight 
attack of bronchitis." The inflammation often enough travels from one part of the 
mucous membrane to another. Beginning for example in the nose, it gradually creeps 
down into the wind-pipe and lungs. Sometimes it passes from the throat up towards 
tlm ear, and produces deafness, or down the gullet to the stomach, causing qualmish 
and other uneasy sensations, and loss of appetite. 

General directions for the treatment of a cold will be found under Acute 
Bronchitis (p. 154). 

Medicinally, the best treatment for a cold is aconite, and the earlier it is given 
the better. A tea-spoonful of the aconite mixture (Pr. 38), should be given every 
hour or two hours, according to the severity of the symptoms. If there is not much 
fever, a still smaller dose may be taken. The patient had better go to bed and keep 
quiet ; he should not take much food, but may drink freely of water if thirsty. This 
treatment may be continued for from six to twelve hours, or even longer. If the 
skin becomes moist the other symptoms usually quickly disappear, and a few more 
doses of the medicine will effect a cure. This treatment is very simple, and is usually 
successful. It is especially useful at the begining of a cold, and is, in fact, applicable 
to the commencement of any acute illness. It is, it will be seen, somewhat different 
from the treatment recommended when speaking of acute bronchitis. The explanation 



COLD. 183 

is very simple : there are two different ways of arriving at the same result, and you 
can adopt which you prefer. 

If a person finds himself unavoidably exposed to cold-producing causes, he may 
often prevent any unpleasant consequences by the use of aconite. As there is as yet 
no fever to subdue, very small doses will suffice. After exposure to cold, and before 
the appearance of any symptoms, a few doses of the same medicine may serve to 
ward off an attack. The great thing is to have your aconite bottle handy ; if you 
have to waste an hour or two sending for it, the opportunity for its use may be lost. 

When the patient has caught cold and is suffering from persistent shivering, 
camphor is the best remedy. From three to five drops of the essence may be given 
every quarter of an hour on sugar, or the camphor pilules may be used. As soon aa 
reaction takes place, and warmth is restored, the camphor should be discontinued, 
and aconite substituted. 

When symptoms of inflammation of any special organ have made their appear- 
ance, the drug indicated for this complication may be given in alternation with 
aconite. Thus phosphorus may be given for pneumonia, belladonna for congestion 
and inflammation of the brain or throat, bryony for rheumatism or lumbago, and 
so on. As soon as the symptom indicating aconite has disappeared or become 
subordinate, the administration of that drug may be suspended. 

When the cold has settled on the chest, bryony (Pr. 49) is an admirable remedy. 
It is indicated when there are heat, pains, and soreness behind the breast-bone, 
and an irritative, shaking cough with scanty expectoration. This kind of cold 
often occurs in elderly people at the beginning and end of the winter, in conjunction 
with stuffiness of the nose, ninning from the eyes, and derangement of the stomach. 
Bryony may follow aconite, or may be given alone. 

Nux vomica (Pr. 44) is useful for a stuffy cold, and for violent coughs with 
little or no expectoration. Ipecacuanha (Pr. 50) is of value where there is much 
sneezing. 

There are other remedies, which are useful when aconite has not been employed, 
or the more acute symptoms have passed away. Thus small doses of arsenic (Pr. 40) 
succeed admirably in some cases. A two ounce dose of the iodide of potassium 
mixture (Pr. 32), taken every night at bed-time for three or four nights, will often cure 
a cold in the head, especially when there is much running from the eyes and nose. 
This is an excellent remedy for deafness arising from cold. It does very little good 
when the cold has settled on the chest. Inhalations of iodine often do good in 
coryza. A table-spoonful of the tincture of iodine should be put in a jug of boiling 
water, and the vapour inhaled. Eight or ten chlorate of potash lozenges a day will 
sometimes arrest a cold ; but this is not one of our best remedies. 

A cold in the head may often be speedily cured by the use of a snuff made as 

follows : — 

Take of Hydrochlorate of morphia, two grain*, 
Acacia powder, two drachms, 
Subnitrate of bismuth, six drachma. Mix. 

Of this powder, from a quarter to a half may be taken as snuff in the course of 
the twenty-four hours. Its employment should be commenced as soon as the 



184 THE TREATMENT OF DISEASES. 

Bymptoms of coryza show themselves, and it should be used frequently at first, 
so as to keep the interior of the nostrils constantly well-coated. Each time the nose 
is blown, another pinch should be taken. It may be taken in the ordinary way, 
from between the thumb and forefinger; but a much more efficacious and less 
wasteful method is to use a small gutter of paper or a " snuff-spoon," placing it just 
within the nostrils, and sniffing up forcibly, so as to carry it well within. Some of 
the powder finds its way into the throat, and may do good if there is any catarrh 
there. The snuff causes scarcely any perceptible sensation ; a slight smarting may 
occur if the mucous membrane is much irritated and inflamed, but it rapidly 
disappears. After a few sniffs of the powder, a perceptible amelioration of the 
Bymptoms ensues, and in the course of a few hours, the powder being inhaled from 
time to time, all the symptoms will have disappeared. 

To diminish excessive sensitiveness to cold, out-door exercise is of the first 
importance. People who coddle themselves in-doors all day long are just the 
people who catch cold. The morning cold-bath should be used by everybody, 
especially if at all subject to colds. Some people like the shower-bath; but the 
majority of town-dwellers find the shock too great. A respirator is of essential 
service in preventing colds. The subjects of asthma, bronchitis, and quinsy should 
always use one on going out into the fog or cold air. 



COLD FEET. 

What a common complaint this is ! and yet no one seems to know anything 
about it. You suffer from it for years, and yet you don't go to a doctor, or if you 
do you derive very little benefit from his advice. Some people suffer from it 
at night only, whilst others are troubled in the daytime as well. It occurs most 
frequently in women, but still you often hear men complain of it. We believe that 
the best remedy is hypophosphite of lime in one or two grain doses twice a day. 
This is soluble in water, and should be taken in the form of a mixture, nothing else 
being put with it, with the exception, if you like, of a tea-spoonful of syrup, to make 
it more palatable, although it is really by no means disagreeable by itself. Another 
good remedy is nux vomica — five drops of the tincture in a little water three or four 
times a day. It is highly recommended, and you may hope for great things from it. 
Then you must do all you possibly can to improve the state of your general health. 
It is probable that you are below par somehow or other, although we must admit that 
it does not follow of necessity. If you feel generally out of sorts, and your appetite 
is poor, quinine (Pr. 9) will do you good. If you are pale and anaemic, you must 
put your faith in iron (Pr. 1). Panish's Chemical Food often does good. Cod-liver 
oil is an excellent remedy for improving the general nutrition ; many people feel quite 
in a glow after each dose. You should live as well as possible, and a glass or 
two of port wine a day will do you good. Cold bathing in the morning will quicken 
the circulation for you, A good brisk walk, if you are able to take it, soon warms 
the feet. It is a great thing to be properly shod ; good stout, well-fitting boots, with 
thick, warm socks. If you for any reason are unable to get walking exercise, 
you will find that five or ten minutes' exercise with the dumb-bells in your room 



colic. 183 

before breakfast is not a thing to be despised. The hot-water bottle in bed at 
night is a palliative, but does nothing to effect a cure. Many people who have 
suffered from cold feet have assured us that they have derived the greatest benefit 
from putting them into cold water at bed-time. It seems a disagreeable remedy, but 
they say that the reaction which almost immediately follows the primary chill is 
delightful, and that the plan succeeds admirably. The best way would be to rub 
the feet quite dry with a bath-towel after bathing them, and then to jump into a 
warm bed. 

COLIC. 

Colic if a very familiar complaint. Sometimes it is known as spasm of the 
bowels, gripes, or belly-ache. It is characterised by severe twisting pain in the 
belly, especially about the naveL It comes on by fits and starts, is not stationary, 
but on the contrary moves about from spot to spot. There is no inflammation, 
and the pain is relieved by pressure. The disorder is accompanied by constipation, 
and often by vomiting ; there is no fever, and no quickness of the pulse, neither is 
there that depressing anxiety which occurs in inflammation of the bowels, although 
the pain may be as severe. 

Colic occurs more frequently in women than in men. It is probable that the 
greater sensitiveness of the fair sex, and their susceptibility to mental and moral 
emotions, favour the development of this complaint. It is more common in youth 
and adult age than in advanced life. It has been noticed that the particular 
temperament of the patient will confer a proneness to, or tend to give an immunity 
from, this complaint ; those who are nervous or melancholic being more liable to it 
than those who are of an indifferent or phlegmatic disposition. A general condition 
of ill-health, or lowered vitality, predisposes to its occurrence. Those who are pulled 
down by over-work or anxiety, or by some chronic illness, are not infrequently 
sufferers. During the convalescence from fever, and after large losses of blood, 
colic is by no means uncommon. Excessive suckling, by lowering the general 
condition of health, favours its development, and the same may be said of excessive 
menstruation, " whites," and bleeding piles. The influence of cold in producing an 
attack of colic is remarkable, especially when cold is applied to the feet. There are 
many people who are sure to suffer from colic if their feet get wet or cold. It would 
seem that mental fatigue, as that produced by long-continued and great intellectual 
efforts, may be followed by the same result. In people whose vocations are such as 
to demand a continued strain of thought, or whose hopes and fears are excited by 
speculation, as in commercial enterprises, and in those whose faculties are stimulated 
by some career of ambition, it is by no means uncommon. Among the causes of 
colic, one of the most frequent is the presence of some indigestible article of food 
in the bowels. Shell-fish, dried salt meats, pork, badly-cooked food, unripe fruit, 
and the like, are great sinners in this respect. That flatulence will often produce 
colic, especially in children, is a fact so familiar as scarcely to merit comment. The 
movement of gases from one part of the intestine to another will explain the shifting 
of the pain. Constipation is undoubtedly the commonest causo of the complaint, 
which is usually not relieved until the bowels are moved. Even when there is 



186 THE TREATMENT OP DISEASES. 

diarrhoea, it may be associated with an accumulation of irritating matter in the 
intestines. "We shall presently have occasion to refer to a form of colic which is 
known as painters' colic, and is due to the presence of lead in the system. Copper- 
smiths, and especially the workers in copper at shipbuilding yards, often suffer from 
a somewhat similar condition, which may be called copper colic. 

The essential and most characteristic symptom of colic is pain. This pain is marked 
by the occurrence of exacerbations of very great and even intense severity. It is some- 
times so severe as to cause even people usually but little prone to give utterance to 
their feelings to utter loud cries and groans. Internal restlessness, and frequent 
turning and twisting of the body, characterise the sufferer from colic. Often enough 
he paces up and down the room, bending forwards and pressing his hands on his 
belly. Sometimes he flings himself on his face on the bed or sofa. Wten lying 
on his back, his knees are drawn up, and are often retained by the hands in this 
position. By firm pressure the pain is sometimes mitigated, or even temporarily 
removed. The attack is often accompanied by great general depression. The skin 
is cool, the face pale, and the pulse, instead of being quickened, is often slower than 
natural. In severe cases, sickness and vomiting may supervene ; and when the 
malady becomes intensified and the agony excessive, the entire surface may be 
bedewed with a chill, clammy perspiration, the extremities becoming cold and of 
venous hue, and the general aspect that of collapse. Much importance is usually 
attributed to the slowness of the pulse in colic, for not unfrequently it enables us 
to distinguish between this complaint and inflammation of the bowels. It should 
always be remembered, however, that in very severe cases the latter condition is 
not unapt to supervene upon the former. When wind is the cause of the colic, 
the abdomen is often greatly distended; and with the expulsion of the confined 
gases not only does this disappear, but the sufferer obtains almost immediate relief. 
A confined condition of the bowels is, as we have already shown, the usual accom- 
paniment of colic, and not infrequently when the bowels have been efficiently acted 
on by medicine the pain entirely disappears. This, however, is not always the case ; 
for, notwithstanding the action of a laxative or purgative, the pain may be persistent. 
In children, spasmodic pain in the bowels is often followed by digestive disturbances, 
and the irritation may give rise to convulsions. 

The mode of onset of an attack of colic is very variable. It may come on quite 
suddenly, and without any apparent cause, or it may be slow and gradual in its 
establishment, the paroxysms being preceded by a sensation of uneasiness in the 
abdomen. The progress and duration of the malady are equally variable ; it may, 
however, be regarded as a fact, that the more severe the fit the shorter will be its 
continuance. It may exist for days, or may last only for hours, or even minutes. 
It is probable that these irregularities are dependent more or less on the nature of 
the exciting cause. The attack is sometimes cut short by the advent of profuse 
perspiration, the supervention of diarrhoea, or even the occurrence of menstruation. 
It sometimes happens, when the affection occurs in women, that the discharge of a 
large quantity of pale or almost colourless urine is at once succeeded by the 
mitigation of the attack. 

We now pass on to the treatment of colic. The great thing is to relieve the pain, 



CONSTIPATION. 187 



and get the bowels to act. In mild cases, little difficulty will be experienced in 
affording relief, A hot glass of brandy-and-water, a tea-spoonful of compound 
tincture of cardamoms in a little warm water, or thirty drops of compound tincture 
of chloroform, will often quickly relieve the pain. A tea-spoonful of spirits of 
lavender, twenty drops of essence of peppermint, or a little sal volatile, or essence of 
ginger or cloves, will usually prove equally efficacious. The carminative mixture 
(Pr. 17) is a capital remedy for colic. Sal volatile and carbonate of ammonia in 
small doses are often useful for children, especially in the case of infants tormented 
with colic as the result of bad feeding. In every case of colic the bowels should be 
thoroughly opened. It is often advantageous to take a table-spoonful of castor oil 
with, for an adult, twenty-five drops of laudanum. The external application of 
warmth to the abdomen, as by a mustard poultice, will often prove a valuable 
accessory. In the case of children, a hot-water bottle wrapped in flannel — or, what 
is even better, a bag filled with warm chamomile flowers — may be used for this pur- 
pose. When the colic has resulted from taking some indigestible article of food, 
it may be advisable to excite vomiting by the administration of an emetic of 
ipecacuanha, or by a draught of warm water. Should the bowels still remain 
confined, it may be necessary to take a more powerful purgative, as a dose of salts 
(Pr. 25), or a black draught (Pr. 24). A large enema of tepid water will often 
speedily relieve the bowels, and ease the pain. A warm bath is in many cases a 
useful auxiliary. 

In obstinate cases of colic other remedies may have to be resorted to. 
Thus, small doses of tincture of colocynth will often succeed when other means 
have failed. This remedy is especially indicated when the pains are cutting or 
griping in character, when they are very severe, and when they are accompanied 
by flatulence or diarrhoea. Ten or fifteen grains of chloral in a little water will 
sometimes ease the pain. Tincture of belladonna (Pr. 39) is especially useful in the 
colic of children. Nux vomica (Pr. 44) is useful when the colic is due to flatulence, 
and is associated with irregularity of the bowels. Bromide of potassium (Pr. 31) 
should be given in a form of colic which sometimes affects children of from a few 
months to one or two years of age. The walls of the belly are retracted and hard, 
while the intestines are at one spot- distinctly contracted into a hard lump, the size 
of a small orange, and this contraction can be traced through the walls of the belly, 
travelling from one part to another. These colicky attacks, which produce excru- 
ciating pain, are of frequent occurrence, and are often unconnected with constipation, 
diarrhoea, or flatulence. 

People who are subject to colic should be particular in the avoidance of all 
indigestible articles of food, and in the protection of the surface of the body from 
the injurious influence of cold. Wearing a piece of flannel round the abdomen, 
and keeping the feet well protected from damp, should be especially enjoined. 

CONSTIPATION. 

By constipation we mean confinement of the bowels. Not only are the stools 
not passed with sufficient frequency, but they are usually at the same time deficient 



188 THE TREATMENT OF DISEASES. 

in quantity, as well as too dry and solid. In many instances it is a mere temporary 
derangement, but in others the bowels are habitually confined. 

There are few who have not experienced at some time or other the inconveniences 
of constipation. Those who suffer from it only occasionally will be prepared to 
attach but little importance to it, but people with whom it is habitual know that it 
is one of the greatest of the minor troubles of life. It may be taken as a rule that 
persons enjoying robust health have a motion at least once daily. Yet there are 
many, apparently equally healthy, who have their bowels relieved habitually every 
two or three days only, or even but once in a week or fortnight. There are, indeed, 
cases recorded in which fairly good health has been maintained for many years, 
although evacuations have during that time occurred only at intervals of six weeks 
or two months. In one instance, that of a lady who indulged largely in opium, the 
bowels were opened only four times in the course of the year, at intervals of three 
months. It must not be forgotten, however, that a degree of constipation which is 
habitual with one person, and in him perfectly compatible with health, may be and 
often is a source of discomfort if not of positive illness to another in whom its 
occurrence is exceptional Thus, to most people whose daily habits in this respect 
are regular, confinement of the bowels for even two or three days is apt to produce 
not only local uneasiness, such as a sense of fulness, heat, tendency to piles, and 
flatulence, but also some degree of general constitutional disturbance, indicated by 
headache, foul breath, loss of appetite, and indigestion. Even in cases where from 
long habit constipation has come to be regarded as the normal condition of things, 
some of the above specified discomforts do actually in some degree co-exist ; but 
having become, like the constipation, habitual, they cease to be observed, or at all 
events become tolerable. When a motion occurs after the bowels have been long 
confined, the expulsion of the fseces is apt, from their bulk and hardness, to be 
attended with considerable pain, and perhaps even with some loss of blood, and to 
be followed by prolonged aching and burning. 

What are the causes of constipation? Of all the causes which originate and 
establish habitual constipation, there is undoubtedly none so common as inattention 
to the calls of Nature, which are too frequently not only ill-obeyed, but even set aside 
by every trivial circumstance. How often does it happen that a lady, finding it not 
quite convenient to retire to the cabinet at the moment she experiences an admonition, 
defers it to a more favourable opportunity, but this opportunity having arrived, 
her efforts are powerless, the bowels will not act, and she has perforce to abandon 
the effort, and retire from the contest disappointed and discomfited. It should be 
remembered that the evacuation of the bowels is a natural and necessary function, 
without which health cannot be enjoyed or preserved, and some resolution should 
consequently be exercised in order to promote this object. Some people never think of 
going to the closet unless urged by an imperative necessity which they cannot resist. 

The want of proper conveniences has undoubtedly much to do with the prevalence 
of constipation. As a rule, little or no attention is paid to the situation and con- 
struction of the water-closet. It is either placed in some out-of-the-way corner, where 
no one can find it, or it is so prominently situated that it requires a vast amount of 
manoeuvring to pay a visit without the fact being patent to every one in the house. 



CONSTIPATION. 189 



Not uncommonly in the country it is a long way off, quite at the bottom of the 
garden, and very likely you have to walk right past the dining-room windows to 
get to it. Instead of being a bright, cheerful little chamber, where you might 
pass five or ten minutes with a certain amount of comfort, and moralise on things 
in general, it is a cold, damp, repulsive room ^iiich gives you the shivers even to 
look at. 

It too frequently happens that the pleasures of a country visit are completely 
neutralised by the difficulty in attending to the bowels. If you ask a friend to come 
and stay with you, one of the first things you should do should be to explain to him 
the " anatomy of the place." In most country houses of any pretensions they put up 
elaborate notices telling you all about the times the post goes out, and so on, but 
they never give you any information respecting the situation of the water-closet, a 
very much more important matter. In every visitor'* room there should be placed 
plain, straightforward directions for finding the w.c. 

In the construction of houses, too much attention cannot be given to detennining 
the situations in which the water-closets are to be placed, in order that the access 
may be easy and the egress private. In many houses there is only one water-closet 
for the whole family. There should never be less than two, and it would be a good 
thing if one were reserved exclusively for ladies. People put themselves to a vast 
amount of expense in fitting up apartments and providing entertainment for their 
friends, but they too often neglect the one thing which is so essential for their comfort 
and well-being. 

Want of exercise is a very common cause of constipation, especially in the case of 
women. Ladies may take a formal walk once a day, but they seldom do much more. 
The upper classes residing in town get very little muscular exercise, except in dancing, 
the use of the legs being almost entirely superseded by the carnage. Considering 
the inactive life led by the majority of women above the station of domestics, one 
feels no surprise that the bodily functions are ill-performed, but rather wonders that 
the consequences are not more serious than they are. In spite of want and privation, 
we find that the majority of girls in the lower classes of society are well-formed, 
whilst the rich and well-to-do are often weak and puny. Many a kitchen-maid has 
a physique that a duchess might envy. 

A man or woman, to keep in " good form," should have, at least, a couple of miles 
brisk walk every day, or its equivalent in some other form of muscular exertion. 
Some people require very much more. Dawdling about in the street and looking in 
the shop-windows does very little good ; what you want is a good sharp walk that 
will bring the colour up in your cheeks, and make you feel in a glow all over. That 
is better than pills. 

Mental anxiety is another cause of constipation. In proof of this we find that 
many people while actively engaged in business experience considerable difficulty in 
regulating the bowels, but as soon as they get away in the country, and emancipate 
themselves from worry and anxiety, the mind recovers its cheerfulness, the spirits 
their wonted elasticity, and the bowels resume their normal condition. 

Literary pursuits are said to be eminently favourable to the development of 
constipation. There are many writers who, partly from want of time, and partly 



190 THE TREATMENT OF DISEASES. 

from the sedentary nature of their habits, seldom have the bowels relieved oftener 
than once a week. 

Travelling has usually the effect of discouraging the action of the bowels, and 
not unfrequently it gives rise to considerable inconvenience by the production of 
constipation. A confined state of the bowels always increases the sensation of 
feverish heat which many people experience when making a prolonged journey in a 
close railway carriage. 

The abuse of purgatives may lead to constipation. The number of aperient 
pills which some people are in the habit of taking is very great. Instead of passing 
away with the action of the bowels they have been taken to accelerate, they some- 
times stick together and form a considerable obstruction. 

The consequences of habitual constipation are often most serious. They, of 
course, vaiy somewhat in different cases, and depend materially on the length of 
time the constipation has existed, and on its degree. Habitual confinement of the 
bowels extending over a period of some years, will naturally generate a train of 
evils more serious in character than when the habit has existed for only a few weeks 
or months. At first, the inconveniences experienced are comparatively trivial, and 
are not of such a nature as to cause anxiety or to attract much attention. Even 
when the general health has distinctly suffered, the indisposition is usually attri- 
buted to anything but the true cause. Among the earliest symptoms are drowsiness, 
and heaviness of the head. A dark rim appears under the eyes, and by-and-by the 
patient suffers from an aching, or beating, or throbbing pain in the forehead or 
temples, or over one eye, with a sense of weight or giddiness. Flushings of the face 
occur, and transient sensations of heat are experienced over the whole body, though 
the feet are at the same time cold. The drowsiness after a time increases, and the 
sufferers usually find it difficult to rouse themselves to any kind of exertion. On going 
to bed they fall instantly into a sound sleep which proves heavy but not refreshing, 
for on awaking in the morning they feel tired, and unwilling to leave the bed, and it 
they do not at once get up sleep quickly overcomes them, only to increase the sense 
of fatigue on again awaking. The menstrual functions may become deranged, and 
there is often a copious white discharge. The appetite is not usually impaired, 
although flatulence is a frequent consequence. These symptoms quickly subside 
when the cause is removed, and it is only necessary to restore the action of the bowels 
in order to re-establish the health. 

When constipation has existed for a longer period, the symptoms assume a more 
serious character, and are less amenable to treatment. The general health suffers 
more seriously, the mind becomes irritable and apprehensive, noises jar and distract 
the brain, and strong light overpowers the eye, while, at the same time, the delicate 
sensibility of these organs is dulled, and the senses, though morbidly alive to power- 
ful impressions, are no longer adapted to acute and nice perception. The pain in 
the head increases, it assumes a distracting character, and is often compared by 
sufferers to the opening and shutting of the brain. In some cases this has ended in 
apoplexy. 

Among the more remote consequences of constipation are sick headache, in- 
digestion, pain in the stomach, waterbrash, colic, irritation of the sexual organs, 



CONSTIPATION. 191 

~—"" '" ——————— ——————— • 

iiTegularity in the functions of the womb, <fcc. Many mental diseases, more especially 
hypochondriasis and melancholy, may be traced to the same cause. Moreover, the 
accumulation of faeces in the lower bowel may give rise to much local trouble, and 
may be the cause of piles, falling of the bowel, itching about the anus, and other 
mischief. 

In the general treatment of disease, it often happens that medicines fail to 
exert their peculiar and specific action when the bowels are obstinately confined. 
Under these circumstances the preparations of iron frequently disagree, and we may 
look in vain for the narcotic influence of opium. 

We have, we think, said enough to show that constipation is not a thing to 
be desired. As we have said, it has been laid down as a rule that eveiy robust, 
healthy person, should have a motion once in the twenty-four hours, but to this there 
are many exceptions. Some people have habitually two or three evacuations daily, 
others only every second or third day. These peculiarities should be respected. The 
less frequent action of the bowels in particular individuals is not properly a state of 
constipation, the dejections being of a healthy character, and not having undergone 
those changes of dryness and hardness which usually occur when so long retained. 
It is obvious that it would be unwise and officious to interfere, seeing that 
not only no inconvenience, but absolute benefit, results from the habit. This, 
refers only to cases where the motions are copious, free, and natural in colour and 
consistence. 

What is the treatment of habitual constipation 1 Purgatives ? No, certainly not ! 
Purgatives may do very well for accidental constipation — constipation, that is, occur- 
ring once in the way ; but for habitual constipation they not only do no good, but often, 
if continued, prove extremely prejudicial. What we want is not to give remedies 
which merely act upon the bowels, but to employ means to correct the derangement 
upon which the constipation depends. 

Early rising favours the natural action of the bowels. By early rising we mean 
rather the avoiding a second sleep in the morning than getting up at any specified 
hour. From the difference of habit in different classes, and of those who reside in 
town or country, the hour which is early to one may be late to another, and vice 
versa. It is the lingering in bed, the going to sleep a second time after having 
enjoyed a good night's rest, that does the mischief. A person awakes refreshed, light, 
and cheerful, but if instead of at once getting up he dozes off to sleep again, he after- 
wards rises with unwillingness, and finds his head heavy, his spirits dull, and his 
bowels indisposed to act. 

A very important point in the treatment of constipation is the habit of regularly 
paying a visit to the closet at the same time every day. Immediately after break- 
fast usually affords the most favourable opportunity. You are then in less of a hurry 
and bustle, and can afford to devote more time and consideration to the subject. Get 
up directly you wake, turn into your bath, and have a good sponge, then dress — no 
sitting about in your dressing-gown — have your breakfast, take your paper, and your 
pipe if you like, and retire for a good ten minutes or a quarter of an hour. Ifc may 
be that you feel assured that your visit will be unproductive, nevertheless go. You 
may be unsuccessful to-day, and perhaps to-morrow, but in time you will succeed. 



192 THE TREATMENT OP DISEASES. 

A.t all events you will have the satisfaction of knowing that you have done your 
duty. After a few weeks you will in all probability find that your bowels act with 
the regularity of clockwork. 

Defsecation is an important matter. It is not a thing to be done in a hurry. 
Many of us spend an hour over dinner, and never grudge the time, but five 
minutes spent over an equally important matter is all too long. Many people rush 
to the closet, and if Nature is not prepared to relieve herself at the very instant, they 
never think of allowing her even a minute's grace, but simply get up and come away 
again ; and the consequence is that they suffer from constipation and all its attendant 
evils — and serve them right too. Attention to a few little points in the regulation of 
the diet will accomplish much in constipation. Coarse brown or bran bread, oat- 
meal cakes, or porridge, often prove efficacious, and figs, prunes, or ripe fruit, may be 
taken with benefit. An orange or two eaten before breakfast is a pleasant and often 
effectual way of overcoming moderate habitual constipation, and sometimes, indeed, 
this simple plan will cure the more obstinate forms. A glass of cold water before 
breakfast, and an orange or two soon after, is another excellent mode of treatment. 
With many people coffee acts as a slight purgative, and where the patient has been 
accustomed to take tea at breakfast it may be substituted with advantage. Bacon, 
either broiled and eaten hot, or boiled and eaten cold, at breakfast, is a useful 
auxiliary in regulating the bowels. It often happens that people who are bilious and 
quite unable to take rich dishes, eat bacon not only without unpleasant consequences, 
but with decided advantage. Of drinks, beer and cider are the best suited to 
constipated habits. 

It is not always easy to avoid going beyond or falling short of our aim. To 
produce diarrhoea is not to cure constipation, and is only substituting one disease for 
another. It is a good plan in cases where the walls of the abdomen are relaxed to 
give them artificial support. Wearing a broad bandage firmly applied round the 
body often proves of service, especially in women. Change of scene, to those who 
suffer from habitual constipation, has often a marked salutary effect. Exercise must 
also be considered as a mode of treatment. 

So far we have said nothing on the subject of drugs, but if the above measures 
prove inoperative they will have to be resorted to. A few drops of tincture of 
colocynth, taken several times a day, may be used with advantage. It is especially 
indicated when the constipation has given rise to griping. The tincture of colocynth 
to which we have referred is officinal in the Prussian but not in the U.S. 
Dispensatory. 

A drop of tincture of mix vomica taken four or five times a day, or a tea-spoonful 
of the mixture (Pr. 44) is very useful in some forms of habitual constipation. As 
our knowledge of the action of nux vomica in its relation to constipation is at present 
imperfect, the results appear to be capricious. It is as well, therefore, not to be too 
sanguine of success, for in some cases it answers beyond all expectation, while in 
other apparently similar cases it completely fails. It is usually found of most service 
when the habitual constipation is accompanied by frequent ineffectual efforts, and 
when there is morning headache. It is said to be especially useful when the com- 
plaint is associated with indigestion resulting from the excessive use of alcohol, tobacco, 



CONSTIPATION. 193 



or coffee. It is also recommended for persons who take too little exercise, and for 

students and literary men. 

Trousseau, the eminent French physician, recommended the use of belladonna in 
constipation. In one of his lectures he says : "I give it in the form of pills, each pill 
containing a centigramme (equal to about J of a grain) and as much of the powder of 
belladonna ; one of these pills is taken daily, fasting, by preference in the morning 
on an empty stomach rather than in the evening ; the number of pills may be in- 
creased from one daily to two daily within the first five or six days : they ought 
seldom to exceed four or five in the course of the twenty-four hours. "Whatever number 
of pills are taken they ought always to be taken at one time. As soon as the stools 
become regular, the belladonna must be discontinued, and the organs be allowed to 
act without assistance." Any intelligent chemist would be able to make these pills. 
It has been found by several medical men that this treatment is useful in all forms 
of constipation co-existing with indigestion, characterised by a thinly-furred tongue, 
pain at the pit of the stomach, especially after food, and more or less headache. It en- 
sures a natural evacuation daily, and must be continued for a fortnight or three 
weeks. Trousseau, whilst recommending this treatment, adds : " By calling to mind 
the similarity of the properties of belladonna and tobacco, you will see how it is that 
many men cannot go to stool unless they smoke a pipe or cigar immediately after a 
meal. Although, at least in our country, it is not considered very proper for women 
to smoke, I almost every week advise ladies to try the effect of smoking a tobacco 
cigarette, to aid in overcoming constipation which had proved inveterate under every 
hygienic treatment." 

In many cases of constipation dependent on torpidity of the bowels relief may 
be obtained by taking one grain, of powdered ipecacuanha every morning while 
fasting. The same treatment will remove the indigestion frequently associated with 
constipation, and characterised by depression of spirits, flatulence, coldness of the 
extremities, and the food lying like a weight on the stomach. Sulphur taken in 
the form of the confection (Pr. 59) is very useful, especially when the patient also 
suffers from piles or skin diseases. Senna may do well, particularly if given with 
gentian or some other bitter tonic (Pr. 16). Aloes in many cases prove highly 
useful, especially when given in the form of the dinner pill (Pr. 65). 

In the treatment of the constipation of old people, drop or half-drop doses of 
tincture of opium (laudanum), given every quarter of an hour for the first hour, 
and then hourly for three hours, have been recommended. It must be remembered, 
however, that daily evacuation, which is the rule in youth and middle life, is often an 
excess in advanced years, when a motion three or four times a week usually proves 
ample. Old people often trouble themselves needlessly on this point. Laudanum 
is especially indicated when there is complete torpor of the bowels, when the 
motions are hard and lumpy, and there is headache, drowsiness, or dizziness. 

In habitual constipation it is often necessary to resort to the use of some of 
the natural waters, such as those of Carlsbad. The imported Carlsbad water acts 
well. It should be warmed to a temperature of from 100° to 110°. The patient 
should begin with three tumblersful, and gradually increase the number to four, 
five, or six, according to the action. It should be taken before breakfast. It 
13 



194 THE TREATMENT OP DISEASES. 

usually causes pulpy slimy stools of dark colour and offensive odour. They are 
generally frequently repeated, and the quantity is often so great that the patient 
expresses his astonishment, and often wonders where it all comes from. The treat- 
ment will have to be continued for three weeks or a month. In some people it 
produces very little purgative action. The beneficial effects are more marked when 
dietary is adopted similar to that enjoined at Carlsbad. The Pullna or Friedrich- 
shall waters are often used with advantage in constipation. 

In many cases the use of an enema or injection proves of the greatest service. 
Unirritating in its operation, and acting directly on the seat of obstruction, an 
injection is far preferable to the administration of strong drugs, which derange the 
whole alimentary track and excite violent action, only in many cases to induce a 
state of greater debility and torpor than existed in it before. It matters little of 
what the injection is composed — either hot or cold water or gruel or starch may 
be conveniently used. 

CONSUMPTION. 

Consumption, or phthisis, as it is technically called, is an affection of the lungs 
accompanied by general wasting. There is no doubt that consumption is hereditary, 
though probably not to the extent that is commonly supposed. It does not follow 
of necessity that because a person comes of a consumptive stock he will suffer from 
that affection. By some authorities it is considered that the disease itself is 
transmitted, whilst others think that it is only a general weakness or constitutional 
debility that is hereditary. 

Most cases of consumption occur between the ages of twenty and thirty. The 
disease is not often observed in early childhood or in old age, but it may come on 
at any period of life. It occurs with nearly equal frequency in men and women. 

People whose general health is below par are the most likely to become the 
subjects of consumption. Those who have a consumptive tendency should scru- 
pulously avoid anything at all likely to weaken them. Nevertheless, cases com- 
mencing with spitting of blood may originate in those whose health is a model of 
excellence. 

There are certain occupations which predispose to the occurrence of consumption. 
It is common amongst stonemasons, grinders and polishers of steel, dressers of flax 
and feathers, straw plaiters, iron and coal miners, tailors and sempstresses. In 
many of these the inhalation of foreign particles into the lungs sets up irritation, 
which proves injurious and deteriorates the constitution ; in others the resnlt is 
occasioned by the combined operation of sedentary employment, impure air, ex- 
haustive work, and bad food. On the other hand, cooks, butchers, tanners, tallow- 
chandlers, and soap-boilers, enjoy to a great extent an immunity from this terrible 
scourge. They get good wages, and as a concomitant have plenty to eat and drink, 
whilst the constant contact with oil and fat is probably not without its influence. 
A consideration of these facts may in some instances be of service in deciding on the 
choice of an occupation. Sedentary habits and want of exercise, intemperance in 
any shape or form, excessive indulgence and debauchery of all kinds, powerfully 
influence the development of phthisis, especially in the young. 



CONSUMPTION. 195 



Imperfect digestion, and the resulting mal-nutrition, favour the occurrence of 
the disease. It is probable that a bad set of teeth, by preventing the proper masti- 
cation of food, is not without its influence. Some doctors lay great stress on a 
deficiency of fat in the system, as a cause of consumption. It is an undoubted fact 
that most consumptives have a great dislike to fat, and will not eat it unless abso- 
lutely made to do so. 

Want of proper ventilation and fresh air undoubtedly tend to produce this 
disease, hence its frequency amongst those whose occupations compel them to remain 
shut up in the same room for many hours at a time. It is of common occurrence in 
ill-ventilated institutions where many people are gathered together. For the main- 
tenance of health a liberal supply of pure fresh air is essential. 

It has always been a disputed point whether the practice of wearing stays 
favours the development of consumption, but the weight of evidence goes to show 
that it has not such tendency. 

It is an undoubted fact that consumption is more frequent in temperate climates 
than in very cold or very warm ones. It may be said that consumption is much 
more prevalent in some localities of the earth, independent of the influences of 
occupation and habit, than in others ; that under certain climatic, hygienic, and 
social conditions, the average duration of the disease is longer or shorter, as 
these conditions are favorable or unfavorable. Probably the most antagonistic 
influence to the existence of consumption is exercised by the climatic conditions of 
extreme altitudes. We are told that in localities in the Andes, 7,000 feet and up- 
wards above the sea-level, where the air is dry, the temperature about 60° in the 
shade, and the sky sunny throughout the greater part of the year, consumption of the 
lungs is known only as an exotic. 

There is strong evidence to show that humidity of the air exerts a powerful in- 
fluence in the production of consumption. It is undoubtedly common in Holland 
and other countries liable to damp fogs and an atmosphere saturated with moisture. 
In many towns in England the death-rate from consumption is in inverse proportion 
to the dryness of the site. By many it is considered that a judicious system of 
sub-soil drainage would in time almost stamp out our national malady. 

Severe mental depression, as from anxiety, grief, or over-study, seems to have 
considerable influence in some cases. Phthisis is by no means uncommon among the 
inmates of lunatic asylums. 

Phthisis may follow other diseases, such as measles, and typhus or typhoid fever, 
scarlatina, and repeated attacks of bronchitis. In some instances it is probably set 
up by over-suckling. On the other hand ansemic girls rarely suffer from it, though 
they are often supposed to be consumptive. The poorness of blood appears to have a 
kind of protective influence. 

In former days it was supposed that consumption was contagious or infectious, 
but this is an exploded idea. At the same time a phthisical patient should not be allowed 
to occupy the same bed as a healthy person. A widow or widower whose partner may 
have died of consumption is not more likely than any one else to suffer from it. 

The general symptoms of consumption are cough, expectoration, spitting of blood, 
shortness of breath, night-sweatings, and general wasting. Some or all of these are 



196 THE TREATMENT OP DISEASES. 

usually present ; there are other symptoms which are of occasional occurrence, and 
will be considered in due course. 

Cough is usually one of the earliest symptoms of consumption, and is that which 
commonly first attracts the attention, and awakens the fears of the patient or his 
friends. Usually, to begin with, it is slight, occasional, and only occurs on getting 
out of bed in the morning or making any unusual exertion in the course of the day. 
Sometimes it will cease for a while, as in the warm weather of summer, and return 
in winter, or on the approach of cold weather. After a time it begins to be trouble- 
some at night, and is attended with more or less expectoration of mucus. The gradual 
onset of a cough in this way is in itself a suspicious circumstance ; it may mean 
nothing, probably does mean nothing, but still, as a matter of precaution, we should 
advise you to go to a doctor and get your chest examined. It is very likely it is 
all stomach, but if there is any doubt there is nothing like being on the safe side. In 
chest complaints it is of vital importance to begin treatment at the earliest possible 
moment. 

The expectoration in phthisis varies greatly both in quantity and character. 
Some patients enquire most anxiously of the doctor if he is quite sure that what 
they are spitting up contains no pus. This is a matter of little importance, for the 
presence or absence of pus in the sputa affords no test at all of the presence or 
absence of consumption. 

Spitting of blood is observed to a greater or less degree in the majority of cases 
of phthisis, varying, however, considerably as regards the amount and the frequency 
of its occurrence. The bleeding is frequently, but not of necessity, brought on by 
an attack of coughing. When the blood occurs in mere streaks, or in quantities less 
than a tea-spoonful, it probably means nothing, and is of little consequence. People 
are often greatly and unnecessarily alarmed by expectorating a small quantity of 
blood that could under no circumstances be of the slightest moment. In any case 
in which more than a tea-spoonful of blood is spat up, you should consult your doctor. 
Moreover, even when the quantity is smaller, and you feel anxious or not quite easy 
about it, you had better obtain medical advice. 

Shortness of breath, although generally present to a greater or less extent, is not 
a very important sign of phthisis. Many people — anaemic girls especially — readily 
get out of breath on exertion, and yet their lungs may be perfectly healthy. 

Nightsweating is often a most distressing symptom, and is especially injurious 
by disturbing the rest and exhausting the strength. It seldom comes on in the 
day-time, but the patient awakes in the middle of the night sweating profusely, 
and perhaps drenched in perspiration. Sometimes the quantity is so great that it 
wets not only the flannel and night-shirt, but even the sheets. 

Wasting is a symptom of very frequent occurrence. If a person loses a few 
pounds, then regains it, then loses it again, and so on, it is of very little importance; 
but when there is progressive emaciation, it is a serious sign. It is often one of the 
earliest, as it is one of the most alarming symptoms the patient presents. If a 
person without any apparent cause grows thin and weak, and gets no better from 
rest and change of air, he should consult his doctor, especially if there is any cough. 

In consumption there is always fever : the temperature is distinctly elevated. 



CONSUMPTION. 197 



If you take your temperature morning and night on several consecutive clays, and 
find that it is never above 99°, you may be pretty sure that you are not consumptive, 
or at all events that there is no active mischief going on in your chest. Taking the 
temperature is one of the best methods of proving the absence of consumption. The 
pulse is usually quickened in proportion to the elevation of temperature. If your 
natural pulse is, say, 70, and you find it continually above 90, and there is nothing 
that you know of to account for it, it is a suspicious sign. If, on the other hand, 
your pulse, especially at night, is normal in frequency, there is probably no fever. 

Pain about the chest is sometimes met with in phthisis, but it is by no means of 
constant occurrence. It is usually a dull, aching pain that is complained of, and it 
is often referred to the region just under one or other of the collar-bones. When 
the pain is a sharp " stitch in the side," there is probably a little pleurisy just at 
that spot. A little localised inflammation of the pleura or covering of the lung 
often occurs in the course of phthisis, but it is of no great moment, and with 
appropriate treatment usually passes away in a day or two. 

Diarrhoea is not of unfrequent occurrence in consumption, but it is not usually 
an early symptom. It is essential that it should be checked as early as possible. 

Loss of hair is a common symptom of phthisis. Women often tell you that 
their hair comes off in handfuls. It must not be supposed that this symptom by 
itself is of the slightest value — other and more decided signs of the malady are 
always present. We recently had a patient under our care with lung mischief 
who in a few weeks lost an abundant crop of hair that had for years grown on 
his chest. 

Absence of the catamenia is another symptom often met with, especiaUy in 
advanced cases. 

A clubbed or thickened condition of the finger-nails is also common. It is 
worth looking for, for it is a favourable sign, indicating that the progress of the 
disease has been and is likely to be slow. 

A red line along the margin of the gums where they meet the teeth is not 
unfrequently seen. 

Such, then, are the symptoms of phthisis. If you suspect, or have any reason to 
suspect, that there is anything wrong with your chest, go to a doctor. If there is 
nothing the matter, it will remove a harassing doubt and a feeling of uneasiness that 
might in itself in time prove prejudicial to your health. You must remember that the 
doctor will have to examine your chest, and you must of course be prepared for 
that. He can do you no good unless you let him go thoroughly into your case. 

Is consumption curable ? Undoubtedly, in many cases. In days gone by it was 
laid down as a law by learned pundits that any medico professing to cure consumption 
was a charlatan. Thank God ! those times have passed away, and we no longer regard 
consumption with the same hopeless horror we used to. A person may be con- 
sumptive, and live on for ten, twenty, or thirty years, or even longer. Cases of 
arrested consumption are now-a-days by no means uncommon. Modern treatment 
will save a life that a few years ago must have been sacrificed. 

A few words, then, respecting the treatment of consumption. If there is much 
fever, the temperature being, say, 103° or 104° every night, begin with the effervescing 



198 THE TREATMENT OP DISEASES. 

ammonia mixture (Pr. 99) ; two table-spoonfuls are to be taken every four hours 
during effervescence. The addition of five drops of antimony wine to each 
dose is advantageous. The chest and back should be painted with iodine liniment, 
which is not to be rubbed on, but applied with a small brush. If you know tha^i 
only one lung is affected, the application should be confined to that side. If it is 
only the apex or upper part of the lung that is damaged, the paint should be put on 
above and below the collar-bone, and over the shoulder-blade only. It must be 
remembered that the iodine liniment is a strong preparation, and that if you put 
it on too thickly it will bring all the skis off. It ought to cause a fair amount of 
pain and smarting, or it will do no good. For children and young people, the weaker 
tincture of iodine may be used, but it is not so valuable a remedy. As soon as one 
coat of iodine clears off — and it will disappear in a few days — put on another. The 
effervescing ammonia mixture will have to be taken for a week or ten days, and then 
the temperature will probably be lower. You must then take cod-liver oil. The 
dose to begin with is a tea-spoonful three times a day. It may be given alone or in 
milk, or weak brandy-and- water, or orange wine, or coffee, or anything you like best. 
The great thing is to float it on the top of the liquid, so that it does not touch the 
sides of the glass, and then you can toss it off without tasting it. Many people can 
take it on the gentian and soda mixture (Pr. 14), when they cannot take it in any 
other way. It does not matter much how you take it, but take it you must. It 
should always be given soon after meals, and never before, or it will spoil the 
appetite. In addition to the cod-liver oil, a table-spoonful of the following mixture 
should be taken twice a day : — 

Take of Hypophosphite of lime, thirty-two grains. 
Syrup, one ounce. 
Water, seven ounces. 
Make a mixture. Dose, a table-spoonful twice a day. 

This should be taken quite by itself, and not at the same time as the cod-liver oil. 
If the cough is troublesome, and especially if it is a short, dry, and hacking cough, 
take a tea-spoonful of the morphia linctus (Pr. 56) occasionally. Other remedies for 
cough will be found under that heading (see Cough) ; but we think you will have no 
reason to be dissatisfied with the one we have recommended. If there is much 
night- sweating take one or two of the oxide of zinc pills (Pr. 66) at bed-time. 
Should they fail to afford relief, you may after three or four nights substitute ten 
grains of compound ipecacuanha powder, which will probably prove successful 
There are many other remedies for the night-sweating of phthisis, and they will be 
found enumerated in their proper place. (See Night-Sweating.) Should there be 
any bleeding, turn to the article on blood-spitting (p. 141), and you will see what 
to do. For diarrhoea, a mixture of equal parts of decoction of logwood and chalk 
mixture usually proves successful. The dose is two or three table-spoonfuls every 
four hours. In obstinate cases, large doses of carbonate of bismuth often succeed 
admirably. From thirty to sixty grains may be given at a single dose, suspended in 
milk. Sometimes a number of remedies will have to be employed before the 
diarrhoea can be stopped. The article on that subject should be consulted. (See 
Diarrhqsa.) Should there be any pain under the collar-bones, or a stitch in the 



CONSUMPTION. 12)9 



side, the application of the iodine paint will do as much good as anything. It is an 
excellent remedy, and ranks high in the treatment of consumption. 

A blister, too, is useful. One may be placed under each collar-bone. They 
should not be larger than a two-shilling piece, and should be kept on for from 
seven to eight hours. The blister need not be cut, but should be covered with 
a layer of cotton-wool. The fluid in the blister will be partly re-absorbed, and 
by not cutting the bleb you prevent the access of air to the raw skin beneath. 
These small blisters are not at all painful, and in fact many people say they hurt 
less than a coat of iodine. 

The use of the cod-liver oil and the hypophosphite of lime mixture will have to 
be continued for many months — in fact, till the prominent symptoms have entirely 
disappeared. The dose of the cod-liver oil may gradually be increased from a 
tea-spoonful to a table-spoonful ; but beyond this it is seldom necessaiy to go. The 
hypophosphite may be occasionally omitted for a day or two, and it should not 
be taken when there is any spitting of blood. Sometimes it is advantageous to take 
the hypophosphite in the form of " Churchill's Syrup of Hypophosphites," a prepara- 
tion kept by most chemists. Directions as to dose, &c, are given on the bottles. 
We are told that no other medicine is to be used whilst taking tl^e syrup, and that 
cod-liver oil and alcoholic stimulants are to be discarded, but this rule need not be 
observed. 

Arsenic is a good remedy in consumption, especially in chronic cases. A dose 
of the arsenic mixture (Pr. 40) should be taken four times a day, shortly before 
meals. It may have to be continued for some weeks, or even months, and it may 
be some time before any improvement becomes manifest. Should it cause sickness 
or diarrhoea, its use should be suspended for a few days, and then, when resumed, 
it should be taken after meals. In some cases it is necessary to reduce the dose 
or frequency of administration for a time. Many chemists keep little arsenic 
granules, each containing a dose nearly equivalent to two drops of liquor arsenicalis. 
They are quite white, not much bigger than a pin's head, ar I are put up in glass 
coi ked bottles, each containing some two or three dozen. They are of French 
manufacture, and can be obtained through any of the leading a.nd reliable chemists. 
They are more convenient to take than the arsenic mixture, foi the bottle can 
readily be carried about in the waistcoat pocket. 

When cod-liver oil cannot be taken, or the repugnance to it cannot be over- 
come, pancreatic emulsion will be found usefid. One or two tea-spoonfuls should 
be taken in a tumblerful of milk, with a table-spoonful of brandy, twice a day, 
^.alf-an-hour after meals. 

A remedy called Chaulmoogra oil has been recently introduced as a remedy for 
consumption. It is expressed from the seeds of a tree known as Gynocardia 
odorata, and is said to have been known for years to the Fakirs of India. The 
dose is from two to twelve drops in a little cod-liver oil, two or three times a day. 
We find that most patients can take this dose without difficulty. The oil is semi- 
solid at the ordinary temperature of the atmosphere, but soon liquefies if held in 
the hand or planed in tepid water for a few minutes. It can be obtained in New York 
without difficulty. It is quite a new remedy, and no trustworthy reports have as 



200 THE TREATMENT OP DISEASES. 

yet been published in this country. A pamphlet, compiled from various sources, 
has been recently brought out by Mr. Richard C. Lepage, late of Calcutta, but it 
throws but little light on the medical aspect of the question. The oil can do no 
harm, and is well worth trying when the patient is making no progress and other 
remedies have failed. 

The diet of the consumptive should be simple and nutritious ; very strict rules 
as to special articles of diet are uncalled for, unless the stomach should have 
exhibited signs of imperfect power. Meat should be taken once or twice a day, with 
a good allowance of fat. Fish is nutritious, especially oysters. Milk is very nourish- 
ing, and two or three pints may be taken in the course of the day. At the Hospital 
for Consumption at Brompton many of the patients have a glass of rum and milk 
the first thing in the morning before breakfast, to help them to dress, and un- 
doubtedly it often does good. Asses' milk may be taken when ordinary milk dis- 
agrees. Another favourite prescription is fat bacon for breakfast. Sugar is very 
fattening, and there is no objection to taking it, even in considerable quantities. A 
moderate allowance of wine or spirits is advisable; but it should be taken with 
caution when it flushes the face or quickens the pulse. 

Raw meat is gery useful in consumption, especially when the appetite is bad, 
or the digestive powers are failing. It sounds very nasty, but is not so in 
reality. What you have to do is this : — You get about half a pound of rump- 
steak — it must be quite fresh — and then cut away the fat and gristle and tendon, 
if there should be any. Then you get the pudding-board and a sharp knife, and 
scrape the meat into a pulp. It is rather hard work, and makes your arms ache, 
but you must not mind that. As you scrape off the meat you will look out for 
the little white pieces of tendon, and carefully remove them. It is very nasty if 
it is stringy. Now put your pulp into a mortar, and bruise it well for a few 
minutes. Next spread it out between pieces of bread-and-butter, and let your 
patient eat it as a sandwich. It is more palatable if you add a little pepper and 
salt. Some people like a little butter with it ; it removes to some extent the nasty 
red colour, but it rather increases the difficulty of digestion. The addition of a 
little mace and allspice is a decided improvement. It is an advantage, too, to vary 
the flavour from time to time. When the patient cannot take it in the form of 
sandwich, it may be mixed up with soup and taken that way. 

Moderate and frequent exercise in the open air is essential. An old writer says : — 
" Bark is no surer cure for ague than riding is for phthisis." This is not literally 
true, but still the opinion is worth quoting. Walking is capital exercise, and swing- 
ing on a horizontal bar is frequently beneficial Gentle gymnastic exercise — the 
so-called musical gymnastics more particularly — and the use of light dumb-bells, do 
much to expand the chest and strengthen the lungs. So, too, does the practice of 
taking deep inspirations, of reading aloud, and of moderate singing. For those who 
are rapidly exhausted, and too weak to get about much, passive exercise in a carriage 
or boat must be enjoined. In summer, sitting or lying well supported in a boat pulled 
on a Saranac lake— while for occupation reading mixed with a little fishing, and the 
conversation of a pleasant companion, the varying tints and outlines of the landscape 
also serving occasionally to occupy the attention — is perhaps the most salubrious 



CONSUMPTION. 201 



kind of exercise for the not over-weakened invalid. Even when it is impossible to 
get right away from home, there is no occasion to stay in-doors. Anthony Trollope 
says, in one of his novels : — " Most of us have recognised the fact that a dram 
of spirits will create — that a so-called nip of brandy will create — hilarity, or at least 
alacrity, and that a glass of sherry will often 'pick up* and set in order the 
prostrate animal and mental faculties of the drinker. But we are not sufficiently 
alive to the fact that copious draughts of fresh air — of air fresh and unaccustomed- 
will have precisely the same effect. We do know that now and again it is very 
essential to * change the air ; * but we consider that to do that with any chance of 
advantage it is necessary to go far afield ; and we think also that such change of the 
air is only needful when sickness of the body has come upon us, or when it threatens 
to come. We are seldom aware that we may imbibe long potations of pleasure 
and healthy excitement without perhaps going out of our own country ; that such 
potations are within a day's journey of most of us, and that they are to be had for 
half-a-crown a head, all told." When nothing else can be done, sitting out in the 
open air should always be insisted on — in a garden, on a balcony, or even at an open 
window. Anything is better than remaining shut up in the same room from morn- 
ing to night. Of course, in taking exercise a certain amount of discretion is 
necessary. We heard of a man who, on being told that riding was beneficial, hired 
a horse and galloped about till he was so exhausted that he did not recover for 
a fortnight. Exercise should be carried to a point short of producing fatigue. 

The bath — tepid or warm in cold weather, cool in the summer — should be used 
daily, or at least twice a week, and should be followed by free friction of the skin. 
Flannel — both vest and drawers — should be worn, but several layers of such covering, 
often seen, especially among the lower orders, are useless. The neck and chest should 
always be covered, and the growth of the beard and moustache in men encouraged. 
Women should avoid low-necked dresses, and should always be prepared with a shawl 
or cloud to throw over the shoulders even in going from one room to another through 
an exposed lobby. 

In ordinary cases of consumption there is not the slightest occasion for the 
patient to keep his room, but still it is very important that the sleeping apartment 
should be properly ventilated. The great thing is to get as much pure air as possible 
consistent with warmth and the absence of draughts. There should be no curtains 
round the bed, an open fire should burn in the room during the winter, and the bed 
should be placed in a position free from the direct draught between the fire and the 
door or window. Only a moderate temperature should be permitted, so that when 
in bed the patient does not feel cold. In summer, good ventilation should be secured 
by letting down the windows for an inch or so at the top. At the Hospital for 
Consumption at Brompton the wards and galleries are kept, winter and summer, at 
a uniform temperature of a little over 60°. The policy of this system is open to 
question ; and in the opinion of many competent judges the patients would do better 
if the temperature were considerably reduced. 

The climatic treatment of consumption is a subject of the utmost importance. 
Each case must be decided on its own merits, and we can do little more than lay 
down a few general principles. In selecting a suitable climate the chief points to be 



202 THE TREATMENT OF DISEASES. 

observed are that it is not liable to either extreme of temperature ; that the air is 
pure and not too moist ; that the soil is healthy ; and that there is no likelihood of 
sudden changes, exposure to cold winds, or continued unfavourable weather. It is 
always well, also, to choose a place rendered attractive by bright sunshine, pretty 
scenery, and pleasant company. One most important object in selecting a climate is 
that the patient may be enabled to be out in the open air as much as possible. 
Though a dry, warm atmosphere is suitable for many consumptives, there are some 
who thrive in a moist climate, or in a steadily cold one : those who like the cold 
temperature usually suffer much from shortness of breath. They are oppressed and 
smothered by the hot air of tropical regions. Knowing these diverse natural 
demands of consumptives, we can appreciate the necessity of a rigid examination of 
each patient. His habits, his surroundings, his tastes, and the special peculiarities 
of his disease should be carefully studied. Then, if the conclusion is that a dry and 
warm climate is best suited for the patient, he may choose between Santa Barbara, 
San Jose, San Diego, and other places in California; Aiken, S.C. ; Santa Cruz, in 
the West Indies, and Honolulu. If a warm climate with much moisture in the air 
is desired, there is Magnolia and St. Augustine in Florida, Bermuda, and Bahama 
Islands ; St. Thomas and sea-port towns of Cuba. A very dry and cool climate can 
be found in Colorado. Those who prefer a climate which is very cold — but, at 
the same time, without sudden or dangerous changes — will be suited in some parts 
of Minnesota, in the Adirondacks, and in the Ramape Valley, in New York State. 
These are the principal winter resorts. {Howe : " Winter Homes for Invalids") 

For the slight cough which often remains for years after consumption is prac- 
tically cured the following receipt will be found useful : — 

Linseed Jelly. — Half a pound of linseed (the brown seed) to three pints of cold 
water. Let it simmer (not boil) for two hours, then strain, or rather squeeze through 
muslin. "When cold it will be in a jelly mass. Sweeten and flavour to taste. A 
breakfast-cup of the jelly once a day, or oftener if necessary, with the juice of one 
lemon in it 

This is not only soothing but strengthening ; and the same may be said of the 
following : 

Egg and Milk Mixture. — Beat up the yolk of an egg, add the juice of one lemon, 
and then sugar to taste. Mix well before adding the milk, or curdling takes place. 
Add milk to the egg and lemon in quantity sufficient nearly to fill a breakfast-cup. 
This may be taken every day at 11 a.m. 



CORNS. 

Corns, as everybody knows, occur most frequently on the feet, where they are 
usually due to the irritation of badly-fitting boots. The boots may be either too , 
small, and compress the feet, or they may be too large, so that they chafe and irritate 
them in walking. When corns occur on the under surface of the foot, they are due 
to friction against the sole of the boot, but when they make their appearance on the 
upper surface, it is, of course, the upper leather which is at fault. High heels, by 
throwing the weight of the body unduly on the toes, are a fruitful source of corns; 



CORNS. 203 



and so are patent-leather boots, which hinder the escape of the perspiration. In a 
smaller degree, tight socks and stockings favour the formation of corns by crowding 
the toes together and preventing their even spread in walking. 

Corns, however, are not always confined to the feet. In tailors and seamstresses 
they may be found on the palm of the hand and on the knuckles, and are then due 
to the friction of the thimble. Occasionally in people who play the harp or violon- 
cello they occur on the tips of the fingers or on the thumb. It is said that in those 
who do much writing they may arise from the friction of the pen. Certain occu- 
pations, such as the miner's, may excite their growth on the prominences of the 
knees and elbows. > 

There can be no doubt that in some cases a predisposition to the formation of 
corns is hereditary. "We have heard people say that one or more of their children 
were born with a corn, and we see no reason for doubting the truth of the statement. 

Corns may be roughly divided into hard corns and soft corns. Soft corns occur 
generally between the toes, their most common situation being on one side of the 
fourth toe. They probably arise from the friction of the toe against its neighbour, 
and they are kept constantly moist by the secretion of the foot, which in this situa- 
tion escapes with difficulty. They differ from hard corns in being more sensitive, 
and in the rapidity of their growth. Their rapid formation is due to the warmth 
and moisture of the foot There is a special form of warty com which occurs only on 
the sole of the foot. It is usually of small size, and round in shape. It is extremely 
sensitive to the touch, and may become the source of the greatest possible pain and 
inconvenience to the sufferer, preventing his walking, and, in fact, completely 
crippling him. 

The pain of a corn is usually most severe in damp weather. It is not uncommon 
to hear people say, " I know it is going to rain, my corns shoot so." As a rule, they 
cause most inconvenience in the spring. Sometimes corns become inflamed and 
matter forms beneath them, giving rise to intense pain. Occasionally the matter 
makes its way into a neighbouring joint, causing all kinds of trouble. 

There can be no doubt that in many cases curvature of the spine has been caused 
by a corn. The sufferer has been for years in the habit of throwing the weight of 
the body in walking on one side, in order to relieve the pain of a corn on the opposite 
foot, and this has gradually given rise to bending of the spine. 

The first thing to be done in the treatment of corns is to remove, as far as 
possible, the cause on which they are dependent. In the case of corns on the feet 
it is very essential to have well-fitting boots, and it may even be advisable to have 
them made of some other material than leather — as, for example, the invention 
rejoicing in the classical but ungrammatical name of pannus corium. We need 
hardly say that the feet should be rested as much as possible. An illness which 
confines a person to bed for some time often relieves him of his corns. 

Anything that mechanically protects the corn from pressure proves advantageous. 
Little circular pieces of felt or leather punched with a hole in the middle, are often 
used for this purpose. If the corn seems inclined to bulge through the hole in the 
corn-plaster, it may be either pared down or covered with a piece of thin rag or 
diachylon plaster. In the case of soft corns, it is a good plan to surround the toe 



204 THE TREATMENT OP DISEASES. 

with a thin layer of cotton-wool, which should be changed at least once a day. It 
is often useful to powder a soft corn with oxide of zinc before using the cotton- wool. 

When these preliminaries have been arranged, the corns should be vigorously 
attacked. In the case of a hard corn, the feet should be well soaked in hot water, 
and then it should be carefully pared down with a knife, avoiding however making 
it bleed. The com is then to be painted over two or three times a day with the 
arsenic solution (liquor arsenicalis) of the Pharmacopoeia. This usually causes the 
gradual disappearance of the corn. Soft corns may nearly always be cured by 
painting them with the arsenic solution. They either diy up and disappear of 
themselves, or they undergo such a change that the shrivelled remains may be cut 
away without pain or inconvenience. The application is unattended with danger, 
but the solution should be distinctly labelled, and should be kept locked up, as if 
taken internally, except in very small doses, it is poisonous. 

Some people prefer using, instead of the arsenic solution, a lotion made by adding 
thirty drops of the tincture of arnica to a wine-glass of water. It should be applied 
on a little piece of lint, and should be renewed twice or thrice daily. 

COUGH. 

When a man says he has "a cough," he generally means that he has a cold 
on his chest, or a slight attack of bronchitis. Directions for treating this complaint 
will be found on pages 158 and 160. One is very often asked what is the best 
cough medicine. This is a question by no means easy to answer. There are a great 
many different kinds of cough, and a mixture that acts like a charm in one may 
prove useless in another. Still, as the proposition is put before us, we must do our 
best to solve it. The following is a very good general cough mixture : — 

Take of Paregoric elixir, 160 minims. 
Chloric ether, 80 minims. 
Oxymel of squill, four drachms. 
Infusion of eascarilla to eight ounces. 
Make a mixture. Take two table-spoonfuls every four hours. 

^his will be found useful, and it generally succeeds admirably, although it is not 
* universal panacea. 

When the cough is hard and dry, and there is no expectoration, the following 
mixture will do good : — 

Take of Solution of hydrochlorate of morphia, 80 niinims. 
Dilute hydrocyanic acid, 24 minims. 
Chloric ether, 80 minims. 
Water to eight ounces. 
Make a mixture. An eighth part every four hours. 

It is |» be used only for adults, and never when there is much difficulty in getting 
ap the phlegm. 

For a dry, hard, irritative cough, nothing does better than the morphia linctus 
(Pr. 56). It is to be taken in tea-spoonful doses, and only when the cough is 
troublesome. The Lozenge Pills (Pr. 69) are also very useful. 

A. cough, as we have seen, often means no more than a slight attack of bronchitis, 



COtTGH. 305 



but it may occur as a "symptom of some far more serious disease. Thus, cough is 
met with in consumption, in pleurisy, pneumonia, and many other chest affections. 
It may depend, too, upon an elongated uvula, or it may be a stomach cough, or it 
may be the result of nervousness, or even of mere habit. 

Usually the treatment has to be directed to the general constitutional condition, 
and not to any one symptom. Nevertheless, it is very useful and even necessary 
to know what medicines are to be used in different kinds of cough. We have selected 
those most likely to be of service. 

Aconite is useful quite at the commencement of a cough, when accompanied by 
fever. The indications for its employment are a dry, hard, recent cough, with 
restlessness, flushed face, headache, thirst, dryness of the throat, scanty urine, and 
confined bowels. It is not likely to do good unless the temperature of the body 
is distinctly elevated. Directions for its employment and mode of administration 
were given when speaking of Cold (p. 182). 

Alum is often used in the form of spray for chronic coughs accompanied by 
hoarseness. The strength of the solution should be ten grains of the alum to an 
ounce of water. 

Assafcetida does good in old chronic catarrhs, especially when accompanied by 
spasmodic cough and by occasional difficulty of breathing. A five-grain compound 
assafcetida pill may be taken three times a day. 

Belladonna is useful in some kinds of cough, but it is difficult to say exactly 
what are the indications for its employment. It is thought to do most good when 
the cough is dry and accompanied by a sensation of tickling in the throat. A 
drachm of tincture of belladonna is to be added to an eight-ounce bottle of water, 
and of this a tea-spoonful may be taken every two hours, with an additional dose 
when the cough is very troublesome. 

Chamomile oil is a valuable remedy for cough occurring in hysterical women. 
The dose is from four to six drops on sugar. The preparation must be of good 
quality, and should present its original green or blue tint. 

Chloroform, used as an inhalation, is useful in many kinds of spasmodic cough. 
Ten drops should be dropped into the palm of the hand, and the vapour quietly 
inhaled. 

Coltsfoot is a popular remedy for coughs of all kinds. It often does good, but 
we do not know what are to be regarded as indications for its employment. 

Drosera has been highly recommended for dry spasmodic cough resulting in 
vomiting. By many it is used for cases of whooping-cough uncomplicated by 
oronchitis or other chest affections. The tincture is the best preparation, and 
only small doses must be used. 

Gelseminum may be given when the cough is dry and irritating. It does best in 
exactly the same class of cases in which the morphia linctus proves useful. The full 
dose of the tincture is ten minims in water every three hours. It must be given 
frequently, as its effect is very evanescent. Giddiness, dimness of sight, double 
vision, and other similar symptoms, are to be regarded as indications for lessening 
the dose or decreasing the frequency of administration. Some people are much more 
susceptible to the action of this drug than are others. 



206 THE TREATMENT OP DISEASES. 



Glycerine of tannin is a very useful application for cough resulting from a 
relaxed throat or elongated uvula. It should be used with a brush, the whole 
of the back of the throat being well swabbled out with it. This is a most valuable 
mode of treatment in the condition we have indicated. 

Ipecaouanha enters into the composition of many of our cough mixtures. An 
ipecacuanha lozenge will often temporarily relieve a cough. The wine, given in drop 
doses in a tea-spoonful of water every hour or two hours, is a valuable remedy for a 
simple spasmodic cough, resembling whooping-cough, and accompanied by much 
retching and expectoration. In the cough of chronic bronchitis, nothing affords 
more speedy relief than the ipecacuanha spray (see p. 160). 

Nitric acid is useful in coughs, but only in chronic coughs. It is suitable for 
patients who, from a long continuance of the cough, are in a state of general bad 
health. There is usually great lassitude and weakness, with loss of energy, a feeling 
of unfitness for exertion or work of any kind, and a state of unusual or abnormal 
tiredness. There is often mental depression, as the result of the physical weakness. 
The digestive organs also indicate a condition of depression ; there is want of appetite, 
associated with a tongue which may be quite clean or slightly coated towards the 
back ; a bad taste in the mouth in the morning, and after food a feeling of fulness 
or distension, often amounting to actual pain. There is generally a considerable loss 
of flesh, sleep at night is unrefreshing, and the bowels are constipated. The cough 
occurs chiefly during the day, and is nearly dry, what little expectoration there is 
being rather difficult to bring up. Sometimes the cough occurs almost entirely in 
the morning, on first waking or on getting out of bed. There is then a good deal of 
cough, with a considerable amount of expectoration of mucus. During the day there 
is nothing more than an occasional cough till the time of going to bed, when there is 
often a marked increase. In some forms of cough, occurring in middle-aged or elderly 
people, this remedy does much good. The symptoms are shortness of breath on 
exertion, and especially on going up-stairs ; paroxysms of cough early in the 
morning, with considerable expectoration. Ipecacuanha spray is of value, but when 
the patient is generally out of health nitric acid may be used internally It not 
only improves the general health, but also the condition of the chest symptoms. A 
nitric acid mixture may be made by putting a drachm of the dilute nitric acid of the 
U.S. Dispensatory into an eight-ounce bottle of water. The dose in all these cases 
is two or three tea-spoonfuls three times a day. 

Sulphur is used for obstinate dry cough, with tightness in the chest and retching, 
and also for loose cough, with expectoration of whitish-coloured phlegm. 

Tartar emetic in small doses is very useful in many different kinds of cough. It 
is especially indicated when the expectoration is profuse, easily expelled, and mucous 
in character. The accompaniment of nausea or vomiting is to be regarded as an 
additional indication. A mixture may be made by adding a tea-spoonful of antimony 
wine to an eight-ounce bottle of water. The dose of this is two tea-spoonfuls every 
two or three hours. 

Often enough a mustard poultice or the application of iodine to the chest will do 
more to relieve a cough than any medicine. As a rule, it will be found a good plan to 
abstain from beer as long as there is any cough. Mucilaginous drinks, such as gum- 



DEBILITY. 207 



water, barley-water, and linseed-tea, are very soothing, and often serve effectually to 
allay the troublesome tickling or irritability in the throat. When there is not much 
expectoration, an effort of the will often does much to restrain the violence of the 
cough. When there is anything to come up, the sooner it is up the better ; but in 
other cases it is a bad plan to give way to the cough. A nervous cough may some- 
times be arrested by pressing firmly on the lip, close to the nose, or on the roof of 
the mouth. 

DEBILITY. 

The term debility is used — somewhat loosely, it must be admitted — to indicate a 
condition in which there is no actual disease, but in which all the functions of the 
body are performed, if not imperfectly, at all events with less than their accustomed 
vigour. The patient has no actual complaint ; his heart, and lungs, and kidneys, and 
so on, are, as far as he knows, healthy, but still he feels that he is " below par " and 
that he is not " up to the mark." This condition is a very common one, and is met 
with in all ranks and classes of society, from the hard- worked, half-starved general 
servant to the rich city banker with thousands and tens of thousands at his command. 
There is a general want of energy, a disinclination for work, and a disrelish for 
everything. The patient cannot point to any particular region and say, "This is the 
seat of my disease" but he feels " queer all over." He knows he is ill, and yet cannot 
say exactly what ails him. Everything seems a trouble, a bother, and a nuisance ; not 
only is work performed with difficulty, but there is even a disrelish for amusement. 
Invitations are declined, and a dinner or party is regarded with absolute aversion. 
When one is " seedy " one almost hates the sight of one's fellow men. The once 
companionable and jovial fellow becomes morose, and cares little for the society of even 
his most intimate friends. He goes home as soon as he can, and lies on the sofa, heavy, 
dull, and fretful, discontented with himself and all the world besides. Nothing 
interests him, nothing amuses him ; he is a misery to himself and to everybody else. 

This condition is frightfully common, and may be induced by a variety of causes. 
It is frequently seen in school-girls ; and we don't wonder at it, considering that now-a- 
days they are compelled to cram their heads with French, German, Italian, rhetoric, 
composition, the elements of astronomy, geology, geometry, chronology, and a host 
of things their grandmothers never even heard of. Boys do not suffer in the 
same way, although they work equally hard, because they get plenty of 
good, healthy out-door exercise. Debility often arises, not from over-work, but from 
dissipation. The young man of fortune who enters upon his worldly career full of 
health and strength, and runs a course of riotous living, spending his substance and 
himself like the " prodigal son," soon finds himself in a state of profound debility, 
which, unless he will consent to turn over a new leaf and live more in accordance 
with the laws of health and the dictates of common sense, soon ends in serious organic 
disease. Young married people often suffer from debility, and have to learn that for 
the maintenance of health it is necessary to be moderate in affection as in every- 
thing else. Some people get debilitated as the result of over-work ; others as the 
result of under- work. To preserve the balance of health it is necessary for every one 
to do something : there must be an outgo as well as an income. Many people fail to 



208 THE TREATMENT OP DISEASES. 

recognise the fact ; they are sufficiently well off pecuniarily to be independent of any 
business or profession, and they do not care to exert themselves. They fail to see the 
necessity for work, there is nothing to rouse them up or urge them on, and the result 
is that they do nothing. There are thousands of people k. this world who are too 
lazy even to amuse themselves. They suffer from ennui and debility, and no 
medicine will ever cure them. The remedy is in their own hands. Really the best 
thing that could happen to them would be a temporary reverse of fortune. When 
they see a pressing necessity for exertion they respond to it, with manifest advantage 
to themselves. Many a man has been cured of his indolent habits and consequent 
debility by having to nurse a near and beloved relative through a long and dangerous 
illness. 

It is difficult to lay down general rules for the treatment of debility, for it springs 
from so many different causes. It is obvious that a man who has been overworking 
himself wants rest, both mental and physical, whilst such a mode of treatment would 
prove anything but beneficial to him whose only complaint is want of occupation. 
There are, however, a few general principles which are applicable to all cases. In 
the first place, lowering treatment is inadmissible. It is a good plan to have the 
bowels regularly open, but anything like active and repeated purgation is to be 
sedulously avoided. In the case of a delicate young woman whose health has been 
lowered perhaps by too frequent pregnancies or by over-suckling, an extra hour or 
two in bed in the morning will do more good than a blue-pill. Do not forget that a 
fresh horse has more " go " in him than a tired one, and that, as an old writer says, 
" roses may be cultivated in beds." A bath should be taken every morning. If you 
are weak and pulled down, do not attempt a cold bath at first, but be content with a 
tepid one. Many people enjoy a cold bath in the summer, but find it too much for 
them during the colder months of the year. If you get the opportunity of having a. 
swim or some sea-bathing, do not neglect it, for nothing can be more invigorating. The 
addition of sea-salt to the morning tub is undoubtedly beneficial. Out-door exercise 
should be taken every day when it is not absolutely raining. Even should you get 
wet it seldom does much harm, provided you walk briskly home and change your 
wet things at once. The duration of the exercise must be in proportion to the 
strength and previous habits. At first, a walk only of a few hundred yards may 
seem all too much, but in a few weeks six or eight miles may be done at a stretch, 
not only with impunity but with positive benefit. In all cases of debility a generous 
diet is absolutely necessary, for it is very difficult to regain strength if you are not 
living well. A fair allowance of stimulant is advisable, and it is best taken in the form 
of a good full-bodied port or nourishing stout. A glass or two of champagne at 
dinner, when there is much depression, is as good a medicine as we know. When 
there is much weakness, a glass of rum and milk may be taken in the morning before 
dressing. An hour or two's rest on the bed in the middle of the day, with an amusing 
book, is an excellent restorative. When there is anaemia it should be treated accord- 
ing to the rules we have already laid down (p. 92). Want of appetite and loathing 
of food is an indication for the administration of quinine (Pr. 9) ; or the gentian and 
aeid (Pr. 15), or gentian and soda (Pr. 14) mixture may be given. Cod-liver oil is a 
most excellent remedy. Begin with a tea-spoonful three times a day, and gradually 



DEBILITT. 209 

tl±e quantity to a table-spoonful, beyond which it is seldom necessary to go. 
In many cases pancreatic emulsion proves usefuL The practice of anointing the 
body with oil is a very old one, and might be advantageously revived in cases of 
extreme debility, where the stomach refuses to tolerate cod-liver oiL Memory recalls 
the abundant use of unguents in ancient Judea. The Bible tells us of kings being 
anointed with sacred oil, of precious ointment running down Aaron's beard to the 
skirts of his clothing, and of Jesus having His feet covered with costly salve im- 
mediately after being washed. Cod-liver oil is unsuited for the purpose of inunctions ; 
those who submit to it become repugnant to the nostrils of their friends, and the 
odour from the skin prevents the delicate stomach from assimilating or even retain- 
ing food. With the smell of fish-oil in the nose, everything seems to taste of it, so 
that rubbing with this substance usually proves a failure and has to be abandoned. 
Scented lard, pure salad or olive oil, or almond oil, may often be used with the 
greatest advantage. We have known many instances of the lives of children having 
been saved by rubbing in pure olive oil over the stomach. The inunction should be 
performed after a warm bath or before the fire. The hand alone should be used for 
the purpose, and care must be taken not to produce rawness or abrasion of the skin. 
The process need not be confined to the trunk, and the limbs should come in for their 
fair share. The frequency of repetition must to some extent be guided by the result, 
but twice a day to begin with is often enough. We may mention incidentally that 
this mode of treatment often proves most valuable in rheumatism and for stiff or 
contracted joints. For debility resulting from excessive brain work, phosphorus is 
by far the best remedy. It may be taken according to Prs. 53 and 54, or the 
hypophosphite of lime mixture (Pr. 55) may be given. 

An important element in the treatment of debility is change— change of air, 
change of scene, and, above all, change of work. To the majority of us life is most 
frightfully monotonous. A perpetual round of duties has a depressing effect both on 
the body and mind. It wearies us day by day to see the same faces, view the same 
things, hear the same voices, smell the same odours, listen to and talk the same 
platitudes. After long experience at home, we know exactly how the tea will taste, 
how the sirloin of beef is likely to be served up, what probability there is of the 
mutton being tough or the steak underdone. We know, too, exactly what the wife 
will say when we come home, and the exact tone in which she will say it. When 
people live together day after day, month after month, and year after year, they find 
it very dim cult to find subjects for profitable conversation. This monotony can best 
be combated by change of air ; for with this comes variation of scene ; with that 
arrives change of thought ; and with that, again, start up new trains of ideas and 
expansion of mind. To go for change of air is, or ought to be, an expedition in quest 
of information and a search for something new. From it one returns with a fresh 
fund of anecdotes, a new collection of stories, a fuller repertoire of experiences, and 
an additional store of illustrations, which for months to come serve to brighten the 
dull realities of life. It is obvious that if the main object of change of air is to get 
over the results of monotony, Paterfamilias should not always travel with his wife 
and family. 

In the majority of cases of simple debility it is not necessary to consult a doctor. 
14 



210 THE TREATMENT OP DISEASES. 

at all events, at first, and until you have tried what you can do for yourself. If you 
do go to a doctor, mind you get him to examine your urine, to make sure there is 
nothing wrong there. Bright's disease often comes on very insidiously, and in cases 
of great debility occurring in middle-aged people this must always be borne in mind. 
Sometimes the term debility, or nervous debility, is used as synonymous with 
spermatorrhoea. The treatment of this complaint is as follows : — 

(1) Sleep on a mattress, and not on a feather bed. Use but little covering in 
the way of bed-clothes at night : a sheet and one blanket must suffice, except in 
the coldest weather. Never remain more than seven hours in bed. 

(2) Take a cold bath every morning, whether you like it or not. Live as plainly 
as possible. Avoid heavy suppers, and eat nothing for two hours before going to bed. 
Do not drink more than two glasses of beer a day. Do not take "grog " or spirits 
in any form. Do not smoke more than two pipes a day. 

(3) Join the militia or a cricket-club, or go in for rowing, or base-ball, or 
gymnastics. Do not stay in-doors more than you can help. Go into society as 
much as you can, and never refuse an invitation. 

(4) If you have any books or pamphlets on the subject of your complaint, put 
them in the fire at once — this is essential. Purity of thought is an important 
element in treatment. 

(5) Take two table-spoonfuls of the bromide of potassium mixture (Pr. 31) three 
times a day. 

Follow these directions for a month, and you will be cured. 



DELIRIUM TREMENS. 

Delirium tremens, or " D T," as it is frequently called, is still, unfortunately, a 
common disease in this country. It may be described as an acute attack of poisoning 
by alcoholic drinks. Men are mnoh more prone to this disorder than women, 
although, as we know, old bourbon is not without its votaresses. At one time it 
was supposed that delirium tremens might be induced by abstinence from stimulants 
in those long accustomed to their use, but this is now an exploded idea, and it is an 
established fact that a man may at any time discontinue his habits of drinking with- 
out any risk of injuring his health. Individuals of an irritable, nervous system, who 
are subjected to any prolonged mental strain, may induce the disease by smaller 
quantities of alcohol than would be required to excite it under ordinary circum- 
stances. It is said that, even in temperate persons, long continued mental anxiety, 
— that state of mind, for example, in which gamblers and great speculators habitually 
live — may cause it ; and in fact it may arise from anything by which the mind is 
over-wrought. 

The first symptom of delirium tremens is very commonly inability to sleep. The 
sufferer may have long indulged to excess in drink or he may be quite a novice in 
intemperance, but in any case a greater debauch than usual has preceded the outset 
•f the attack. The patient finds himself quite unable to obtain any sleep, or at most 
can gain only short snatches of slumber, disturbed by horrible dreams and visions. 
Even during his waking moments and in. broad daylight he suffers from hallucin* 



DELIRIUM TREMENS. 211 



tions of sight, which usually take the form of disgusting or terrifying objects, such 
as snakes, insects, or monsters. Sometimes he fancies he sees armed men pursuing 
him with threatening gestures. More rarely he hears voices denouncing threats or 
mocking him, and occasionally he thinks he smells disgusting odours. He manifests 
great impatience of any interference or assistance in his ordinary duties, which he 
discharges in a bustling and tremulous manner. Usually there are at first no real 
delusions ; and even when there are hallucinations the patient frequently recognises 
them as such, and is able by an effort of the will to banish them. There is commonly 
a complete loss of appetite, and little or no food is taken. After a time, distinct 
delusions become apparent ; the patient talks incessantly in a rambling fashion, and 
points to imaginary terrific shapes about him, which he is constantly seeking to push 
aside with a restless motion of his hands. The delirium is not a fierce or 
mischievous delirium, but a busy delirium : he does whatever he is told, but does it 
in a hurried way, with a sort of unsuccessful anxiety to perform it properly. He is 
not altogether inattentive to the objects and proceedings that are going on around 
him, but his mind soon wanders away to other subjects. Sometimes he is very 
suspicious that those about him intend to do him some injury, or he thinks that he 
is surrounded by enemies. He is haunted by spectra, fancies that rats, mice, and 
other vermin are running over his bed, or perhaps sees spiders crawling on the 
ceiling, or a horse's head thrust through the wall of the room. He addresses remarks 
to imaginary strangers, and looks suspiciously behind the curtains, under the 
impression that the devil is there waiting for him, or that there is somebody watch- 
ing him. It is seldom that he meditates harm either to himself or others, and there 
is usually a mixture of cowardice or dread with the delirium If you question him 
about his disease, he answers quite to the purpose, describes in an agitated manner 
his feelings, puts out his tongue, and does whatever you bid him ; but a moment later 
he is wandering from the scene around him to one that exists only in his imagination. 
He gives orders to absent servants, refers to some imaginary appointment he must 
keep, or speaks of strange adventures he has met with during the night. The 
publican thinks that he is drawing beer for hosts of customers, and the lawyer that 
he is making an effective speech to the jury. The patient may be recalled by 
addressing him in a firm and determined manner, and may even be temporarily 
reasoned out of his delusions. The tremor which, from its striking prominence in 
many cases, has given the disease its name, is by no means universally present. It 
is usually observed in the case of confirmed dram-drinkers, but often enough it is 
only an exaggeration of a tremulousness of the hands, which has existed for months 
or even years. Even when the tremor is not present there is a constant restless- 
ness ; the patient shifts from side to side in bed, and will get out twenty times in an 
hour, if allowed to do so. The tremulous tongue is moist and creamy, the pulse is 
frequent, the eyes are in almost constant movement, and the pupils are usually, 
though by no means always, dilated. Yery often the face is flushed, but sometimes 
it remains deadly pale. Usually there is much sweating, which is obviously due in 
great part to the constant muscular movements. Attacks of sickness are not 
uncommon, the bowels are confined, and pain may be complained of about the pit of 
the stomach. 



212 THE TREATMENT OF DISEASES. 

In favourable cases, a critical sleep comes on about the beginning of the third or 
fourth day, and the patient slumbers heavily for twelve hours or more. From this 
he awakes fearfully weak, but free from delirium. Such is the rule ; but, unfor- 
tunately, after many hours' profound sleep the patient sometimes awakes as delirious 
as ever, or in a state of complete prostration, which may terminate in death. The 
occurrence of sleep marks the commencement of convalescence only when, on awaking, 
the intellect is clear, the delusions and hallucinations have disappeared, and the pulse 
is reduced in frequency. The stage of convalescence once established, everything 
progresses favourably. But, unfortunately, in many cases there is no sleep at all ; 
the wakefulness continues, and the case becomes critical. 

Let us now discuss the treatment of delirium tremens. The patient should be at 
once put to bed in a quiet, darkened room — the less furniture the better — and every- 
thing should be avoided that could in any way excite his imagination. Friends and 
relatives often annoy him by their presence, and it is as well that they should be 
replaced by a good automatic attendant who will not talk. In cases in which the 
patient is both violent and of considerable strength, two trained nurses, with 
experience in the treatment of lunatics, should be in constant attendance. It is 
always most desirable to avoid the use of the straight-jacket, or even of bandages, 
for the purpose of restraint ; and this may usually be done by a little tact and 
management. 

It is of vital importance that the patient should be well supported by the 
frequent administration of food. He will not take mutton-chops, or anything of that 
kind, and it is useless trying to induce him to do so ; but you may get him to 
swallow the whites of a dozen eggs with a little lemon-juice in it, or he may take 
whey of milk with lemon-juice, and, perhaps, just a dash of wine or brandy to 
flavour it. It is desirable that plenty of milk should be taken, or soup, or strong, 
hot broth with bread in it. The addition of plenty of Cayenne pepper to the soup 
or broth often proves beneficial to still the nervous excitement. The necessity for 
the administration of some nutriment is imperative ; and if the stomach be at first 
too irritable, or the loss of appetite too complete, to allow of food being taken in the 
usual way, it must be given in the form of an injection. Even more depends on 
dietetic than on medicinal treatment. In young people no hesitation need be felt 
in completely cutting off stimulants, but in those who are old and feeble a small 
quantity of wine or brandy must be allowed. 

It is a good thing to get the bowels open ; two or three watery motions do good, 
but excessive purgation must of course be avoided. Three or four table-spoonfuls of 
the white mixture (Pr. 25) will generally be found to answer as well as anything. 

"With many people it is the custom to give very large doses of opium in delirium 
tremens, with the view of producing sleep ; but the practice is by no means a safe 
one. If there is much restlessness at night there is no objection to the administra- 
tion of two grains of opium in the form of two five-grain compound soap pills 
or thirty drops of laudanum in water. A hypodermic injection of morphia is pre- 
ferable to giving opium by the mouth, as it does not interfere with the stomach. 

Chloral is a most valuable agent in the treatment of delirium tremens. In 
ordinary cases it will suffice to give two tea-spoonfuls of the syrup of chloral at bed- 



DERBYSHIRE NECK. 213 



time, but when the symptoms are urgent it may be necessary to give a tea-spoonful 
every hour for three or four consecutive hours. It usually produces a calm and 
refreshing sleep. 

Three table-spoonfuls of the bromide of potassium mixture (Pr. 31), given every 
two hours, will succeed, in a large number of cases, in calming the nervous agitation 
and producing a good sound sleep. As soon as the patient awakes the administra- 
tion may be resumed to the extent of three or four doses more. These are large 
doses of bromide of potassium, but it is much safer to give them than to administer 
knock-down doses of opium. Bromide of potassium is especially serviceable in 
dispelling delusions remaining after the partial subdual of an attack. 

Belladonna, in two-drop doses of the tincture every two hours, has been recom- 
mended. Sleep and a quiet night, with marked improvement the next day, are said 
to be the results. 

Stramonium answers well in cases characterised by violent, noisy delirium and 
complete loss of sleep. A tea-spoonful of the tincture should be put in an eight- 
ounce bottle of water, and of this a tea-spoonful should be given every hour or every 
two hours. 

It is important that the skin should act well, and benefit is often derived from 
the use of the wet pack. It has frequently a most soothing influence. In every 
case of delirium tremens a doctor should be called in. 



DERBYSHIRE NECK, GOITRE, OR BRONCHOCELE. 

By the terms Derbyshire neck, goitre, or bronchocele, we mean hypertrophy, 
or enlargement of the large gland called the thyroid, which naturally exists on the 
front of the windpipe. 

The circumstances which favour the production of this complaint have been 
frequently investigated, but the question is still to a great extent involved in 
obscurity. Goitre is essentially an endemic disease — that is, it prevails in certain 
localities, but scarcely occurs elsewhere. It has been frequently noticed that people 
who have gone to live in these districts have become affected with the complaint j 
whilst, on the other hand, persons who have migrated from the locality have been 
sometimes cured by the mere change in residence. Goitre abounds in the hollows 
and valleys of many mountainous districts, among the Alps, for example, and in the 
Pyrenees, and on this account it was supposed to be due to some peculiarity in the 
atmosphere. It was at one time said that the disease was always found and occurred 
only in deep, close, moist valleys, shut in by high mountains. On further investi- 
gation, this statement was found to be too general, and in fact there is now abundant 
evidence to show that the complaint occurs quite independently of atmospheric 
conditions. ' 

It has been proved pretty conclusively that goitre has its origin in some impurity 
in the water, but of what that impurity consists is not precisely known. At one 
time — probably from its frequent occurrence in Alpine regions — the disease was 
ascribed to the use of snow-water. A very little consideration will serve to show 
that this explanation is insufficient, for the people in almost all the valleys of 



214 THE TREATMENT OF DISEASES. 

Switzerland drink the water which, comes from the glaciers, but in only a few of 
them is goitre prevalent. Then again, as we know, it occurs frequently in Derby- 
shire, where the snow never lasts long, and even in Sumatra, where snow is never 
seen. There are reasons for supposing that it is the presence of limestone in the 
water which produces these injurious effects. In some parts of England — Yorkshire, 
Derbyshire, Nottinghamshire, Hants, and Sussex — where the disease prevails, there 
is a ridge of magnesian limestone running from north to south throughout the entire 
district. On the other hand, there are many goitreous regions in which the. water is 
not unusually hard. Of late years an attempt has been made — and we think unsuc- 
cessfully — to show that the constituent of water which is the actual cause of goitre 
is some salt of iron, or more rarely of copper. The prevalence of the disease in 
limestone regions is explained on this theory by supposing that the water has 
travelled the metalliferous strata of the rocks. 

Goitre may be very rapidly produced. There are certain waters in Switzerland 
which would cause it even in eight or ten days, and cases have occurred in almost 
as short a time in other places. It is said that both in France and Italy the drinking 
of certain waters has been resorted to, and apparently with success, for the purpose 
of producing goitre, and thereby gaining exemption from military conscription. 

Goitre occurs much more commonly in women than in men, the proportion being 
about twelve to one. At the same time, it must be remembered that our fashion of 
dress renders a small bronchocele much more noticeable and less easily concealed in 
females. It is probable that bad food and low living, by depressing the general 
health, conduce to the production of goitre. It is met with in all classes of society, 
but occurs most commonly amongst the very poor, who live in cellars and kitchens, 
or in damp, ill-ventilated streets and courts. As a rule, the complaint does not show 
itself in children younger than eight or ten ; but it is occasionally seen in young 
people shut up in school-rooms or leading a sedentary life — as unnatural as it is 
prejudicial. It is said that the disease is hereditary ; but it must be remembered 
that in the majority of cases the children are living under identically the same 
conditions as their parents. Every race of man is liable to bronchocele, and it 
occurs in all latitudes, from the Arctic regions to the tropics. Franklin found it 
amongst the inhabitants of the Polar regions, and Mungo Park amongst those of the 
interior of Af rica. 

A goitre may attain a very considerable size, but in many cases it causes merely 
a slight fulness of the throat, which by many people is thought to be not ungraceful. 
It may continue for years without reaching any extreme or very troublesome magni- 
tude. In some cases it has remained stationary for a very considerable time, and 
has then suddenly, and without any apparent cause, increased rapidly in size. The 
swelling is usually larger during the menstrual periods, or wnen from any cause the 
health is temporarily deranged. Bronchocele is not in itself a painful disorder, 
nor does it taint the system or affect the constitution in any way. It is, as a rule, 
a perfectly innocent tumour, and presents no signs of malignancy. Any distress or 
inconvenience which it may occasion will be from its size, and the pressure it exerts 
on the windpipe, gullet, and neighbouring structures. Sometimes it obstructs the 
return of blood from the head, and gives rise to headache, giddiness, noises in the 



DERBYSHIRE NECK. 215 



ears, confusion of thought, and other disagreeable symptoms. When it presses on 
the windpipe it may cause hoarseness, wheezing, and shortness of breath. 

There is one form of goitre which differs so strikingly from that of which we have 
already spoken that it requires a separate description. It is known as exophthalmic 
goitre, or sometimes as Graves' disease, after the doctor who first described it. It 
is characterised by the concurrence of three notable symptoms — palpitation, enlarge- 
ment of the thyroid body, and prominence of the eyeballs. The last-mentioned 
symptom is so peculiar and striking as to at once arrest the attention. The eyes 
are pushed forwards, so that they look almost as if they were going to drop out of 
the head. In extreme cases they are bulged to such an extent that the lids cannot 
be closed even during sleep. This projection of the eyeballs gives the patient a 
remarkably wild and strange appearance. The pulsation is at all times t persistent, 
but is increased by bodily exercise or mental exertion. It is not confined to the 
region of the heart, but is experienced more or less all over the body. The swelling 
on the front of the neck never attains any great size. These are the three symptoms 
which together may be said to constitute the complaint, but there are others which 
are more or less commonly observed. Thus, there is often a change in temper, which 
becomes capricious, irritable, and peevish. A disposition to flush under slight 
emotion, a tendency to bleeding from the nose, and a sense of heat, accompanied by 
profuse perspirations, are often experienced. The complaint usually occurs in young 
women, and most commonly in those who are suffering from some derangement of 
the uterine functions. Its production appears to be quite independent of any 
influence of soil or climate. Very many of the patients are found to be markedly 
anaemic. 

Let us now consider the treatment of bronchocele. One very important point, 
which should be preliminary to all other modes of treatment, is the removal of the 
patient from the dangerous locality. When the patient has been removed to some 
more salubrious place of abode, we may administer our drugs and apply our 
lotions and ointments with greater hope of success. When this preparatory step is 
absolutely impossible, every drop of water should be boiled, or, what is still better, 
distilled. The best remedy for bronchocele is, in all probability, iodine — iodine 
inside and out. It is best given internally in the form of iodide of potassium. 
Two, four, or even six table-spoonfuls of the mixture (Pr. 32) should be taken three 
or four times a day. In addition, the swelling may be painted as often as it can be 
comfortably borne with the tincture of iodine, or the iodine ointment may be rubbed 
in freely. By this method of treatment the enlargement often very rapidly diminishes, 
and a considerable improvement is noticeable in the patient's general condition. 
In cases in which anaemia is present, it is very desirable to get rid of this compli- 
cation, and iron should be administered without delay. Prs. 1, 2, and 63 will be 
found useful for a preparatory course of iron ; but in some cases it may be advan- 
tageous to take the iron and iodine in combination, and then the syrup of iodide 
of iron (Pr. 4) should be preferred. 

In India, an ointment of red iodide of mercury is largely used in the treatment 
of goitre. It is made as follows : — Melt three pounds of lard or mutton suet, strain 
and clean; when nearly cool, add nine drachms f»f fiaely-DOwdered red iodide of 



318 THE TREATMENT OP DISEASES. 

mercury (obtainable from any chemist), and rub up in a mortar until no red grains 
are visible, and keep it. in pots protected from the light. The ointment is applied 
to the swelling at sun-rise, and is well rubbed in for at least ten minutes. The 
patient then sits in the sun as long as he can endure it. In some six or eight hours 
there will probably be more or less pain from the blistering action of the application. 
About two in the afternoon the ointment is again well rubbed in with the hand. 
Some ointment is then left in contact with the swelling, and this becomes absorbed 
by about the third day. In ordinary cases one such course is usually found to 
effect a cure ; but in bad cases it may be necessary to repeat the treatment after an 
interval of from six to twelve months. In America, the kitchen fire will probably 
have to be substituted for the rays of the sun. Very good results have been 
obtained by rubbing in the ointment night and morning, and afterwards covering it 
with oil-silk. 

For many years spongia, or roasted sponge, has been used in the treatment of 
goitre. It contains both iodine and bromine, and it is probably to the presence of 
one or both of these bodies that its curative properties are due. It has, however, 
sometimes proved successful where iodine has failed.. To be of service it must 
be given in small doses and frequently. 

For exophthalmic goitre, tincture of belladonna is the best remedy. Its effects 
are often very striking. In one case, five tea-spoonfuls of the belladonna mixture 
(Pr. 39), taken hourly, afforded great relief in four or five days, although the disease 
had lasted more than a year, and in two months a cure was all but effected. Of 
course, in this, as in the other form, iron should be given when ansemia is a marked 
symptom. 

Such, then, is the medical treatment of bronchocele. Should these remedies fail, 
it may, under certain circumstances, be necessary to resort to surgical interference. 
It may, however, be laid down as a rule that so long as the disease is merely a 
deformity — so long as it does not interfere with any of the important functions of the 
body, nor produce serious discomfort — does not distress the breathing by pressing 
upon the windpipe, nor interfere with swallowing by pressing upon the gullet, nor 
impede to any great extent the flow of blood to or from the head by pressing upon 
the great blood-vessels of the neck, nor grievously encumber the patient by its 
weight, a surgical operation is neither advisable nor justifiable. 

We must now say a word or two on what is known as cretinism. By cretinism we 
mean a strange, melancholy disease, which has a curious and as yet but little under- 
stood connection with goitre. It is a kind of idiocy, accompanied by some deformity 
or affection of the bodily organs. The mental affection varies in degree from mere 
obtuseness of thought and purpose to complete obliteration of intelligence. Many 
cretins are incapable of articulate speech ; some are blind, some deaf, and others 
labour under all these privations. They are usually dwarfish in stature, with large 
heads, wide vacant features, goggle eyes, short crooked limbs, flabby muscles, and 
retracted bellies. This disease occurs most commonly in goitreous districts. It is met 
with in the Pyrenees, in the Alps, in the mountains of Syria, in the hilly parts of 
China, and in the Himalaya regions. With few exceptions, cretins have bronchocele; 
bat of course bronchocele is not always accompanied by cretinism. What is tha 



DIABETES. 217 

exciting cause of cretinism we do not know, but by many it and goitre are supposed 
to have a common origin. It has been shown experimentally that the permanent 
removal of the unfortunate cretin from the infected district, combined! with judicious 
medical and moral discipline, will often ensure a perfect restoration to health and 



DIABETES. 

This is a constitutional disease, characterised by the passing of large quantities of 
water. There are two kinds of diabetes — one in which the urine contains sugar, 
and another in which there is no sugar. The former is known as diabetes mellitus, 
and the latter as diabetes insipidus. They agree in the fact that in both there is an 
excessive secretion of urine, but they differ in so many important respects that they 
must be regarded as two totally different diseases, and we shall accordingly discuss 
them separately. 

Diabetes Mellitus. — This is the commoner form, and the one which is usually 
meant when the term diabetes alone is used. If you are suffering from diabetes, 
and yet have no sugar in your urine, this is not your complaint. You must pass on 
to diabetes insipidus. 

In the first place, we will describe the urine passed in diabetes mellitus, so that 
if you have any suspicion that you are suffering from this disease, you may compare 
the water you are passing with our description. 

To begin with, there is a marked increase in the quantity secreted. If you 
were to collect all the urine passed by a healthy person in twenty-four hours, and 
were to measure it, you would find that it amounted to something between one and 
four pints. Of course, the quantity is subject to a little fluctuation, according to 
the quantity of drink taken and the amount of water given off by the skin and 
bowels ; but on an average it is about fifty ounces, or two pints and a half. Now, 
in cases of diabetes the quantity is very much greater. It is usually somewhere 
between eight and fifteen pints, and in some cases it has been known to exceed 
thirty-two pints. This is an increase you could not possibly overlook ; or at all 
events all you want to make quite sure is a common half-pint measure. 

Then, again, urine containing sugar differs strikingly in many particulars from 
healthy urine. It is commonly of a light colour, and being so copious is usually free 
from any deposit. Its odour is somewhat peculiar, and is said by some to resemble 
sweet hay, and by others to be like the faint smell of an apple-chamber. Moreover, 
its taste is more or less decidedly sweet. If you just dip your finger into ordinary 
healthy urine, and put it to the tip of your tongue, you find that it is tasteless, or 
very nearly so ; but if you do this to urine containing sugar, you, naturally enough, 
perceive that it is sweet. Sugar in the urine occasionally testifies its presence in 
other ways. Sometimes it undergoes a kind of rude crystallisation as the urine 
dries. A girl who suffered from this complaint observed that if her water were 
accidentally spilt upon her black stuff shoes every drop left a white powdery spot 
behind it* In another instance the patient was first alarmed by finding that her 
black worsted stockings were sticky and covered with a white dust, from the same 
cause. Tn still another case the patient's attention was first drawn to his urine by 



218 THE TREATMENT OF DISEASES. 

the number of flies and wasps whioh its sweetness attracted to the chamber-pot. It 
is said that in India the red ants have been observed to swarm in the same way about 
a vessel containing diabetic urine. 

The presence of sugar in the urine naturally increases its density. The urine of a 
person suffering from diabetes mellitus is heavier than the urine of a healthy person. 
If we take the specific gravity of healthy urine by means of a urinometer (see 
Urine) we find that it lies somewhere between 1,015 and 1,025, the specific gravity 
of water being 1,000. Now, if we take the specific gravity of the urine of a person 
suffering from diabetes mellitus, we find that it is very high. It ranges from 1,030 
to 1,060, but is generally a little above or below 1,040. Do not try the specific gravity 
of your urine directly it is passed, but let it get cold first. The best way is to mix 
all the urine passed in twenty-four hours, and to examine a specimen of this. By 
this plan you get a good average result, for naturally the specific gravity of the urine 
varies a little at different periods of the day. 

There is a very simple and beautiful test, by means of which the presence of 
sugar in the urine may be detected. A few crumbs of German yeast are put into 
the bottom of a small, narrow-necked bottle ; this is filled up to the brim with the sus 
pected urine, covered with a saucer, and then inserted. If a little urine be put in 
the saucer and the bottle be kept upright, the fluid will not run out. The saucer 
and inverted bottle should then be placed on one side in a warm place — say on the 
mantel-piece. If sugar be present fermentation takes place, giving rise to carbonic gas, 
which forces out of the bottle the whole or a portion of the urine. There is one pre- 
caution which should be observed. Some specimens of yeast spontaneously evolve 
bubbles of gas, so that it is desirable to perform a similar experiment with simple 
water in the place of the urine, and to compare the results. A pennyworth of 
German yeast may be purchased at any baker's. 

The presence of sugar in the urine on one occasion is not an infallible sign of 
diabetes, for it may exist as a temporary condition, as the result of some error in 
diet. As a rule, however, it is a matter of serious import. In many cases the 
quantity of sugar contained in the urine is very great, and in some instances people 
have been known in a few months to pass their own weight of sugar. 

So much, then, for the urine. We need hardly say that this is not the onlj 
symptom. As so much fluid is poured out by one channel the others naturally suffer. 
The skin is usually very dry. We have heard a patient say, " Nothing ever makes 
me perspire. It does not matter how hot it is, or how fast I walk, my skin is always 
quite dry, even under the armpits." The dryness of the skin is usually in proportion 
to the amount of urine secreted. The bowels are confined and the motions dry and 
hard. Excessive thirst is usually a common symptom, and often leads to the 
detection of the nature of the case. It is not uncommon for a diabetic patient to 
drink from eight to twelve pints a day, without satisfying his thirst. The mouth is 
usually dry ; and the tongue dry, parched, and sticky. There is, as a rule, no falling- 
off in the appetite, and it is not uncommon for the patient to eat very much more 
than when in health. We often hear people say that as long as they can eat well 
there cannot be much the matter with them ; but this is not always true. In spite of 
the quantity of food taken, the patient gradually loses strength and gets thinner and 



DIABETES. 219 



thinner. This is the rule, but it is not without exceptions. We had recently under 
our care a man suffering from diabetes who weighed over twenty-three stone. He 
had not the slightest idea that there was anything serious the matter with him, and 
all he complained of was that he was so fat that he could not get about comfortably. 
The breath of diabetic patients has usually a peculiarly sweet and very characteristic 
odour. They often suffer from boils and carbuncles, frequently in an aggravated 
form. Cataract is not an uncommon accompaniment, so that the sight becomes 
affected. 

Diabetes is generally a chronic disorder, creeping on at first insidiously, and 
under judicious treatment prolonged over a long course of years. Sometimes, how- 
ever, it runs a very rapid course. In many cases the lungs become affected, and the 
patient ultimately dies from a form of consumption. 

Having enumerated the symptoms of diabetes mellitus, we will now proceed to 
consider the circumstances which favour its production. In the first place, it is twice 
as common in men as it is in women. It prevails chiefly among young and middle- 
aged adults. It is relatively more common in urban and manufacturing districts 
than right out in the country. It is not usually considered to be an hereditary 
disease, but still, in some cases it would appear to run in families. It is difficult to 
say from what it arises. In a considerable number of cases it has followed soon after 
exposure to wet and cold. In some instances it is said to have been caused by 
drinking cold water whilst the body was hot ; and in others it is supposed to have 
been the result of alcoholic excesses. A violent mental emotion has sufficed to pro- 
duce it. In one case it followed distress of mind caused by unjust suspicion of theft ; 
in another it came on after the burning down of the patient's place of business ; 
whilst in a third it was attributed to anxiety attendant on a Chancery suit. In one 
instance it followed a violent fit of anger — a warning to bad-tempered people. There 
can be no doubt that in many cases it has followed blows or falls on the head. 

In all cases of diabetes or suspected diabetes a medical man should be consulted. 
It will not, in the majority of cases, be requisite to remain permanently under his 
care. You will learn from him the exact nature of the complaint from which you 
are suffering, and he will give you directions as to your mode of living and the 
general method of treatment to be adopted. You will have to see him occasionally, 
and he will require you to carry out his directions most implicitly. 

The first and foremost point to which attention must be paid in the treatment of 
diabetes is the diet. The plan to be pursued is to withdraw, as completely as 
possible, but not too suddenly, all articles containing sugar or starch (which is easily 
converted in the system into sugar), and to replace them by appropriate substitutes 
from the vegetable kingdom and by animal food. It is well known that life and 
strength may be sustained on a purely animal diet. The best proof of this is that 
the inhabitants of the Arctic region subsist exclusively on the flesh and blubber of 
seals, on fish, and such produce of the chase as the climate affords. Moreover, the 
fur-hunters of British America, an extremely vigorous and muscular body of men, 
subsist for many consecutive months on flesh alone. As the diabetic may take his 
choice of almost any article of animal food, he is clearly in no danger of dying of starva- 
tion. The only articles derived from the animal kingdom which are absolutely forbidden 



220 THE TREATMENT OP DISEASES, 



are honey and liver, both of which contain sugar. Milk is usually prohibited because 
it contains sugar, but it is found that if taken in moderation it does but little harm. 
From the extensive diffusion of sugar and starchy matter through the vegetable 
kingdom, nearly all the vegetable alimentary substances in common use will have to 
be eschewed. Of course, starch is contained largely in bread and other kinds of 
corn food, whether derived from barley, oats, rye, maize, or rice, and these are con- 
sequently prohibited. Potatoes must be abandoned for the same reason, as must be 
peas and beans. Carrots, parsnips, beetroot, turnips, and radishes contain sugar, and 
are ineligible as articles of diet. Sago, tapioca, arrowroot, and other forms of fari- 
naceous food, must be avoided. Macaroni, vermicelli, and Italian paste are pre- 
pared from wheat, and abound in starch. As regards vegetables other than those 
which have been already mentioned, it may be laid down as a general rule that 
anything white contains sugar, so that cauliflower, brocoli, cabbage, seakale, celery, 
and asparagus are objectionable. Any vegetable which, by exposure to the light, 
has become green, has lost its sugar, and may be freely used. Greens and spinach 
are allowed ad libitum, and so are watercresses and green lettuce. Radishes and 
celery contain sugar, but only in small quantities, so that, although they are pro- 
hibited, they may be taken occasionally as a treat. All fruits contain sugar, and 
must be avoided. 

Most people complain bitterly of the deprivation eaused by cutting off bread. 
We are all so accustomed to its use, that it is no joke to have to do without it. 
There are several articles which are used by diabetics as substitutes for bread, one 
of the best being the "bran cake." The husk or bran of wheat is quite devoid of 
starch and sugar, and can consequently be used with perfect safety. When it is 
washed and ground it may be made up into a kind of bread with butter and eggs, 
and forms a valuable addition to the restricted diet. The following is the mode of 
making these bran cakes :— Take a quart of wheat bran, boil it in two successive 
waters for a quarter of an hour, each time straining it through a sieve ; then wash 
it well with cold water on the sieve until the water runs through perfectly clear ; 
squeeze the bran in a cloth as dry as you can, then spread it thinly on a dish, and 
place it in a slow oven. If put in at night let it remain till the morning, when, 
if perfectly dry and crisp, it will be ready for grinding. The bran thus prepared 
must be ground in a fine mill, and sifted through a wire sieve of such fineness as to 
require the use of a brush to pass it through. That which remains in the sieve 
must be ground again until it becomes quite soft and fine. Take three or four 
ounces of this bran powder, "from three to seven new-laid eggs, one or two ounces 
of butter, and about half a pint of milk. Mix the eggs with a little of the milk, 
and warm the butter with the other portion ; stir the whole well together, and add 
a little nutmeg, ginger, or other spice, according to taste. Bake in small tins 
(patty-pans), which must be well buttered, in a rather quick oven, for about half an 
hour. The cakes when baked should be a little thicker than a captain's biscuit. 
They may be eaten with meat or cheese at breakfast, dinner, or supper, and at tea 
they may be taken with rather a free allowance of butter. It is very important 
to follow the directions given for washing and drying the bran. If not properly 
washed the bran will not be freed from starch, and the patient will suffer ; whilst 



DIABETES. 221 

if not properly dried it will be impossible to reduce the bran to a fine powder. In 
some seasons of the year, or if badly prepared, tlie cake soon undergoes a change ; 
but this may be obviated by placing it before the fire for five or ten minutes every 
day. There is no difficulty in obtaining these " bran cakes " already made, as there- 
are several bakers and confectioners in Xew YVk and other large towns who prepare 
them. We, of course, cannot recommend any particular baker ; but that is not a 
point which is likely to present any difficulty. Eor our own jmrt, we must confess 
that we believe that it is better, if possible, to prepare the bread at home. It is 
not much trouble, and only requires a little practice to turn out a very palatable 
article. Moreover, you can vary the proportions of the ingredients according to 
taste. Some people buy the bran already prepared, and then make the biscuits. 
The bran biscuits have many advantages, but they are not free from disadvantages. 
Thus, many diabetics have loose or decayed teeth, and find some difficulty in 
masticating them. Sometimes the bran causes looseness of the bowels, or even 
decided diarrhoea. 

Anothei substitute for bread will be found in "gluten bread." This is prepared 
by washing out the starch from wheaten flour, and then using the remaining gluten 
for making cakes and loaves. It is sometimes made into little buns, which are by 
no means bad to eat. The gluten may be obtained ground down into a meal, and 
is used for thickening broths and making puddings. Gluten bread is not without 
its objections: for although some people like it, others complain that when they get 
it into the mouth it seems as if they were chewing so much india-rubber. 

Of late years rusks and biscuits have been prepared with eggs from sweet 
almonds ground to powder, and deprived of their starch by pouring over them 
boiling water slightly acidified with tartaric acid. They are often relished for a 
change. 

We must next consider what may be taken in the way of beverages. Sweet 
wines, sweet ales, porter, and stout should be avoided ; but dry sherry, claret, bitter 
ale, and occasionally a little brandy or whisky, are allowable. Amongst non- 
stimulating beverages, tea and coffee (without sugar), and cocoa from the nibs may 
be used. There is no objection to soda water, but lemonade contains sugar. No 
advantage has been found to be derived from curtailing the amount of fluid taken. 
It is sometimes recommended that all fluids should be taken tepid, as they allay the 
craving for liquid more effectually than when cold. 

The following table will, we trust, be found useful : — 

Diet Table for People suffering from Diabetes. 

May eat 

Butchers' meat of all kinds, except liver. 

. "bacon, or other smoked, salted, dried, or cured meats, 

Poultry. Game. 

Fish of all kinds, fresh, salted, and cured. 

Soup (except vegetable soup), beef tea, and broths. 

Bran, gluten, or almond substitutes for bread. 

Eggs dressed in any way. 

Cheese. Cream Cheese. 

Butter. Cream. 



222 THE TREATMENT OF DISEASES. 



Dot Table fob Pboplb sufvsrikg from Diabetbb (eonHnnwl). 

May eat 

Greens. Spinach. 

Watercress. Mustard and cress. Green lettuce. 

Celery and radishes occasionally. Spring onions. 

Jelly, flavoured but not sweetened. 

Blancmange, made with cream but not milk. 

Custard made without sugar. 

Nuts of any description, sparingly. 

Must avoid eating 

Sugar in any form. 

Bread, wheaten or otherwise. 

HiC«. Arrowroot. Sago. Tapioca. Macaroni. Vermicelli 

Potatoes. Carrots. Parsnips. Turnips. 

Peas. French Beans. 

Cabbage. Brussels Sprouts. 

Asparagus. Seakale. 

Pastry and puddings of all kinds. 

Jams and marmalade. 

Fruit of all kinds, fresh and preserved. 

May drink 

Tea. Coffee. Cocoa from nibs. 

Dry sherry. Claret. 

Brandy and spirits that have not been sweetened. 

Soda water. Seltzer water. Vichy water. 

Bitter ale, sparingly. 

Must avoid drinking 

Milk, except sparingly. 

Sweet ales, mild and old. Porter and stout. 

All sweet wines. Port wine. Champagne. 

Liqueurs. 

The general mode of life to be adopted by the patient is that common to most 
chronic complaints. It consists essentially in avoiding excesses of all kinds. A 
warm bath once or twice a week promotes the action of the skin, and adds greatly 
to the patient's comfort. The Turkish bath often proves beneficial. 

We must next consider the medicinal treatment of diabetes. Opium frequently 
proves of considerable benefit, often quickly reducing the quantity of urine passed. 
As there is a great tolerance of opium in confirmed diabetes, large doses will have 
to be given. In the case of an adult, it would be well to commence with one grain 
doses, but two, three, and five grains three times a day are generally well borne. 
It should be given in the form of the compound soap pill. 

Phosphoric acid often proves of value. It is especially indicated when frequent 
urging to urinate, pain in the loins, emaciation, and prostration are prominent 
symptoms, and it is particularly useful in cases of nervous origin. Improvement 
quickly follows its use, both in the general health and in the condition of the urine. 



DIABETES. 223 

It should be given in two or three-drop doses in a tea-spoonful of water every two 
hours. 

Bromide of potassium has been used with success in some cases. 

Nitrate of uranium has sometimes proved efficacious. It not only quickly 
reduces the quantity of urine, but restores the strength and improves the general 
condition ; the dose is one-sixth of a grain in water three times a day, or a smaller 
dose more frequently. 

The liquid extract of ergot, given in thirty-drop doses in water thiee times a day, 
has proved of such signal benefit in diabetes insipidus that where other remedies 
have failed we should advise a trial of it in saccharine diabetes. In one case in 
which we gave it, it undoubtedly did good. 

There is one special form of treatment to which some reference must be made. 
It is known as the " skim milk " treatment. Several cases are reported in which 
the quantity of urine was steadily and greatly diminished and the specific gravity 
correspondingly reduced, by restricting the patient to a daily allowance of six pints of 
skimmed milk. It has the great advantage that it can be adopted without in any 
way interfering with the patient's ordinary occupation. The skim milk is the only 
food allowed ; and nothing else of any kind is to be taken. The quantity of milk 
should be fixed, and it should be taken at definite times, so as to constitute meals. 
It will probably have to be continued for six weeks, and then any kind of animal 
food may be allowed once or twice daily ; bran bread, gluten bread, &c, being 
gradually added to the dietary. 

This, then, completes our account of diabetes mellitus, and we must now consider 
the other form of diabetes. 

Diabetes Insipidus. — In this complaint, as we have already seen, the patient 
passes very large quantities of water, but it is free from sugar or other abnormal 
ingredient. 

The quantity of urine secreted by persons affected with insipid diabetes is usually 
greater even than in saccharine diabetes ; and it is not uncommon for fifteen, thirty, 
or even forty pints, to be passed in the twenty-four hours. We at one time had under 
our care a man who habitually passed twenty-two pints of water in the course of the 
day and night. He was kept under constant supervision, and the urine was care- 
fully measured, so that there was no mistake about it. He usually had to pass his 
urine two or three times in an hour, and was on this account unable to go to church 
or to any place of amusement. He usually had a slop pail under his bed in addition 
to two ordinary chamber-utensils. In the case of another patient, it was stated 
that the ordinary chamber-utensil was " not a bit of good to her," and she was 
always obliged to have a big pail in her room. The urine is generally of a light 
straw colour, clear and free from deposit. Its specific gravity is always very low, 
and in this respect it presents a marked contrast to the urine passed in diabetes 
mellitus. Sometimes, in fact, it is very little heavier than water, so that the 
urinometer may stand at 1,001 or 1,002. This thin, limpid urine decomposes very 
rapidly, and usually becomes extremely offensive after standing for even a very 
short time. 

The intense thirst experienced in these cases is one of the most distressing 



224 THE TREATMENT OP DISEASES. 

symptoms. The patient to whom we have referred assured us that he had drunk as 
much as twenty-two quarts in the twenty-four hours. He had measured it on 
several occasions, when this had been the quantity. He seldom drank less than a 
quart at a time. He went out as much as possible to " keep away from the water." 
He generally , kept a little pebble in his mouth to check the sensation of thirst. 
His sufferings when he was unable to get water were very great. He said he should 
never forget one day when he was left alone in the house, without, anything to drink. 
He was laid up at the time, and too weak to get about. For about an hour he was 
pretty comfortable, but then became very thirsty. He bore his thirst as well as he 
could, hoping that some one would come to him, but it finally became so intolerable 
that he suddenly caught up his chamber-pot and took a long, deep draught of his urine. 
During the day he drank the urine he passed seven times. It was at last so salt 
that it hardly quenched his thirst at all. 

The appetite is variable ; sometimes it is voracious, but more commonly moderate 
or indifferent. Our patient often went for days together without touching meat. On 
one occasion he stated that he had nothing to eat but half a small French roll for 
four days. He had "no appetite, and could not eat anything." He was usually a 
week or more without having a motion, and had sometimes gone from a month to six 
weeks. The fasces were very hard, and were passed with great difficulty. 

As might be imagined, the skin is usually dry. Our patient could walk as 
fast as he liked, even in the hottest day in the summer, without perspiring about 
the body. We remember a little boy who suffered in the same way, and whose 
mother declared that she believed that he had perspired only once in all his life. 
Diabetes insipidus is a complaint which is usually unattended with pain ; but this 
little boy suffered greatly from cramps in the legs. He, like most diabetics, suffered 
greatly from cold. He " was always over the kitchen fire, and you could not get 
him away from it." Our man stated that " as soon as lie got away from the fire 
he was all of a shake." 

Loss of flesh, general weakness, and inaptitude for work are usually prominent 
symptoms. 

Insipid diabetes occurs more commonly m men than in women. It may occur 
at any age, but the majority of cases are met with in people below thirty. In one 
or two instances the disease appears to have actually existed from birth. It is diffi- 
cult to say what it arises from. In a very large proportion of cases no exciting 
cause whatever could be assigned, and the patient had no idea what brought it on. 
In some instances it seems to have followed exposure to cold, and in others to have 
arisen from muscular exertion. The patient to whom we have so frequently re- 
ferred was able to speak very definitely as to the origin of his complaint. On 
a bitterly cold winter's day he had run as hard as he could for a distance of four 
miles. He was " dripping wet " and the perspiration was running off him ; but 
before he had time to get cool he had to drive a pony-chaise home a distance of 
six miles. Tha,t was the commencement of his illness. 

Some patients suffering from diabetes insipidus have an intense dislike for 
vegetable food, whilst others care for nothing else. Some are very sensitive to 
alcoholic drinks, whilst others exhibit a remarkable tolerance of stimulants. Th« 



DIABETES. 225 

French physician, Trousseau, relata° *he case of a man who from the commencement 
of his illness had acquired a remarKable immunity from the causes of drunkenness. 
He had frequently drunk a litre (a pint and three-quarters) of brandy in two hours 
without inconvenience. On one occasion he laid a wager that he would drink 
twenty bottles of wine at a single sitting, and he won it, without tha least dis- 
turbance of the nervous system. 

Is this complaint curable? What is the best method of treating it? We 
believe that there is no remedy equal to the liquid extract of ergot. Go to a 
chemist and sjet half an ounce of it. It is a black fluid in appearance, not unlike 
laudanum. Take thirty drops in a little water three times a day, or half the dose 
six times a day. It is a perfectly safe remedy, and no harm will come from its 
use. If you tell the chemist how much you are going to take, he will probably 
tell you that the dose is excessive, so you had better say nothing about it. Measure 
all your water passed in the twenty-four hours for several days before you begin 
your treatment, and continue to do so whilst taking the medicina If your urine 
decreases in quantity you will have a good proof that it is doing you good. Do not 
be disappointed if you fail to perceive much improvement for the first week; 
the medicine takes a little while to do its work. We once saw a man's urine 
reduced from twenty pints to the normal quantity in less than a month, and all 
his distressing symptoms left him. When you have got your water down to three 
pints in the twenty-four hours you had better discontinue the medicine. If you 
will take the trouble to take the specific gravity of your urine every day, you will 
find that it rises as the quantity of water passed decreases, and this of course is 
a good sign. In the man to whom we have referred the specific gravity of the 
urine rose under the treatment from a little over 1,000 to 1,017. 

We have known cramps in the legs occurring in a patient suffering from insipid 
diabetes quickly cured by the ergot. Of course, in the case of children and young 
people smaller doses than we have mentioned should be given. 

Although we have the greatest faith in the ergot as a remedy for insipid 
diabetes, we must not neglect to mention other remedies. Common nitre is often 
given with success. The best way is to buy half an ounce of nitre, shake it up 
in a pint bottle of water, and take a tea-spoonful every hour or every two hours. 
The urine should be measured, to see what effect it has on the quantity. 

The use of valerian in large and repeated doses has sometimes been attended 
with success. The application of a blister to the nape of the neck has in some 
cases done good ; but in others it has succeeded better when applied to the pit of 
the stomach. 

There is no occasion to restrict the diet in any way in the insipid form of 
diabetes. You may eat what you like, and as much as you like. Enforced absti- 
nence from fluids aggravates most of the symptoms ; the skin becomes unbearably 
hot, a sense of intolerable sinking, or even of intense pain, is felt at the pit of the 
stomach, and the mind becomes confused. Only take one medicine at a time, and 
give it a fair trial. Do not say that it is useless because you are not cured straight 
off. Chronic diseases often take a long time to get rid of f va you have probably 
already discovered. 
15 



226 THE TREATMENT OF DISEASES. 

Ought you to go to a doctor ? Certainly, or you may possibly make some 
mistake as to the complaint from which you are suffering. Only, if you are sure 
that you have diabetes insipidus, and have not tried the ergot, we advise you 
to do so. 

DIARRHOEA, OR LOOSENESS OF THE BOWELS. 

There is no complaint more common, and none which requires greater care for its 
successful treatment, than diarrhoea. It may be dependent on so many different 
causes, that it is absolutely necessary that the individual case should be thoroughly 
investigated before any treatment is commenced. People often ask, " What is the 
best thing for diarrhoea ? " and in answer to this question we can only say that there 
is no best remedy, and that the treatment must depend entirely upon the nature of 
the case. It is quite true that a general diarrhoea mixture is kept at most of our 
hospitals, and is given away during the summer months, but this necessarily fails in 
a large number of cases. A remedy which would prove beneficial in one instance, 
or in one form of diarrhoea, might in another prove utterly useless. 

In examining a bad case of diarrhoea, either in a child or in an adult, we must 
learn all we possibly can, either from the patient or the friends, respecting the onset 
of the attack and its subsequent progress. We must try to find out what was the 
exciting cause, and from what other symptoms the patient is suffering, as a con- 
sideration of these circumstances will do much to enable us to arrive at a correct 
conclusion in the choice of our remedy. The motions should be seen, so that then- 
characters may be determined, and as much information as possible derived from 
this source. 

There is so great a diversity in the symptoms which accompany diarrhoea, that 
there is scarcely any phenomenon common to all the varieties, except that the stools 
are more liquid, frequent, and copious than in health. The evacuations may be very 
few, not exceeding two or three daily, or so frequent that the patient scarcely satis- 
fies one call before he experiences another. There is generally more or less pain 
before the evacuations, which are almost always followed by relief; but in some 
cases, no pain whatever is experienced throughout. Along with the discharge is 
occasionally a very disagreeable sinking sensation in the abdomen, with a general 
feeling of exhaustion or faintness, a cold skin, and a feeble, irregular pulse. Diarrhoea 
is sometimes attended with fever, but in most cases it is absent. The skin is usually 
dry and the urine scanty. Every possible diversity exists in the degree, duration, 
and danger of the complaint. It may be quite trivial, getting well in a day or two 
without aid, or it may run on for months, or even years, resisting every variety of 
treatment. In some cases death ensues rapidly from great exhaustion ; but more 
commonly a fatal termination is preceded by slow emaciation and gradual loss of 
strength. In the large majority of cases the attendance of a medical man is un- 
necessary, and a little judicious treatment is followed by a rapid cure. At the same 
time, it must be remembered that simple diarrhoea passes almost insensibly into the 
graver form. It is a golden rule that if you are in any doubt about sending for 
the doctor, you had better do so. If you err, err on the right side. 

Diarrhoea is a prominent symptom of many diseases. It is an essential part of 



DIARRHCEA. 227 

cholera, dysentery, and typhoid fever, and is too frequently an accompaniment of the 
last stage of consumption. It often proves the immediate cause of death in people 
who have been long confined to bed by chronic illness. 

Diarrhoea, however, is not unfrequently the sole, or at all events the essential, 
cause of complaint. It is the disease itself, and not a mere symptom of some other 
malady. 

The causes of diarrhoea are numerous, one of the most common being some error 
in diet. It may be the result of over-eating and drinking, or of taking some 
particular article of food which has disagreed with the stomach and set up 
irritation. People after a large dinner not uncommonly suffer from diarrhoea. It 
is usually attributed to the salmon or oyster-sauce, or to some perfectly innocent 
article, whereas in reality it is due to the mixture of the various kinds of food and 
drink, and more especially to the actual quantity taken. The stomach and bowels 
not unnaturally rebel when made the receptacle of such a heterogeneous collection of 
substances. There are certain articles of diet, however, which undoubtedly have a 
strong tendency to provoke diarrhoea ; and amongst these comparatively indigestible 
substances we may enumerate unripe fruit, raw vegetables, sausages, pork, veal, 
goose, duck, &c. Many kinds of shell-fish, such as lobsters, crabs, and muscles, are 
apt to act as irritants. Putrid food, or, to use the more refined phraseology of 
gastronomers, food which is high, has the same effect on many people, who would 
consequently do well to take their venison and game with a certain amount of 
caution. Articles of diet which are in themselves perfectly good and wholesome 
often cause diarrhoea when resorted to for the first time. This is, in all probability, 
the explanation of the free purging from which many of us suffer on our first visit 
to the Continent. Bad cooking may lead to diarrhoea, and has sometimes caused quite 
an epidemic in large establishments. 

Impure water is another common cause. Water contaminated with decomposing 
animal matter, or with sewage or sewage gas, is pretty certain to cause diarrhoea, 
either at once or gradually, according to the degree of impurity and the quantities in 
which it is consumed. Symptoms resembling those of cholera are sometimes pro- 
duced by drinking the waters of the Volga, which are impregnated with sewage. In 
St. Petersburg, the water of the Neva, which is rich in organic substances, gives 
diarrhoea to strangers. When diarrhoea prevails over a limited area, as in only a 
certain row of houses, the condition of the water supply should always be investigated. 

Bad smells often give rise to diarrhoea. Many people who live in the neigh- 
bourhood of grave-yards suffer in this way. The smell from a newly-opened cesspool, 
or the emanations from a manure heap, or, worse still, a manure manufactory, have 
been known to have the same effect. Medical students when first they commence 
dissecting, or at later periods of their career, if they apply too assiduously, are often 
sufferers. 

Worms are not unfrequently the cause of looseness of the bowels, not only in 
children, but also in adults. The round worm, as. a rule, causes more irritation 
than the tape-worm. • 

Mental emotions, more especially fear and anxiety, sometimes act as an 
exciting cause. The anticipation of any unusual ordeal, such as spea ki ng in public, 



228 THE TREATMENT 07 DISEASES. 

going up for an examination, or the thoughts of a surgical operation, may induce 
diarrhoea. A sudden panic will operate on the bowels of some persons as surely as 
a black dose, and much more speedily. Sudden atmospheric changes, or the removal 
from a warm to a temperate climate, will often bring on an attack of diarrhoea. In 
women it is sometimes induced by getting chilled in damp, cold places. Standing 
for some time on stone flags has been known to excite it. 

Summer diarrhoea, or choleraic diarrhoea, or English cholera, as it is often called, 
is prevalent in this country from June till the end of September. It is as constantly 
observed when the temperature rises above 60° as are coughs and colds when it falls 
below 32°. The attack is generally sudden. At first the ordinary contents of the 
bowels are discharged, and then a large quantity of fluid is expelled, both by 
purging and vomiting. The stools are copious and watery, dark-brown or green in 
colour, and are often shot out with a considerable amount of force. The seizure is 
often accompanied by colic and pain in the region of the navel. Exhaustion may 
ensue very rapidly, so that in a few hours the pulse becomes weak, the voice feeble, 
the temperature of the body reduced, and the patient passes into a very critical 
condition. Sometimes the disease resembles in its intensity Asiatic cholera, and 
death may ensue rapidly. 

Sometimes diarrhoea is met with in the chronic form, and this is by no means 
uncommon in " old Indians," whose health has deteriorated from a long residence in 
a tropical climate. There is one form which is commonly known as " white flux," 
from the paleness of the stools. This complaint usually begins without any particular 
symptoms beyond those of relaxed bowels. Sometimes there are two or three 
motions in the twenty-four hours, the stools being liquid and frothy, and having the 
appearance of chalk and dirty water, or being of the consistence of thick gruel. The 
health is gradually undermined, the motions increase in size and frequency, and 
unless treatment proves successful in arresting the complaint the most serious 
consequences may follow. 

There is another form of diarrhoea which, although not very common, we should 
be loth to pass over in silence. Many unquestionable instances are recorded, both 
in ancient and modern literature, of persons who, while suffering from diarrhoea, have 
voided oil or fat. In one instance a woman discharged every day for fourteen 
months a considerable quantity of yellow fat, that lay upon the motions like melted 
butter. We are told that when voided into a vessel of water it floated like oil upon 
the surface, and when cold it assumed the consistence and appearance of fat. Like 
fat, it was inflammable and burned with a bright flame. In another case a portion 
of the substance was analysed, and was found to ponsist of true fat. In several cases 
this condition has been found after death to be associated with disease of the 
pancreas, or sweetbread. We know nothing about the treatment ; but a lady who 
suffered from this complaint recovered after swallowing a pint of sweet oil. A late 
distinguished physician, upon this hint, gave his patient, who was labouring at the 
same time under diabetes, a quarter of a pint of olive oil, and from that time the 
voiding of fat diminished and soon after ceased. 

In cases of chronic diarrhoea the possibility of slow poisoning must be taken into 
consideration. Even if the symptoms have been caused by the introduction <rf 






DIARRHCBA. 229 

poison into the system, it does not follow that it has been administered intentionally. 
There are several cases on record in which obstinate diarrhoea has resulted from 
living in a room hung with paper containing arsenic. If you have any reason to 
suspect that poison is being secretly administered, it is your duty to at once call in a 
physician on whom you can place the most implicit reliance, and put the whole 
circumstances of the case before him. It too frequently happens that the patient 
himself is so weakened and debilitated by his complaint that it would be useless, or 
worse than useless, to communicate your suspicions to him. You must remember 
that whatever is done must be done quickly ; prompt action in such a matter may 
avert a great calamity. An examination or analysis of the patient's urine will in 
most cases show whether your suspicions have been well founded. 

We must now pass on to the consideration of some of the most approved methods 
of treating the various forms of diarrhoea. When the complaint is dependent upon 
the presence of some irritant in the bowels, such as any of the different kinds of 
indigestible food of which we have already spoken, we cannot expect to do much good 
until we have got rid of the offending body. Castor oil is often used for this purpose, 
and usually acts admirably. Another good remedy is rhubarb, which has this 
advantage : that it acts first as a purgative, and expels the irritant, and then as an 
astringent, and checks the diarrhoea. For adults it is conveniently given in the form 
of compound rhubarb pill, and for children as Gregory's powder. This may be 
followed, if necessary, by one or two table-spoonful doses of the ordinary chalk 
mixture, or of the diarrhoea mixture (Pr. 28). These are simple enough cases, and 
seldom give any trouble or anxiety. 

Camphor is the recognised remedy for diarrhoea excited by the effluvia of drains, 
but arsenic (Pr. 40) often proves useful. 

Diarrhoea which has been induced by mental emotion is said to be often cured by 
the tincture of gelseminum, given in two-drop doses every ten minutes for an hour. 
The complaint is so common amongst public men, that any trustworthy means of 
treatment must be regarded as a boon. In diarrhoea arising from fright, small doses 
of laudanum may be given with advantage. 

When the diarrhoea is attended with fever — in other words, by elevation of 
temperature, as shown by the thermometer — aconite is indicated. A tea-spoonful 
of the aconite mixture (Pr. 38) may be given every ten minutes for the first hour, 
and subsequently hourly. Should this fail, Pr. 48 may be expected to do good. 

The remedy on which we place the greatest reliance in the treatment of summer 
diarrhoea is undoubtedly camphor. It is of inestimable value in the diarrhoea which 
is often epidemic during the hotter months of the year, and is especially indicated 
when the onset of the attack is sudden. E^en when the strength is sinking rapidly, 
as the result of the excessive purging, and the face is pale and livid, and the whole 
body is icy cold, camphor will restore warmth to the extremities, and rescue the 
patient from an apparently almost hopeless state. It is essential to give the strong 
preparation — the essence of camphor ; to give it frequently ; but, above all, it is 
essential to give it as soon as possible, for every moment's delay is of importance. 
The dose is six drops every quarter of an hour till the symptoms abate, and hourly 
afterwards. It is a good plan to mix it with a little brandy, but it answers 



230 THE TREATMENT OF DISEASES. 

admirably if given in milk or water. If the essence of camphor is not at hand, the 
camphor pilules, sold at any chemist's, will do as well. The tincture of cinchona or 
bark also gives good results in the treatment of these cases. It should be given in 
drop-doses after every loose motion. 

In summer diarrhoea, and, for the matter of that, in all kinds of diarrhoea, the 
greatest attention must be paid to the diet. It is of not the slightest use giving 
solid food, for it will only be ejected immediately. The best thing is for the patient 
to take nothing but fluid nourishment, and to take it cold. Get a tumblerful of 
milk, and put in it a table-spoonful of brandy and a few pieces of ice ; give the 
sufferer only a tea-spoonful at a time. If you give more at first it will be almost 
sure to excite the vomiting and purging. When you find this small quantity is 
retained, you can gradually and carefully increase the dose. You will remember 
that milk is extremely nutritious, and that if the patient can take this and digest it 
he is in no danger of being starved. When the stomach is very irritable the 
following will often prove useful : — Take a table-spoonful of cream and beat it up 
thoroughly with the white of a new-laid egg. Add slowly to the froth of the 
mixture thus obtained a table-spoonful of brandy, in which a lump of sugar hag 
been dissolved. As a rule, we prefer the iced brandy and milk. 

In many of the chronic forms of diarrhoea, and more especially in the " white 
flux " of the " old Indian," great benefit will be experienced from the administration 
of arsenic. A tea-spoonful of the mixture (Pr. 40) should be given three or four 
times a day, or after every loose motion. Small doses of mercury, given frequently, 
as in Prs. 48 and 71, will often do good. It is very essential in these cases to 
endeavour to improve the general health, and tonics will often afford much more 
satisfactory results than astringents and diarrhoea mixtures. The acid and gentian 
mixture (Pr. 15), or the perchloride of iron mixture (Pr. 1), will do much to give 
tone to the system. In obstinate cases, the adoption for a time of an exclusively 
milk diet will sometimes effect a cure. 

When the complaint has been contracted in a malarial, i.e., aguish, district, or 
the patient has previously suffered from ague, a course of quinine (Prs. 9 and 10) 
will often afford the happiest result. 

There are many other valuable remedies for diarrhoea besides those to which we 
have already referred. We now proceed to enumerate the chief, giving after each a 
short description of the class of cases in which it has proved most useful. 

Camphor. — We have already spoken of the value of this drug in the treatment 
of summer or choleraic diarrhoea. The great indication for its employment is the 
suddenness of the attack. But it may be said, " Surely diarrhoea always comes on 
suddenly ; you would not expect it to take a month about it." That is quite true, 
but some kinds of diarrhoea come on very much more quickly than others. You are 
in the midst of an animated conversation, let us say, when suddenly you feel that if 
you cannot make some excuse to get away something dreadful must happen. That is 
just the case for camphor; and the more startling and unexpected is the onset of the 
attack, the greater is the probability that camphor will do good. The motions in 
these cases are usually watery, and dark in colour. When there is coldness of the 
surface of the body, camphor will usually quickly restore warmth to the extremities. 



DIARRHOEA. 231 

It is the best remedy for that form of diarrhoea which is excited by standing on cold 
stones. We have already insisted on the fact that if camphor is to do good it must 
be given early and frequently. The dose is from four to six drops of the essence of 
camphor every ten minutes till the symptoms abate, and hourly afterwards, or ©ne 
of the camphor pilules may be given in a similar manner. 

Mercury, in small doses, is an excellent remedy for many forms of diarrhoea. It 
is useful when the patient voids pale, clayey, or pasty stinking motions, and at the same 
time suffers from acidity, flatulency, a furred tongue, a little yellowness about the 
eyes, or other symptoms of deficient action of the liver. It is also indicated when 
the motions are passed with pain and straining, and are very slimy, and perhaps 
mixed with blood. It will also do good when some ten or a dozen watery, offensive, 
muddy-looking, or green-coloured stools are passed daily. It will be given either a* 
Pr. 48 or Pr. 71. 

Podophyllum is especially indicated in morning diarrhoea. The motions are 
usually hig/i-coloured, and their passage is attended with sharp, cutting pains. The 
Pr. 51 will be found useful. 

Arsenic is useful in autumnal diarrhoea. The motions are usually watery, slimy, 
and green or brown. It will nearly always succeed when a burning sensation attends 
the effort of expelling the motion. Another indication for its employment is the 
occurrence of the diarrhoea immediately after eating or drinking, a form which is not 
at all uncommon in sufferers from indigestion. A tea-spoonful of the arsenic mixture 
(Pr. 40) should be given every four hours, or after every loose motion. 

Pulsatilla is serviceable in diarrhoea arising from indulgence in rich, indigestible 
food, such as duck or pork. It is especially useful when the motions differ from one 
another in colour. A drop of the tincture of pulsatilla should be given in water 
every ten minutes for the first hour, and subsequently hourly until an improvement 
is noticed. 

Ipecacuanha should be given when the diarrhoea is attended with nausea or 
vomiting, paleness of the face, weakness, and a desire to remain lying down. It 
does most good when the stools are slimy, green or not, with or without blood. The 
dose is a tea-spoonful of the ipecacuanha mixture (Pr. 50) every hour, or a smaller 
quantity more frequently. 

Colocynth is indicated when the diarrhoea is attended with griping. 

Nux Vomica is the remedy for diarrhoea alternating with constipation. The 
motions are usually scanty, and often mixed with slime or blood. (See Pr. 44.) 

Cinchona or Bark is useful when the diarrhoea was excited by over-indulgence in 
fruit. It is also useful when it is most troublesome at night. The motions in this 
kind of diarrhoea are usually liquid, and brownish in colour. A drop of the tincture 
of bark should be given in water every ten minutes for the first hour, and then hourly. 

Chamomile is the best remedy for diarrhoea occurring in fretful children, especially 
when they are teething. The motions at these times are usually watery, bilious, 
green, yellow, or slimy, or smelling like rotten eggs. Half a tea-spoonful of chamomile- 
tea should be given every ten minutes for the first hour, and subsequently hourly or 
after every loose motion. The method of preparing the tea will be subsequently 
given. (See Chamomile in the Materia Medica.) 



232 THE TREATMENT OF DISEASES. 

Lime water is often of great benefit in young children suffering from chronic vomit- 
ing and diarrhoea, and consequent wasting. It improves the digestion and removes 
the irritating condition of the urine, which is so common an accompaniment. It 
neutralises any excess of acid that may be present in the bowels. It may be given 
in milk : one part of lime water to three of milk. 

Opium is an excellent remedy in almost all kinds of diarrhoea, although it must 
be confessed that in this, as in the case of several of the following, the indications 
for its employment are not as yet very strictly defined. It may be given in the 
form of laudanum in a twenty-drop dose in a little water. This is for an adult ; it 
must never be given to children. 

Acetate of Lead (sugar of lead) is another good remedy. It should be given in 
five-grain doses every four hours, as in Pr. 30. It will also arrest bleeding at the 
same time. It is suitable for obstinate cases. 

Oxide of Zinc is also useful in diarrhoea. It may be given in the form of the 
pills (Pr. 66), two to be taken every three hours. 

Sulphate of Copper, or blue stone, is sometimes used in obstinate cases. It is a 
very powerful astringent, and should be used with a certain amount of caution, and 
only in severe cases. The same may be said of nitrate of silver. Either may be 
given in half-grain doses made into a pill. 

Gallic Acid, Tannic Acid, Catechu, and Kino are all useful in simple cases of 
diarrhoea, and a mixture containing several of these astringents may be given. 

Bismuth is a remedy which often succeeds when everything else has failed. A 
drachm of the nitrate of bismuth should be given in milk several times a day. This 
dose is larger than is usually recommended, but it will not disturb the stomach or 
cause any inconvenience. It is a remedy of which we can speak highly in obstinate 
cases. We have seen it succeed when almost everything else has been tried in 
vain. Children do very well with smaller doses, but on the Continent they are 
frequently given from thirty to sixty grains hourly. 

Chlorodyne is a remedy not to be despised. It is not a great favourite with 
doctors because it is a patent medicine, but that is a matter of very little conse- 
quence if it will cure you. 

These are the remedies to be given by the mouth, but sometimes, when the case 
is urgent, it is absolutely necessary to give an injection. The quantity of fluid 
employed for the injection should be small, or the bowel will contract and expel it, 
whereas it is desirable that it should be retained as long as possible, in order to 
exert its influence. An injection of an ounce (two table-spoonfuls), or at most two 
ounces, is sufficient for an adult; and it may be repeated several times a day, 
according to the urgency of the symptoms. The material used for these injections 
is starch and water of the consistence of cream, and of about the heat of the body. 
A starch injection alone is often useful, but its astringent and sedative action is 
greatly heightened by the addition, for an adult, of twenty drops of laudanum. 
Five grains of acetate of lead added to the injection will do much to increase its 
efficacy. An injection will often save a life that appeared almost hopeless. 
Sulphate of copper or bismuth may at the same time be given by the mouth. 

Many doctors employ cold or tepid packing in diarrhoea, especially in the 



DIPHTHERIA. 23S 

summer diarrhoea of children. "We have had no experience of this method of 
treatment, but from the published accounts the results appear to be very favourable. 

In obstinate chronic cases of diarrhoea, and more particularly in the "white 
flux," good results are often obtained by directing the attention to the diet. It is 
a good plan for the patient to put himself temporarily on a restricted diet, and he may 
with advantage confine himself exclusively to milk. The milk is often more readily 
digested if mixed with a fourth part of lime water. In summer it is pleasanter to 
have the mixture iced. The quantity taken need not be limited, but it is advisable 
to take it at regular intervals. If the patient has been accustomed all his life to 
the use of stimulants, he will at first find a little difficulty in doing without them, 
but it is imperative that he should make the effort, at all events for a time. 

The patient should be very careful about his clothing. He should wear flannel 
next the skin, and should have, in addition, a flannel bandage round the abdomen. 
He should keep as much as possible in a uniform temperature, and should be very 
particular to avoid draughts and chills. In wet or unfavourable weather he should 
remain in-doors. When there has been a distinct improvement, the patient may 
gradually and cautiously return to his ordinary diet. He must, however, still be 
very abstemious both in eating and drinking. Beef tea, mutton broth, or a raw 
egg beaten up with milk and flavoured with a tea-spoonful of brandy, is generally 
well borne. The following will form an agreeable variety : — Boil a pint of new 
milk, with sufficient cinnamon to flavour it pleasantly, and sweeten with white 
sugar. This may be taken cold with a tea-spoonful of brandy, and is useful in 
many forms of diarrhoea. Tea, and more especially coffee, are to be avoided. 
Wines and spirits of all kinds are bad. The diet will, at first, be to some extent 
experimental. The sufferer must feel his way, and find out for himself what he can 
take with safety. He must exercise the greatest moderation both in eating and 
drinking. He must be very careful not to take too much of anything, and should 
he make a mistake he must take care not to repeat it. 

Some people would say that life was not worth living for under these conditions. 
Let them try, and we think they will soon change their opinion. We should say 
that moderation both in eating and drinking was essential for the attainment of 
true happiness. 

DIPHTHERIA. 

Considerable diversity of opinion exists amongst medical men as to the true 
nature of diphtheria. Speaking generally, however, and without any pretension to 
scientific accuracy, we should say that it was a malignant sore throat, attended with 
the formation of a membrane. 

Few diseases are more dreaded both by patients and their doctors than diphtheria. 
It is a disease which must have been known as long as the history of man extends, 
but it is only during the last twenty or thirty years that attention has been especially 
directed to it in this country. Many men now living were in practice in London 
for more than a quarter of a century before ever meeting with a case, although it 
was common enough on the Continent. In 1855 it was alarmingly prevalent at 
Boulogne, and it presently appeared among us in the form of a most fatal epidemic. 



234 THE TREATMENT OF DISEASES. 

The epidemic reached its height in 1858 and 1859, and during those two years it is 
estimated that over twenty thousand people died from it. Since then, isolated cases 
have been of frequent occurrence in every country. A medical man in active 
practice seldom goes more than three or four months without seeing a case. 

Diphtheria is a disease which attacks children more frequently than adults, and 
girls more commonly than boys. It may occur at any season, and is little affected 
by either heat or cold, draught or rain. In different epidemics it has been found 
that neither the heat of the dog-days nor the frost of winter affected the prevalence 
of the disease. Its development is apparently particularly favoured by poverty 
and uncleanliness, for it quickly invades the hovels of the poor, where too frequently 
men and animals are crowded together under the same roof, and dung-heaps, 
privies, and other sources of putrefaction fill the air with their effluvia. It very 
often breaks out in factories, schools, and barracks, which not uncommonly are 
insufficient in size or defective in ventilation. But even families and people who 
live under much more favourable conditions are not spared, and children who enjoy 
the best of care and nourishment are frequently seized and carried off by this 
fatal disease. Some people appear to be much more susceptible to its influence 
than others ; thus of two families residing in the same house, and apparently under 
identical conditions, one has suffered severely, whilst the other has entirely escaped. 
A difference of susceptibility is also observed in members of the same family, and 
this is not always in favour of the more robust. It is said that people of great 
mental activity and a high degree of nervous susceptibility are especially prone to 
suffer from the disease. 

Is it contagious ? Undoubtedly. "We know that it is Contagious, although we are 
not acquainted with the exact mode in which the contagion operates. The infec- 
tious matter is not capable of any wide diffusion through the air, but it clings in the 
most persistent manner to particular places, houses, and even rooms. There is, we 
believe, no known instance of its having been conveyed from one house to another 
by a person not suffering from the disease. It is still very doubtful whether it can 
be inoculated. There is a good deal of contradictory evidence on the subject. The 
following case would appear to be a strong argument in favour of its inoculability. 
M. Valleix, a well known and esteemed French surgeon and writer, was in attend- 
ance upon a little girl suffering from diphtheritic sore throat. Under energetic treat- 
ment she recovered. One day, however, while M. Valleix was inspecting her throat 
he received into his mouth a small quantity of saliva driven out of that of the patient 
in the act of coughing. Next day a little exudation appeared on one of his tonsils. 
The other tonsil and the adjacent parts became speedily covered with false membrane, 
a profuse discharge took place from the nostrils, delirium supervened, and in forty- 
eight hours M. Valleix was dead. In another case of diphtheria the medical man in 
attendance found it necessary to open the windpipe to relieve the breathing. There 
was some obstruction from the accumulation of blood, when the operator, to save the 
patient's life, applied his Tenth to the wound in the neck, and sucked the fluid out. 
In forty-eight hours ^z (&e& from symptoms identical with those from which M. 
Valleix suffer*^ xrousseau, the celebrated French physician who relates these cases, 
being du^tlsned with the evidence advanced in favour of the view that the disease was 



DIPHTHERIA. 235 

capable of being inoculated, punctured his arm, his tonsils, and throat, with a lancet 
moistened with the membrane which he had just removed from a diphtheritic sore throat. 
The attempt to inoculate himself was unsuccessful, and M. Trousseau suffered in no 
way from his devotion to science. The experiment was subsequently repeated by 
another French physician, with the same negative result. 

Do people ever have diphtheria twice ? There can be no doubt that a person may 
suffer from it any number of times. The fact of having had and survived the 
disease does not grant that immunity against a second attack which is so markedly 
a characteristic of measles, scarlatina, and small-pox. 

Diphtheria usually begins, both in adults and children, with marked symptoms of 
fever, there being an elevation of the temperature of the body by four or five degrees, 
and an increase in the rate of the pulse which is often very marked. Sometimes the 
attack begins with a little sensation of chilliness, but it is never ushered in with that 
marked shivering which occurs in some other fevers. The patient usually complains 
of a stupid feeling, of pain in the head and neck or in the loins, of debility, weakness 
in the limbs, and increased thirst. Sometimes he is restless or inclined to be drowsy, 
or he may be sick. Children, when first taken ill, are apt to sleep during the day 
more than usual, and are restless or even light-headed at night. 

Very shortly the patient experiences a sensation of dryness and burning in the 
throat, as well as pain on swallowing. If the space under the jaw be examined, some 
little hard, tender lumps will be felt, which are the enlarged glands. If the throat 
be now carefully examined, it will be found to be of a dark-red livid colour, the uvula 
which hangs down at the back being swollen to twice its size. In a few hours the 
affected parts become covered with a false membrane, which is most marked on the 
tonsils and soft palate. This diphtheritic inflammation, with the formation of the mem- 
brane, is very prone to spread, both upwards to the back of the nose and downwards into 
the larynx and windpipe. At first the membrane is easily detached, and the tissues 
beneath are apparently healthy, but as it grows thicker and tougher it may be torn 
off in strips, and the subjacent structures will be seen to be raw and bleeding. As 
the local mischief extends the temperature of the body usually rises, and the general 
constitutional disturbance is increased. The difficulty in swallowing is in proportion 
to the amount of inflammation, swelling, and exudation. "Wearisome and painful 
efforts to clear the throat are often occasioned by the abundant secretion of a thick 
tenacious mucus. In some cases the breath becomes extremely offensive. From the 
first there is usually a good deal of cough ; but should the windpipe become affected 
both cough and voice assume a hoarse, husky, muffled tone, and a difficulty is experi- 
enced in breathing. During the whole course of the disease the bowels are either 
quite natural or they are confined, diarrhoea being very unusual. 

Several varieties of diphtheria are recognised by medical men ; in some the 
symptoms are much milder than we have described, and in others they assume a more 
malignant type. 

The great danger of the slighter forms is that they may be entirely overlooked. 
The patient is apparently so little indisposed that professional aid is not considered 
necessary, and the true nature of the complaint remains undetected. It may so 
happen that this is of very little moment to the patient himself, but it is a matter of 



236 THE TREATMENT OP DISEASES. 

the very gravest importance to all who have the misfortune to be brought in contact 
with him. This slight attack is capable of communicating to other people the disease in 
its most malignant form. It is difficult to over-estimate the serious consequences 
that might ensue from a case of this description being allowed to run loose in a 
school. 

These slight attacks usually begin without any symptoms which might give 
warning to the patient or his friends of the approaching danger. There is a little 
fever or none at all ; there is a trifling sensation of malaise, a little uneasiness in 
the throat, and a feeling of dryness or a slight pricking pain in swallowing. In adults 
these symptoms are very easily pverlooked, and in children they cannot be ascertained. 
The glands of the jaw and neck swell moderately, and are somewhat tender or 
painful on gentle pressure, only in rare cases does this light form of the disease give rise 
to more marked symptoms. The fever is then more intense, the temperature of the 
body stands three or four degrees higher than normal, the skin feels dry and hot, 
the pulse is frequent and full, and the face slightly congested. The patient com- 
plains of heaviness about the head or of a sense of stupidity, of lassitude, increased 
thirst, and of an annoying or painful sensation on swallowing. Sometimes even there 
may be a little stomach disturbance and the patient may be sick ; still, after a short 
time — usually in the course of from twelve to twenty-four hours — these symptoms 
disappear as quickly as they came, and the patient soon forgets all about what he 
characterises as his little temporary indisposition. 

If, however, we could have examined his throat, we should have found that it was 
in places swollen and of a vivid red colour. A few hours later a number of greyish- 
white or whitish-yellow spots would have been seen, perhaps confined to one tonsil 
and a little of the adjacent tissues, and we should then have entertained no doubt as 
to the true nature of the disease. The diphtheritic membrane gradually clears off, 
and in a few days the attack may be over; or, on the other hand, the termination may 
be less favourable. 

It should always be remembered that in these cases the absence of fever and 
general constitutional disturbance is no guarantee that mischief is not going on in 
the throat. The temperature may be scarcely elevated above the normal, the pulse 
may be but slightly accelerated, the difficulty in swallowing may be nearly gone, and the 
general condition apparently quite satisfactory, and yet the formation of the diphtheritic 
membrane may be gradually extending. On the fourth, or perhaps the sixth, day the 
temperature may suddenly rise to 103° or 104°, and the pulse to 120 or 130 beats in 
the minute. The head is hot and painful, and the patient says he feels very ilL 

He complains of a feeling of dryness and burning in the throat and pain on swallow- 
ing, and there is now no difficulty in recognising the fact that he is in for a bad attack, 
and is suffering from the more serious form of the disease, which we have already 
described. 

If there be any wound or abrasion of the skin during en attack of diphtheria it 
is apt to become covered with a pellicle of membrane similar to that which forms in 
the throat. Even in people not suffering from the disease, but who are exposed to 
an atmosphere charged with the diphtheritic poison, sores or abrasions will undergo 
this thange, and it is said that in this way an attack sometimes commences. What 



DIPHTHERIA. 237 



it teaches us practically is this : that we should not apply blisters, or inflict even the 
most trivial wound, during the prevalence of an epidemic of diphtheria. Even the 
application of leeches should be avoided. 

Diphtheria may cause death simply mechanically by suffocation, but the exhaus- 
tion occasioned by the intensity of the constitutional disturbance is usually an 
important factor. The duration of the disease may vary from forty-eight hours to 
fourteen days. When death takes place within a week from the first appearance of 
symptoms of illness, it is always preceded by the extension of the inflammation to the 
larynx. When death occurs as the consequence of the general disease, the fatal issue 
usually ensues during the second week of the disorder, unless, indeed, the patient has 
been greatly weakened by some previous illness. 

During the progress of the case the kidneys not unfrequently become affected, and 
diphtheria may cause Blight's disease, just as scarlet fever does. 

After recovery from an attack of diphtheria there i<? often paralysis of different 
parts of the body. As the paralysis is developed only gradually and slowly, it is 
seldom noticed until the second or third week from apparent recovery from the 
disease. 

The soft palate is usually the first part affected, and difficulty is experienced 
in talking, swallowing, and expectorating. The voice becomes nasal and the 
sounds run into one another, so that it is no easy matter to understand the 
patient. In eating or drinking the food is always going " the wrong way,"- that is, 
it falls into the larynx, and is forcibly ejected during a violent fit of coughing. Very 
frequently fluids, instead of being swallowed, run out through the nose. The patient is 
almost unable to expectorate ; and should he get a cold on his chest his condition may 
become critical; 

Sometimes the muscles of the eyes are affected and there is disturbance of vision. 
At first there is difficulty in reading fine print, the effort being attended with con- 
siderable discomfort and even pain. At a later stage the patient is found to squint, 
and he often sees everything double. After a time the paralysis may extend to the 
limbs and other parts of the body, so as quickly to reduce him to a condition of the 
most utter helplessness. The muscles of the neck may be involved, so that when the 
head falls backwards or forwards the patient is unable to lift it again without help. 
If the muscles of the trunk are considerably affected it becomes impossible for him 
to raise himself from the horizontal position, or to turn himself in bed from one side 
to the other, and when placed in a sitting posture he simply collapses. When the 
affection becomes so general as this, there is always a fear lest the paralysis should 
extend to the heart or to the muscles by which respiration is carried on. When the 
palate is the part affected, the food may enter the windpipe and cause sudden suf- 
focation ; or it may pass into the lungs and set up inflammation. As a rule, how- 
ever, a good recovery is made from all these paralytic symptoms. 

What should be done when diphtheria breaks out in a family ? In the first place, 
send for the doctor. There is no disease in which the personal attendance of a medical 
man is more imperatively demanded. He will take the entire charge of the treat- 
ment, and you will not only have done the best for the sufferer but will have relieved 
yourself from a fearful responsibility. 



238 THE TREATMENT OP DISEASES. 

Unfortunately, however, the attendance of a medical man is not always procurable ; 
and for the benefit of those who have to rely on their own unaided resources, we give 
a short sketch of the mode of treatment. In the first place the patient should be at once 
sent to bed, for early rest in these cases is of the utmost importance. The room 
should, if possible, be large and airy, and the greatest attention must be paid to ventila- 
tion. At least one of the windows should be kept constantly open for an inch 
or two at the top, so as to avoid any chance of stuffiness. It is a good plan to have 
plenty of carbolic acid and water placed in basins about the room. It may be used 
for receiving and disinfecting the discharges ; and a little occasionally sprinkled on 
the floor will do much to keep the air sweet. Means should be taken to isolate the 
patient ; and people who are not actually in attendance should not be allowed in the 
room, both for their own sakes and for the sake of the sufferer. 

It is a good plan to give the patient plenty of ice to suck, in pieces of such a size 
that they can be conveniently and comfortably held in the mouth. Ice is useful in 
allaying the beat and pain in throat, and in checking that abundant secretion of 
mucus which is so annoying from the constant hawking which it occasions. Its 
beneficial effects are most marked when its use is commenced at the very onset of 
the attack, and it should be continued as constantly as possible until it has fairly 
declined. 

During the whole of the illness the patient's strength should be carefully sup- 
ported by the administration of strong beef tea, milk, raw eggs, and other nutritious 
diet. 

The drug on which we place the greatest reliance is iron. It is, we believe, best 
given in the form of the solution of the perchloride of iron. The tincture of per- 
thloride of iron is of the same strength and answers equally well, but it is made with 
spirit, and we may not always want to give alcohol. In the case of an adult, thirty 
minims should be given in an ounce of water every alternate hour, or half the quantity 
hourly. The dose for a child is ten drops every hour in a little water. These are 
large doses, but in diphtheria, as in erysipelas, iron, to do any good, must be given 
frequently and in considerable quantities. The taste is rough, and should it prove 
very objectionable, may be modified by the addition to each dose of twenty drops of 
glycerine. 

We do not know exactly in what way the medicine acts. It may produce 
its beneficial effects either by coming in direct contact with the throat or by 
its general influence on the system. The solution of perchloride of iron does 
good when frequently painted over the back of the throat. Great pains must 
be taken to apply it very gently, or by increasing the inflammation it may do 
more harm than good. 

In many instances the internal administration of the red iodide of mercury, 
in doses of -fa grain, has been attended with the most favourable results. It 
should be given every alternate hour in a few grains of sugar of milk. 

The question of the amount of stimulant that should be given is a very 
delicate one. The mere fact of the patient suffering from diphtheria in itself 
affords no grounds for the administration of alcohol. The stimulant should be 
given because the general condition of the patient requires it, and not because 



DIPHTHERIA. 239 

he is suffering from any particular disease. In the slighter cases of diphtheria 
no stimulant at all is wanted; whereas in the more severe forms, where the 
patient's strength is utterly worn out, nothing but the free administration of 
brandy will enable him to weather the storm. Do not be in too great a hurry 
to give wine or brandy, or you may find when it is too late that you have 
thrown away your best card. Remeinoer, too, that the mere fact of your getting 
down so much brandy does not prove that it is taken into the system, for it 
may remain in the stomach unabsorbed, and might just as well, for all the good 
it does, be outside the body. Feel the pulse, and if you find your stimulant 
strengthens it you may hope that it is doing good. In severe cases, attended 
with great prostration, as much as four or five ounces of good brandy may be 
given in the twenty-four hours, even to a child. 

In the majority of cases of diphtheria it is not necessary to use gargles, but 
should the breath become very offensive they may have to be resorted to. One 
of the most useful is made by adding half an ounce of the solution of chlorinated 
soda to half a pint of water 

We must now consider the treatment to be adopted for the different forma 
of diphtheritic paralysis. When the paralysis is limited to one part, as the eye 
or palate, no very active measures are required, for the symptoms usually disappear 
of themselves in a few weeks. If, however, the patient is still a little out of 
health, and feels pulled down by his late illness, he will derive benefit from a 
course of tonics, and especially from iron (Prs. 2, 3, and 4) and quinine (Pr. 9). 
He should have a good nourishing diet, and should pass most of his time in the 
open air. 

When, however, the paralysis involves several distinct parts -j assumes a 
more serious aspect. As in the former case, we give the patient plenty of 
nourishment and some iron and quinine, but we do not let him take much exercise, 
preferring to keep him quiet and free from excitement. When the paralysis is 
no longer progressing, we cautiously apply electricity to the parts, using either 
what is called an induced or a constant current. In some cases doses of from one 
to five drops of tincture of gelseminum, given hourly in a little water, have been 
found materially to assist the restoration to power. This drug is especially 
indicated when the eye is affected and there is double vision. 

Whe.a the palate is involved to such an extent that the patient loses either 
entirely or in a great measure the power of swallowing, we may find it neces- 
sary to feed him for days and days together either by injections into the bowel, 
or by means of the stomach pump. We do this for two reasons — firstly, because 
when an attempt is made to take food in the ordinary manner the smaller 
particles are apt to go the wrong way and pass into the lungs, and set up in- 
flammation of those organs; and secondly, because such a small amount of 
nourishment is taken that the patient is in danger of dying of starvation. 

Of late years, hypodermic injections of strychnia have been frequently used 
in the paralysis following diphtheria, and very favourable results have been 
obtained. The quantity injected is six drops of the U.S. Dispensatory solution 
of strychnia, which is equivalent to one-twentieth of a grain. The injection 



240 THE TREATMENT OF DISEASES. 

should be made into the muscles every second day, or even daily. This, of course, 
is a method of treatment which could be practised only under the immediate 
superintendence of a medical man. 

It must be distinctly understood that the remarks we have made concerning the 
treatment of diphtheria are for those only who are unable to obtain personal medical 
advice. There are many different methods of treating this disease ; and if the plan 
adopted by the doctor in attendance is at variance with the directions we have laid 
down, it should be remembered that one who has had the opportunity of seeing and 
examining the patient is likely to prescribe better for him than one who has not. 

Sometimes the amount of obstruction caused by the membrane in the throat is 
so great that the windpipe has to be opened to admit air and prevent the patient 
from dying of suffocation. The operation, which is technically known as " tracheo- 
tomy," was performed by Trousseau in more than two hundred cases, and of these a 
quarter recovered. An eminent authority thus describes an instance in which tra- 
cheotomy was performed on the person of a physician ill with diphtheria : — " There 
is not a shadow of doubt," he says, " on my mind that he would have been dead in 
two minutes had his larynx not been opened at the moment it was. I never saw 
any one so manifestly brought back from the threshold of death. His complexion 
had the bluish pallor that precedes immediate dissolution. My hand was on his 
wrist. I felt his pulse failing under my finger, until at last it was imperceptible. 
His eyes closed, and his diaphragm was making those convulsive contractions which 
indicate that respiration is about to cease, when the knife entered the larynx, and air 
was drawn, by what really seemed the last effort of the diaphragm, into the lungs. 
The natural hue of his face returned ; his pulse was again perceptible ; his eyes 
opened ; consciousness was restored, and the patient was alive again. He finally 
recovered. Now, a thousand failures of the operation in saving life cannot, after 
seeing this case, prove to me that tracheotomy ought not to be performed when 
suffocation is imminent from the presence of lymph in the larynx or trachea ; for 
here is a man whose life was invaluable to his family and most useful to society 
restored to health, who, but for the operation, would have been dead." 

When the softer parts of the chest recede whilst a breath is being taken, or the 
patient looks ever so slightly blue or livid, it is to be regarded as an indication that 
there is some obstruction to the free entrance of air into the lungs, and the doctor, if 
not present, should be at once sent for. 

At the conclusion of a case of diphtheria, whether it terminate favourably 
or unfavourably, the room in which the patient has slept should be thoroughly 
disinfected. 

DROPSY. 

Dropsy is regarded by medical men rather as a symptom of disease than as a 
disease itself. It consists essentially in the accumulation of fluid, either beneath the 
skin or in one or more of the large cavities of the body. It is known by different 
names, according to the situation in which it is found. Thus, when the brain 
becomes distended with fluid, as it does sometimes in children, we call it " hydro- 
cephalus," and the patient is said to have water on the brain, or to be " hydrocephalic." 



DROPSY. 241 

When the fluid accumulates in the membrane which lines the chest or thorax and 
covers the surface of the lung, the condition is known as " hydrothorax ; " and when 
it collects in the pericardium, or membrane of the heart, it is called " hydroperi- 
cardium. Sometimes the liquid accumulates in the belly, and then we speak of it 
as " ascites." When the limbs and body are distinctly swollen from the accumulation 
of dropsical fluid beneath the skin, the patient is sometimes said to be suffering from 
" anasarca." By " general dropsy " is usually meant a combination of anasarca with 
dropsy of one or more of the large cavities to which we have referred. 

Dropsy may be due to many different causes. Thus, it may arise from disease of 
the heart, or from disease of the liver, or from disease of the kidneys — more especially 
from the form of kidney disease which we have already described under the name 
of " Bright's." The way in which these complaints produce effusion of fluid is in all 
probability by increasing the pressure of blood in the vessels — the arteries, and veins, 
and smaller vessels called capillaries ; so that its more fluid portion infiltrates or is 
squeezed through their walls. It is easily understood that if the kidneys are diseased 
they cannot throw off the water from the system, and the blood-vessels get too full. 
The same thing happens in disease of the heart, for that organ may be so weakened 
and may perform its functions so imperfectly as to be unable to push on the blood, 
and an obstruction with increased pressure is the result. In disease of the liver, 
dropsy usually begins in the form of ascites, or effusion into the belly, and the 
explanation of this is that the liver contracts and narrows the calibre of the blood- 
vessels, so as to increase the pressure of the blood and squeeze out the fluid. 

The influence of obstruction to the circulation in producing dropsy is well seen 
in the case of the complaint known as " white leg," which is common in women soon 
after child-birth. The foot, leg, and thigh become enormously distended. The 
essence of the complaint is inflammation of the vein of the thigh, precluding or 
retarding the return of blood from the limb. Again, in pregnancy, the womb some- 
times presses upon some of the large veins in the belly, obstructing the current of 
blood in them, and in this way giving rise to dropsy of the lower extremities. It 
is but a temporary condition, and soon disappears after the confinement. Sometimes 
effusion of fluid is so strictly localised as to be confined to one joint, as the knee or 
elbow, but then it is nearly always due to some injury to the part, as a blow or 
sprain, and is not the result of any constitutional disease. 

It is quite conceivable that we may get dropsy without any increased pressure in 
the blood-vessels, and this undoubtedly does sometimes occur. Thus, in cases of 
marked anaemia, the blood may become so thin that its fluid part niters through the 
blood-vessels independently of any unusual pressure, and in this way gives rise to 
dropsy. It is, we think, not generally known that very extensive dropsy may be 
dependent solely on the presence of anaemia. Many women suddenly become drop- 
sical as the result of flooding, and this condition rapidly disappears when the quality 
of the blood improves. A sharp attack of diarrhoea has been known to give rise to 
a temporary dropsical effusion. 

There is seldom any difficulty in recognising the presence of dropsy. The limbs 
are commonly increased in size; they are soft and inelastic, and when they are 
pressed upon with the finger a little pit or depression is left. Usually there is 

16 



242 THE TREATMENT OF DISEASES. 

undue pallor and a peculiarly white glistening appearance of the skin ; but in chronic 
cases, where the effusion of fluid is great, the skin often becomes smooth, shiny, and 
of a dull red or purple colour. In some situations — as over the shin-bone, for 
example — it gets livid or blackish, and may even be broken, so that sloughs form. 
The water of dropsy is liable to change its place in obedience to the force of gravity, 
so that when the patient is up and about the swelling usually first becomes visible in 
the feet and ankles. In the morning, after the horizontal position has been main- 
tained for some hours, this probably disappears, but the neck and face become bloated 
and puffy. The feet towards evening usually swell more than the hands ; and for a 
very obvious reason, for the hands receive the dropsical fluid from the arms alone, 
but the feet that which sinks down not only from the legs and thighs, but from the 
head and trunk as well. 

The piincipal symptoms attendant on dropsy are those of the disease to which it 
owes its origin, but the effusion may itself give rise to the most distressing conse- 
quences. Thus, a large accumulation of fluid in the abdomen often by its pressure 
impedes the action of the heart and lungs, causing painful shortness of the breath. 
The patient may, on this account, be unable to lie down, and the fatigue, sleeplessness, 
and exhaustion so caused may materially aggravate his sufferings. Other symptoms 
frequently associated with the different varieties of dropsy are palpitation, dryness 
of the skin, excessive thirst, vomiting, and constipation The pain and inconvenience 
arising from swollen legs need only be mentioned 

We will now consider the treatment of dropsy. It may, perhaps, be urged that 
it is unsound in principle to treat, or endeavour to treat, what is confessedly a mere 
symptom, instead of directing our attention to the disease on which it depends. This 
is quite true, but it must be remembered that in many cases the original disease is 
beyond the reach of our art ; whilst in almost every case, even if only temporarily, 
we are able to relieve many of the most distressing symptoms by getting rid of some 
of the effusion. 

In the majority of cases, we endeavour to promote the discharge from the body 
of the superabundant fluid by purging the patient or by increasing the action of the 
ikin or kidneys. 

Bitartrate of potash often proves very useful from the copious watery stools 
it produces. It is especially serviceable in dropsy arising from Bright's disease, 
as it tends to prevent watery accumulation to a dangerous degree beneath the skin, 
or in the cavities containing the more important organs, as the heart and lungs. 
With the water, too, it draws off many of the effete and poisonous matters which 
in this disease are retained in the blood. Jalap may be used for the same purpose 
as the bitartrate of potash, and it is often convenient to administer them together. 
A powder, composed of twenty grains of compound powder of jalap, with ten grains 
of bitartarate of potash, forms an efficient combination (Pr. 98). This dose, which is 
intended for an adult, may be taken every alternate morning for a week. It should 
be borne in mind that free purging has always a tendency to reduce the strength, 
and care should be taken to see that it does not become excessive. 

Resin of copaiba acts powerfully on the kidneys, and in the majority of cases 
proves of considerable value in the treatment of dropsy. In some instances it has 



DROPSY. 243 



been known to completely cure ascites, or dropsy of the belly. It is of the very- 
greatest value in nearly all forms of dropsy resulting from Blight's disease or kidney 
mischief, and will often succeed admirably even when the heart is the organ at fault. 
The resin of copaiba may be made up into pills, each containing five grains, two of 
which should be given three times a day. Spirit of juniper has an action which is 
especially directed to increasing the flow of water from the kidneys, and is on this 
account valuable in many forms of dropsy. It is especially indicated in dropsy 
following scarlatina. It may be given either alone in water, in thirty-drop doses 
every four hours, or, as it is contained in both Hollands and gin, it may be taken 
in that perhaps more agreeable and accessible form. 

Tincture of squill, in doses of from fifteen to twenty drops in a little water every 
four hours, has been found useful in nearly all kinds of dropsies. It acts chiefly on 
the kidneys. 

In many forms of dropsy, especially those dependent on heart disease, digitalis 
or foxglove is a most valuable remedy. Its administration is especially indicated in 
the following class of cases : — There is dropsy, which is often extensive; the breathing 
is short, especially at night, and is often so bad that the patient cannot lie down in 
bed, and has to take his rest sitting up in an arm-chair. The pulse is quick, feeble, 
fluttering, and irregular, and the urine is deficient in quantity. On measuring it, it 
may be found to amount to not more than half a pint in the twenty-four hours; it is 
high-coloured, and gives a copious deposit on cooling. Under these circumstances, 
digitalis usually gives speedy relief. It should be given in doses of one fluid drachm 
of the infusion of digitalis of the U.S. Dispensatory twice a day. Any chemist 
will make the infusion, and it is essential that it should be quite freshly prepared. 
Digitalis is a powerful remedy, and it is advisable not to increase the dose we have 
indicated, or to give it more frequently than twice in the twenty-four hours, unless 
under the immediate direction of a medical man. The effects of this method of 
treatment are often very marked, and we can testify to the favourable results which 
frequently ensue. The pulse usually grows considerably stronger, more regular, 
and much slower, till in many cases all irregularity ceases, and it becomes natural 
both in frequency and rhythm. At the same time, the urine increases to one, two, 
four, or even eight pints a day ; and in proportion to the increased flow the dropsy 
diminishes, until it finally disappears. In these cases it is necessary to give some 
stimulant, and gin and water or gin and seltzer, from its action on the kidneys, 
is be&t adapted for this purpose. 

Arsenic is a useful remedy in many forms of dropsy, especially in dropsy of the 
hands, face, and feet, arising from disease of the heart. It does least good when 
the dropsy is confined to the belly, and depends on disease of the liver. It is espe- 
cially indicated in the following class of cases : — There is much general debility, with 
rapid emaciation and anxious depression ; constriction and oppression of the chest, 
and a sensation of suffocation, are experienced on attempting to lie down ; the skin 
is dry and pale or burning and itching, and sometimes it peels off in large flakes ; 
the tongue is red and parched, sometimes with excessive burning thirst ; the pulse 
feeble and irregular, and the extremities cold. Arsenic often increases the flow 
of urine to an astonishing extent, after which the dropsy disappears. It may be 



244 THE TREATMENT OF DISEASES. 

administered in the form of the arsenic mixture (Pr. 40). Its action is usually 
prompt, and if it does no good in a few days it will be useless to continue its 

administration. 

Hellebore often proves valuable in cases of water on the brain, and when there 
is effusion of fluid into the chest. It may be administered in doses of from ten to 
fifteen drops every four hours. 

Apocynum cannabinum. — An American plant ; has been highly recommended 
in the treatment of dropsy, and its administration is said to have been followed by 
the most favourable results. The precise indications for its employment are at 
present not thoroughly understood, but it has been known to succeed where almost 
everything else has been tried in vain. It should be given in the form of a 
tincture, prepared from the fresh root, the dose being five minims three times a 
day, or oftener. We have derived no benefit from the use of preparations made 
from the dried root. 

In some cases of dropsy benefit is experienced from the Turkish bath, but this 
method of treatment should be adopted with a certain amount of caution. It is 
indicated in dropsy arising from kidney disease, when there is but little action of 
the skin ; but it should not be employed when there is heart disease. 

There is a drug, known as Jaborandi, which has the power of producing profuse 
perspiration. A single two tea-spoonful dose of the tincture should be given, once 
or twice a week, in water. The patient should be in bed between the blankets, 
which should have been previously warmed by a hot water-bottle or warming-pan 
The perspiration usually commences in about ten minutes, and may last an hour or 
more. A single dose often reduces the amount of dropsy in a manner which is 
little less than marvellous. The only objection is, that it often makes the patient 
expectorate freely. The saliva should not be swallowed or it may cause vomiting. 
The tincture of jaborandi is obtainable from almost any chemist. It may be taken 
without the slightest hesitation, for it never causes more than a temporary 
inconvenience. When the sweating is over, the skin should be quickly rubbed dry, 
and the damp blankets exchanged for warm ones. In many cases of dropsy, 
dependent on kidney disease, we have seen the remedy act like a charm. With 
one man especially it succeeded when almost everything else had been tried in vain. 
The drug has been comparatively recently introduced, and is yet but little known 
to medical men. 

In some cases where dropsy effusion is very great it may have to be let out by 
mechanical means. 

Dropsical subjects are generally benefited by removal to a dry and moderately 
warm atmosphere. A damp climate or soil usually proves particularly unfavourable. 
In chronic cases every effort should be made to support the strength. In the 
majority of cases the attendance of a medical man is necessary. 



DYSENTERY. 

A couple of hundred years ago dysentery raged like a plague in large cities ; 
aow-a-days a physician may pass through a long hospital career without 



DYSENTERY. 245 



having half a dozen cases under his charge, save those which have been imported 
from abroad. In most tropical regions, at certain seasons of the year, it is very 
prevalent and destructive ; but it is in fleets and armies, and more especially 
among troops on active service, that it most frequently displays its terrible power. 
In all ages armies and garrisons have been peculiarly liable to suffer from it, and 
the records of campaigns and military marches are full of accounts of its devastating 
ravages. It is often said that there is no disease which is so crippling to an army 
in the field as dysentery. It is the most fatal of all their diseases, and is often 
spoken of as " the scourge of armies." 

What are the causes of this frightful malady ? One of the commonest exciting 
causes is cold, especially when combined with moisture. It is of frequent 
occurrence amongst people who are exposed to the cold dampness of night after 
having been heated during the day. It is very common among the seamen serving 
on the rivers in the aguish districts in China. We are told that the men, when 
they lie down on the deck to sleep, pull up their frocks and coarse under-flannel 
jackets, so as to expose the abdomen. When the cool night wind sets in, the 
exposed skin of the sleepers, from being bathed in perspiration, becomes dry and 
finally chilled, and in a veiy short time they awake to find themselves suffering 
from the early symptoms of an attack of dysentery. 

Another cause is impure water. Eor example, nearly every person, native or 
European, who visits Calcutta, suffers from some kind of bowel complaint. The 
seafaring men who obtain their supply of drinking water by buckets let down over 
the sides of their ships are said to be the greatest sufferers. We are not surprised 
to hear this when we learn that opposite the town the water is frightfully impure, 
and that it receives every day some 40 tons of excreta, besides a multitude of 
dead cattle, and about 15,000 corpses yearly. 

Substances which act as direct irritants to the bowels may act as exciting causes. 
All kinds of indigestible foods are credited with this power, as are also acid and 
imperfectly fermented alcoholic drinks, such as cider, weak wines, and malt liquors. 

By some eminent authorities it is considered that dysentery is due to the 
entrance into the system of a marsh poison similar to that which causes ague. 
They urge in favour of this view that although the ordinarily accepted causes are 
in constant operation in this country, yet we never suffer from the disease. They 
believe that the disappearance, both of ague and dysentery, from the metropolis is 
the result of the improvement in our sanitary conditions. 

Dysentery attacks indiscriminately persons of both sexes and all ages, and if 
one class of individuals is affected more than another it is probably owing to their 
greater exposure to the cause of the disease. It is more prevalent in summer and 
autumn than in winter, and in hot than in temperate climates. It is frequently 
found in those countries in which ague is prevalent ; and strangers are more likely 
to be attacked than natives. 

Dysentery is not contagious, or at all events its contagiousness is very slight. 
When once established, it is propagated by the effluvia from the evacuations of 
those affected. Sometimes it occurs as an epidemic, but more frequently it is confined 
within small and often very accurately defined limits. 



246 THE TREATMENT OF DISEASES. 

Several different varieties of dysentery are spoken of, but they in reality pass by 
such insensible gradations the one into the other, that it will be sufficient for our 
purpose to describe an ordinary simple acute case. The patient, in all probability, 
gets chilled by careless exposure to the cold night air in an aguish district. The 
chill is succeeded by slight heat of skin, loss of appetite, and a feeling of nausea. 
These are followed by griping pains in the belly, irregular in their position and 
periods of return, but attended with discharges from the bowels, by which they are 
partially relieved. The action of the bowels is accompanied by most distressing 
straining, which quickly becomes one of the prominent features of the case. From 
the first the stools are very offensive, the smell, which has been described as " the 
most offensive of all organic effluvia," being characteristic of the disease now under 
consideration. After a time the calls to stool become more urgent and frequent 3 
the patient is hardly in bed ere he desires to rise again, each time convinced that he 
is about to pass something which will relieve him. At last he can hardly be induced 
to leave the stool : he remains on it, and strains involuntarily. After the first few 
evacuations, which may have the appearance of ordinary motion, the stools are very 
small, and consist of transparent or whitish mucus, or of mucus mixed with blood, 
and sometimes even of almost pure blood. With these are little shreds or patches 
of membrane. As the disease progresses, the patient becomes irritable and depressed, 
and the countenance indicates suffering and despondency. If no improvement takes 
place, the stools become of a brownish colour and very copious, causing the most 
terrible exhaustion. The distressing straining and griping cease, and the patient, 
misled by the absence of pain, often thinks that he is on the high road to recovery. 
By-and-by his mind begins to wander, and, as if in some degree to compensate for 
past sufferings, his delirium takes pleasing forms, and he dies exhausted, without 
more pain. In more favourable cases, treatment steps in and averts the fatal 
termination, or the disease takes a favourable turn, and the patient recovers. 

Sometimes, however, the patient neither dies nor completely recovers, for the 
disease becomes chronic. The discharges still maintain somewhat of their offensive 
odour, are for the most part fluid, and mixed with blood and slime. Sometimes they 
are pale and frothy, and are voided with considerable force. The general health is 
poor, night sweats are frequent, the hair drops off, boils are common on all parts 
of the body, and the patient ages rapidly. 

There is seldom any difficulty in distinguishing dysentery from ordinary diarrhoea. 
The excessive griping and straining, the presence of blood and slime in the stools, 
and, above all, their peculiar odour, serve as distinctive characters. 

Fortunately, dysentery is a disease for which we have a remedy, which is almost 
a specific, and that remedy is ipecacuanha given in large doses. The earlier the 
patient is submitted to treatment the more likely are we to succeed in our efforts to 
check the progress of the disease. In tropical climates, more especially, it is impos- 
sible to over-estimate the importance of prompt treatment. The patient should be 
at once put to bed, and brought under the influence of the drug. From twenty-five 
to thirty or even sixty grains of powdered ipecacuanha should be at once adminis- 
tered in as little fluid as possible. It may be thought that so large a dose would 
produce vomiting, but if the patient keeps perfectly quiet, and takes neither food nor 



DYSENTERY. 247 



drink of any kind for about three hours, the medicine seldom causes any incon- 
venience. Some people precede the ipecacuanha by a dose of thirty drops of laudanum, 
to prepare the stomach, as they say, for its reception ; but this is quite unnecessary, 
and involves the loss of valuable time. Should the ipecacuanha, however, be rejected 
in spite of all precautions, it must be given in the form of an injection. The effects 
of the medicine in suitable cases are almost instantaneous, the motions even in the 
worst cases becoming natural in frequency and character. Very frequently, ninety 
grains of the ipecacuanha will cut short at once severe attacks of dysentery, not only 
restraining the discharge, but immediately freeing the patient from pain, and removing 
the straining and griping. After a dose of sixty or ninety grains, an interval of ten 
or twelve hours should be allowed to elapse before repeating it, and should the bowels 
in the meantime have remained quiet, even the second dose may be unnecessary. 
When only twenty or thirty grains have been given, the dose may be repeated in 
about eight hours, the precautions respecting perfect quiet and abstinence from food 
and drink being observed as before. After taking the medicine, the patient often 
falls asleep, and awakes refreshed, and in fact quite another man. As a matter of 
precaution, smaller doses of the ipecacuanha — say ten, five, or three grains — should 
be given daily for some days. No other treatment is, as a rule, necessary ; but a 
large mustard poultice applied over the abdomen often proves grateful to the patient. 
During the acute attack no solid food should be given, but the patient's strength 
should be supported by milk and similar unirritating diet The disposition to relapse, 
which is so common in acute dysentery, is seldom observed after this method of 
treatment, a point of no small importance. 

The treatment should always be commenced with ipecacuanha, but in some 
epidemics it is less successful than in others, and it is consequently an advantage 
to have other methods of treating at our disposal. Mercury given frequently and 
in small doses often proves successful. A tea-spoonful of the mixture (Pr. 48), given 
hourly or every two hours, according to the severity of the case, rarely fails to free 
the stools from blood and slime, although a diarrhoea of a different character, may 
continue for a little while longer, and perhaps require other remedies for its 
removal. 

When the motions contain much blood, the tincture of hamamelis virginica 
may be given hourly in drop doses, with the view of arresting the haemorrhage, 
or Pr. 45 may be employed. 

In chronic dysentery both ipecacuanha and mercury may be used with almost 
as much success as in the acute form. The precautions we have enjoined after 
taking the ipecacuanha should be strictly observed. Chronic dysentery, however, 
is an obstinate disease, and we cannot have too many strings to our bow, so we will 
consider what other drugs will do for us. Alum often proves of service, and 
acetate of lead in five-grain doses every four hours is a good remedy (Pr. 30). 

The solution of per-nitrate of iron does admirably in the case of men returning 
to this country from tropical regions, more especially when they are suffering from 
anaemia, as the result of loss of blood and the depraving influence of malaria. It 
should be given in thirty^drop doses three times a day in a little water. Under the 
influence of this remedy the whole svstem often rallies wonderfully, colour returns 



248 THE TREATMENT OF DISEASES. 

to the blanched cheek, the stools become more natural and less frequent, the appetite 
improves, and digestion is more perfectly performed. 

Sometimes an injection of a pint of water in which ten or twenty grains of 
sulphate of copper — our ordinary " blue-stone " or " blue vitriol " — have been 
dissolved, will answer admirably. Above all, it is most important that the patient 
should get a change of air, and if he is residing in a malarious district he should 
be at once removed to the sea coast, or should be recommended, if it be possible, 
to take a sea voyage. 

Before leaving the subject of dysentery, we must point out the necessity of re- 
ceiving the stools into a vessel in which they can be immediately mixed with some 
disinfecting fluid. In the country they should be at once removed from the house, 
and carefully and deeply buried. 

EAR. — DISEASES OF THE EAR, 

Foreign Bodies in the Ecvr. — Children not unfrequently poke such substances as 
peas, glass beads, and buttons, into the ear. They may generally be removed by a 
little gentle syringing with tepid water. Before taking any active measures it is 
very necessary to see that there is actually some foreign body present. Stories are 
told of doctors who have spent hours trying to extract some substance from the 

ear, the existence of which has 
subsequently proved to have been 
imaginary. Children are often 
brought to the hospital on the 
supposition that they have a pea 
or something in the ear, when an 
Tig. s.— eax 8FBOX7LUK. investigation serves to disclose 

the fact that there is nothing 
there. For an examination of the ear, an ear speculum is invaluable. It is 
a tube made of bright metal and of the shape shown in the accompanying figure 
(Fig. 3). No difficulty will be experienced in using it The patient is made 
to sit or stand in a good light, and the smaller end of the speculum is then intro- 
duced into the passage of the ear. This is readily effected by gently drawing the 
ear upward. Not only will any foreign body be at once seen, but its position 
will be at once distinctly made out, and this may, in a great majority of cases, 
facilitate its removal. When the ordinary process of syringing fails to accomplish 
the desired object, the patient may be made to lie down with the head projecting 
over the side of the bed or couch, the ear being in the most dependent position, 
and then syringing may be again resorted to. We thus call into play one 
action of gravity, and there is a much greater chance of our efforts proving suc- 
cessful. 

When the return current of water is not sufficiently powerful to remove the 
body, it may be necessary to use a small pair of forceps, or a piece of bent wire. 
Instruments, however, should not be introduced into the ear without a certain amount 
of caution, for the foreign body is just as likely to be pushed in farther as to be 




DISEASES OF THE EAB. 



removed When syringing fails, the best thing is to go to a surgeon. In some cases 
considerable ingenuity is required to extract the foreign body from the ear. In one 
instance a small ivory ball had been detached from the top of a pen-holder in the 
ear of a little boy. Syringing had done no good, and the forceps failed to grasp it 
and only pushed it in further. At last it was extracted by bringing the point of a 
small brush, dipped in glue, in contact with its surface, allowing the glue to harden, 
and then removing brush and ball together. This is a hint that might be of service in 
difficult cases. It must be remembered that a foreign body may remain in the ear for 
a very long time without doing any harm. A few hours* delay, or the delay of even a 
day or two, is a matter of no moment. The only exception to this is the case of peas 
or seeds, and these sometimes swell considerably under the combined influence of 
warmth and moisture. Unskilful efforts to extract a foreign body may cause 
rupture of the membrane of the ear, and may in this way give rise to permanent 
deafness. The case is recorded of a nurse who, having failed to remove a button 
from a child's ear, actually tried to push it out the other side. We need hardly say 
that not only would such a thing be impossible, but such treatment is highly 
dangerous. In the case in question inflammation of the membranes of the brain 
was set up, and the child died. Insects occasionally get into the ear, when all 
that is necessary is to pour 
in a little water, when the 
intruder either crawls out 
or is drowned. 

Accumulation of Wax 
in the Ear. — This is a very 
common cause of deafness. 
The patient usually com- 
plains of loud noises and a 
feeling of discomfort, with 
more or less defect of hear- 
ing. The wax may usually 
be removed by syringing. 
Even in such a simple 
operation as syringing the 
ears there is a right and a 
wrong way of doing it, and 
if not skilfully performed 
but little benefit will be 
experienced. It is almost 
impossible to do it satis- 
factorily yourself, and you 

must try and get some one to do it for you. The external ear should be drawn 
upwards with the left hand, so as to make the passage almost straight ; and 
the nozzle of the syringe, which should be small, should be directed against 
the roof. The syringe should work easily and accurately, so that no air- 
bubbles are squirted in. A little vessel about the size of a finger-glass should be 




Fig. 4.— METHOD OF SYBINCHNG EAB. 



250 THE TREATMENT OF DISEASES. 

held by the patient under the ear so as to catch the water as it flows out. It will 
answer much more effectually than a large basin, and there will be no necessity to 
use towels or napkins to prevent the neck and shoulders from getting wet. Many 

people prefer a tin pan with a concavity on 
one side, so that it may be made to fit in nicely 
Pig. 5.— bYKiNGE. under the ear. The syringe to be used is of 

the ordinary form, as shown in Fig. 5, and it 
may be made of either brass or gutta-percha. Care must be taken not to introduce 
the nozzle too far, or there may be danger of injuring the drum of the ear. The 
syringe may be obtained from any instrument-maker, or your chemist will procure 
it for you. It is best to use plain water, and it should be just warm enough to be 
comfortable. 

The water injected should be clean and in a separate basin, and on no account 
should the dirty water be used over again. In ordinary cases the wax may 
easily be dislodged, but if it has been there for a long time, perhaps for years, and 
becomes, as it will do sometimes, of almost stony hardness, its removal is not so 
easily effected. In this case the patient should lie on the opposite side for a time, 
and have the ear filled with water so as to let the wax soak and become softened. 
Sometimes it becomes so hard as to render it necessary to pour in water or oil — it 
matters little which — on several successive nights. It is well not to use the syringe 
for too long at a time ; and at intervals during the proceeding the ear should be 
examined with the speculum to see if all the wax has been removed. This is very 
essential, for syringing directly on the drum of the ear when there is nothing to 
bring away is not unlikely to set up inflammation. Violent syringing is never 
advisable, and is far more likely to do harm than good. Wax in the ear sometimes 
gives rise to what is called " ear-cough." Cases are on record where a distressing 
cough has persisted for years, and defied all treatment until, by some fortunate 
chance, attention has been directed to the ear, the accumulated wax removed by 
syringing, and a cure at once effected. 

Eczema of the Ear. — Eczema occurring on the outer ear is a very common 
complaint The symptoms are in the main those of eczema of other parts of the 
body. There are redness and swelling, with the formation of little vesicles, which, 
on bursting give rise to an unsightly crust, from which a discharge occurs. The 
auricle may, in severe cases, become a mis-shapen mass, and the disease may extend 
into the passage of the ear, so as greatly to impair the hearing. Fulness and 
noise in the ears are then added to the other symptoms, and the patient suffers 
great distress. When left to itself it is apt to run a very chronic course. It 
occurs chiefly in those of weakly constitution, and is usually associated with eczema 
of some other part of the body. 

When there is much inflammation, and when the surface is raw and weeps 
copiously, a lead lotion not only allays the inflammation, but checks the discharge 
and quells the itching, burning, and tingling so often accompanying this condition. 
Two or three drachms of the strong solution of sub-acetate of lead in ten ounces 
of water is generally sufficient ; but a stronger lotion, consisting of two ounces of 
the lead solution, two ounces of glycerine, and four ounces of water, sometimes 



DISEASES OF THE EAB. 251 



proves more successful. If the inflammation is great and the weeping abundant, 
the rash must be constantly covered with rags soaked in the lotion. In some 
cases it is useful to apply a poultice at night and the lotion during the day. The 
stronger lotion is especially useful when there is no weeping, but itching and 
tingling are prominent symptoms. The part should be sponged with the lotion 
several times a day. 

In the acute stage, too, frequent bathing with warm water proves peculiarly 
grateful, allaying inflammation and itching. Rain or boiled water should be used, 
or the water may be made more soothing by the addition of a small piece of 
common washing soda, or a little gelatin, bran, or potato-starch. The part must 
be dabbed dry with a soft toweL When the part is . highly inflamed, red, and 
swollen, linseed-meal poultices applied hot, and removed as soon as they become 
cool, do much to alleviate pain. 

Lime-water is a nice soothing application, and will do much to ease smarting 
and tingling ; it is especially useful when there is an abundant discharge. When 
the inflammation has been subdued, an equal quantity of glycerine may be added to 
the lime-water. 

In more chronic cases zinc ointment proves useful. It is a mild stimulating 
application, and may be employed when, inflammation having subsided, the raw 
surface is left in an indolent condition, with very little disposition to heal. When 
there is but little inflammation carbolic acid ointment, made with ten minims of the 
acid to an ounce of lard, moderates the weeping and allays the tingling and itching. 
Petroleum soap, coal-tar soap, and carbolic soap, are useful in very chronic cases. 
As these soaps are made of different strengths, if one kind proves too strong and 
irritating, a milder form may be substituted. 

The passage of the ear will have to be syringed out with warm water. When 
there is much active inflammation going on this may have to be done almost hourly, 
but in more chronic cases twice or thrice daily will suffice. It always allays itching, 
and usually proves very grateful. The ear speculum will have to be employed to 
see what progress is being made. The use of warm water alone will sometimes 
cure most obstinate cases of inflammation of the canal that have existed for years. 

So far we have recommended only local applications, but there are several 
remedies which do good when taken internally. One of the best of these is arsenic 
(Pr. 40). It is useful in very chronic cases. Rhus toxicodendron is regarded by 
many as almost a specific for this complaint. Its use is especially indicated when 
there is much itching, which i3 worse at night. When there is marked constitu- 
tional weakness it will be necessary to give remedies directed to the improvement 
of the general health, such, for instance, as cod-liver oil, iron and quinine. 

Inflammation of tlie Internal Ear. — This may arise from exposure to currents of 
cold air, sea-bathing, violent syringing, probing, or other similar causes. It not 
unfrequently follows an attack of fever, especially scarlatina. It occurs most 
frequently in weak, neglected, or unhealthy children. The symptoms are sudden 
and intense pain in the ear, increased by coughing, sneezing, or swallowing; a 
feeling of fulness in the ear ; tenderness and soreness in its vicinity ; noises in the 
head ; deafness either partial or complete ; a high fever, indicated by elevation of 



252 THE TEKATMENT OF DISEASES. 

temperature, quick pulse, <fco. If the inflammation progress matter may form in the 
interior of the ear, the tympanic membrane may ulcerate or burst, and there may 
be a considerable discharge externally. In a disease of such severity it need hardly 
be said that energetic treatment must be resorted to. The sooner that aconite is 
given the better. A drop of the tincture should be taken in water every ten 
minutes for the first hour, and subsequently hourly, until the inflammation has been 
reduced, or Pr. 38 may be employed. Hot fomentations or poultices may be em- 
ployed externally. Should there be any discharge scrupulous cleanliness must be 
observed. The ear should be frequently washed out, and then gently but thoroughly 
dried. A doctor had better be called in, but no time should be lost in administering 
aconite, for in all cases of inflammation that is our sheet-anchor. 

Perforation or Rupture of tlie Tympanic Membrane. — This may be caused by 
blows on the head, by boxing the ear, by violently blowing the nose, by injudicious 
syringing, by the introduction of probes, as in attempts to remove a foreign body ; 
by going down in a diving-bell ; and lastly, by loud noises, such as the discharge of 
cannon. When the rupture takes place suddenly there may be a sense of shock in 
the ear, as if something had given way, accompanied by bleeding and deafness. In 
many cases perforation occurs as the result of inflammation of the internal ear, 
matter being discharged through the opening. It often follows scarlet fever. A 
person whose membrane has been broken is able to force air out of the ear in 
blowing the nose. People who in smoking can make the smoke come out of their 
ears have met with this accident. The hole in the membrane can often be distinctly 
seen on using the ear-speculum. When the aperture is small its situation may be 
indicated by air-bubbles and mucus issuing from it on blowing the nose. When the 
opening is large it gives rise to considerable deafness, but when small it may cause 
very little inconvenience. Fortunately, much may be done in the way of treatment. 
If inflammation still remain it must be subdued in the manner already indicated. 
When there is much discharge, syringing with warm water should be resorted to, so 
as to keep the parts sweet and clean. When the ground has been cleared by this 
preparatory treatment, it is necessary to resort to more direct measures for the 
restoration of hearing. A capital plan is to take a little bit of cotton-wool 
moistened with water or oil, and to pass it down to the membrane so that it will 
block up the hole. It is easy to learn how to introduce and withdraw this cotton 
for yourself by means of a bodkin or pair of forceps, and to place it exactly in the 
right spot. Sometimes a drop of glycerine placed in the ear temporarily closes the 
aperture, and does as much good as anything. 

Running from the Ears. — This is one of the commonest affections of the ear. 
It, in the majority of cases, is accompanied by perforation of the tympanic mem- 
brane. In weak, sickly children it sometimes follows an ordinary cold. It most 
frequently results from scarlet fever, but it may come on after measles, whooping- 
cough, or in fact any exhaustive illness. It will be found that children suffering 
from a running at the ears frequently put their hands to them and rub them, as 
if they felt that there was something wrong there. These children cry, too, 
when their ears are washed, and usually they dislike being jumped or suddenly 
moved. Often there is great pain, both on blowing the nose and on swallowing \ 



DISEASES OF THE SLAB. 253 



and on examination it will be found that there is deafness more or less complete. 
When there is acute inflammation of the ear, as indicated by a general condition 
of feverishness and elevation of temperature, aconite (Pr. 38), as we have already- 
seen, is the appropriate remedy. In chronic cases — when the discharge has existed 
for some weeks or, perhaps, months — local & ^plications must be resorted to in 
addition to constitutional treatment. One of the best remedies for discharge 
from the ears occurring in children after a severe illness, is glycerine of tannin. 
The passage of the ear is to be filled with it, and it should be retained there 
by a piece of cotton wool. One application usually suffices, but a slight discharge 
may remain, or it may return in a few weeks, when a repetition of the application 
is necessary. This treatment is inapplicable when there is severe inflammation, 
but it succeeds admirably in old-standing cases. An injection made by dissolving 
a drachm of alum in a pint of water often does good, although, as a rule, it 
will be found to be inferior to glycerine of tannin. When there is still active 
inflammation in the ear, common lime-water forms an excellent injection. A 
very useful wash for these cases is made by adding from one to two drachms of 
tincture of pulsatilla to four ounces of water. 

In every case of running from the ears, it is of very great importance to 
pay strict attention to cleanliness. The irritating discharge, if allowed to 
accumulate, undergoes decomposition, and may give rise to much mischief. The 
intractable character of this affection is often in a great measure due to 
want of care. When there is much discharge it is never safe to put cotton 
wool into the ears with the view of preventing its escape. We are told of an 
itinerant quack who used to "cure" this affection by blocking up the passage 
of the ear with plaster of Paris. Such treatment is not at all unlikely to 
prove fatal. 

Attention to the general health is of the utmost importance. Children suffering 
from this complaint should be fed well, and should get plenty of out-dcor exercise. 
Cod-liver oil proves beneficial, but often a few weeks at the seaside will do more 
good than anything. 

Far ache. — This may arise from inflammation of the ear, and is then to be treated 
in the manner already indicated. When the pain is very severe, relief may often 
be obtained by placing a hot linseed-meal poultice, sprinkled with twenty or thirty 
drops of laudanum, over the ear and adjacent parts. Should this fail, the ear may 
be rubbed all round with a mixture of equal parts of extract of belladonna and 
glycerine. Sometimes a few drops of chloroform sprinkled over a pocket hand- 
kerchief and then held against the ear will do good. Often enough earache arises 
from neuralgia, and not from inflammation at all. Earache caused by neuralgia 
may be distinguished from the earache of inflammation by the sudden intensity 
of the pain, which is throbbing, does not progressively increase in severity, and 
comes and goes capriciously. If there is any doubt or difficulty, the thermometer 
will at once settle the question : in neuralgic earache the temperature is normal, in 
pain arising from inflammation of the ear there is a marked elevation of tempera- 
ture. The treatment of neuralgia of the ear is the same as for other kinds of 
neuralgia. When the patient is pale, and suffers from poorness of blood, a course 



254 THE TREATMENT OP DISEASES. 

of iron (Prs. 1, 2, 3, 7, or 63) may afford relief. The strong quinine mixture (Pr. 
10) frequently proves efficacious in these cases. Often enough neuralgic earache 
depends on decayed teeth, and then either they should be extracted, or gelseminum 
(Pr. 41) should be given. Five grains of croton-chloral-hydrate dissolved in an 
ounce of water and taken every four hours for some days, is an excellent remedy. 
It is not the same as common chloral, and acts quite differently. 

Singing in the Ears. — This is a most distressing symptom which often attacks 
those who are in bad health or in the decline of life. It varies in degree in different 
cases from a slight humming, of which the patient is conscious only when everything 
is quiet, to a noise of a most aggravated character. The sounds in the ears of which 
patients complain are variously described : some speak of a ringing of bells, others 
liken them to the murmur of trees, the hum of a tea-kettle, &c. ; one old lady said 
her noise was like the low singing of birds. The descriptions which people give of 
the noises they hear depend to a certain degree on their fancy, their power of graphic 
expression, and not infrequently upon their rank in life and the sounds with which 
they are most familiar. An Irish writer once said : — " Persons from the country or 
rural districts draw their similitudes from the objects and noises by which they have 
been surrounded, as the falling and rushing of water, the singing of birds, the 
buzzing of bees, and the, waving or rustling of trees; while on the other hand, 
persons living in towns, or in the vicinity of machinery or manufactories, say they 
hear the rolling of carriages, the hammerings and the various noises caused by steam- 
engines. Servants almost invariably add to their other complaints that they suffer 
from the ringing of bells in their ears ; while in the country, old women much given 
to tea-drinking sum up the category of their ailments by saying that ' all the tea- 
kettles in Ireland are boiling in their ears.' " 

Singing in the ears is often associated with deafness, but it may exist for a time 
in people in whom the hearing power is not defective, and with them many causes 
may suffice to produce it, such as anxiety and annoyance, mental fatigue, over-work, 
prolonged suffering, and so on. With many persons a few doses of quinine will 
quickly produce singing in the ears. It is by no means an easy complaint to treat 
successfully. In the first place, the ear should be examined for wax with a speculum, 
and should there be any accumulation, it should be removed by judicious syringing. 
Then the general health should be carefully inquired after, and should any error be 
detected, that should if possible be remedied before anything else is done. After 
this preparatory treatment, remedies may be resorted to, directed especially against 
the complaint itself. When the noises are associated with deafness, small doses of 
quinine or tincture of pulsatilla may be given. When the noise is buzzing or loud 
like a steam-engine, tincture of digitalis is said to be the best remedy. Plumbago, 
the black-lead of our pencils, is reputed to be of service when the noises are roaring 
or thundering ; it may be given in five-grain doses every four hours. Sometimes the 
bromide of potassium mixture (Pr. 31) will succeed as well as anything. 

Deafness occurs as a symptom of many ear diseases, such for instance as rupture 
of the membrane. Sometimes it is due to an accumulation of wax in the ear. It 
is said to be nervous deafness when it depends on general torpor and debility, is 
better sometimes than at others, especially in fine weather and when the oatient is 



DEAFNESS. 



255 



cheerful or animated, and the stomach and liver are in good working order. Deafness 
varies greatly in degree in different patients. We meet with one person who, as he 
says, is " only a little hard of hearing," whilst another is " as deaf as a post." 
Curiously enough some people hear very much better in the midst of a noise than 
when things are moderately quiet. Although very deaf to conversation they tell 
you that when travelling in a carriage or cab, or by railway, they hear much better 
than usual. It has been said that the improved hearing is imaginary, and that it is 
explained by the fact that people raise their voices in order to counteract the 
surrounding noise. This may, in some instances, be the true explanation, but it 
must be remembered that ordinarily the speaker raises his voice sufficiently only for 
those whose hearing powers are intact. And it has been proved too, experimentally, 
that some people who can ordinarily hear the tick of a watch at only an inch or two 
from the ear, can in a railway carriage hear it at a distance of some feet. Instances 
are related of people who, although ordinarily very deaf, could hear fairly well when 
near the noise of a mill, or in a blacksmith's shop when hammering was going on. 
An American writer tells us of a mail agent, on one of the railways, who was deaf, 
but was never supposed to be so by those who only talked with him amid the noise 
of the train. The treatment of deafness is not on the whole very satisfactory. In the 
first place the ears should be examined for wax by means of the speculum, and should 
there be an accumulation it must be removed by syringing as already directed. 
Should there be no wax the introduction of a drop or two of glycerine may do good. 
Should the general health be below par, iron and cod-liver oil may be given advan- 
tageously. Often benefit is derived from taking a table-spoonful of the tonic quinine 
mixture (Pr. 9), three 
or four times a day. 
For old people, or 
those who have done 
much brain - work, 
phosphorus, or the 
hypophosphites (Prs. 
53, 54, or 55), may 
be employed with a 
fair chance of success, 
although of course 
they often fail to do 
any good. Several 
kinds of hearing 
trumpets are sold, 
some of which are 
here figured. The 

first is a flexible speaking-tube, which is very convenient for conversation, and 
is, in fact, often called a conversation-tube. The second and third figures represent 
the ordinary metallic trumpets which are used by persons with impaired hearing to 
hear addresses, sermons, and so on. In some churches long flexible tubes run from 
beneath the pulpit to the seats of those whose hearing is impaired, and are used as 




Fig. 6.— HEARING TRUMPETS. 



256 THE TREATMENT OP DISEASES. 

——————— . ,^ 

is the conversation-tube. It may be stated that as a rule the simpler forms of 
hearing apparatus are by far the best. The so-called " invisible " tubes which are 
worn in the passage of the ear usually prove of little or no value. Should your 
own efforts to obtain relief prove of no avail, it must be remembered that a consul- 
tation with an experienced surgeon or physician, who has made diseases of the ear 
a speciality, may be attended with the happiest results, although often enough, it 
must be confessed, it ends in nothing but disappointment. 

Deaf-mutism. — Deaf-mutism may be dependent on several different conditions, 
but in the great majority of cases it is caused by total or partial deafness, the result 
either of congenital defect or of disease occurring during early life. A child who 
has never heard cannot acquire language in the ordinary way, and is consequently 
dumb. It is not at all necessary that there should be a complete absence of hearing 
power, for a very moderate degree of deafness is quite enough to give rise to this 
misfortune. When it is remembered that children acquire language by hearing each 
word frequently repeated, and that every new word they learn is imitated imper- 
fectly at first, the articulation being corrected only after many successive efforts, it 
will be understood that, in the case of a child partially deaf, the only way in which 
he could be taught to talk would be by repeating every word over and over again in 
a loud voice close to the ear, and correcting the articulation until it was perfect. 
A child may be born with good hearing power and lose it either totally or in a great 
measure before it has learned to speak. This often results from scarlet fever. A 
child who has learned to talk may become deaf when four or five y^ars old, and then 
often enough gradually loses the faculty of speech. When children are in process of 
becoming dumb, their articulation gets more and more indistinct, until, after a time, 
it becomes impossible to make out what they say. They have not practised the art 
of speaking sufficiently long for it to have become with them a second nature ; and 
when they can no longer hear what is said, the remembrance of how to produce the 
different articulate sounds is gradually lost. It is exactly parallel to the case of a 
child losing one language whilst acquiring another. It is well known that a boy or 
girl of four or five years of age, who has been brought up in India with a native 
nurse, and taught as a first language Hindostanee, will have completely forgotten it 
in six months if brought to England. The first point to be ascertained in any case 
in which the speech has been lost or not acquired in consequence of deafness, is 
whether any treatment is likely to improve the hearing, and, if so, to what extent. 
If a fair amount of hearing can be restored, no further treatment or management 
will be required, and the child will learn to talk all in good time. When nothing 
can be done, and the child is totally or partially or incurably deaf, it becomes a 
question of grave moment how he is to be educated. Until recently the deaf and 
dumb have always in this country been taught to express themselves manually — in 
other words, to talk on their fingers. Another system has for many years prevailed 
on the Continent, and is now rapidly making progress with us. The finger alphabet 
is not employed, but the children are taught to use articulate speech, and to under- 
stand by watching the lips of others what is being said. This power can be achieved 
only by diligent cultivation of the powers of observation and imitation. The space 
at our disposal will not permit of our entering fully into the merits of this system, 



DIAF - MUTISM. 267 



but the following account, condensed from a lecture recently delivered at one of the 
London hospitals, will serve to convey some idea of the means by which this object 
is accomplished : — 

The so-called German system of education of mutes may be briefly described as 
one where deaf and dumb children are taught to understand and employ language by 
observation and imitation of the articulation of others ; the finger alphabet and all 
artificial signs being rigidly excluded. For this as for any other system, it is of 
course necessary that the child's intellectual faculties be not deficient, and obviously 
where any malformation of the organs of speech exist it is not applicable. The 
education is usually commenced at about the age of seven, and it extends over a 
period of eight years. Let us begin, then, with the first lesson of a deaf and dumb 
child who has previously received no instruction of any kind. He is brought into a 
room where a hearing person is spoken to by the teacher. The child soon notices 
that as the teacher's lips move, the listener turns round and looks at him, and he 
thus learns to direct his attention to the lips of the instructor. Without entering at 
any length into the subject of sounds and letters as taught to mutes, it will, with a 
little consideration, be seen that though it is a difficult matter to elicit proper sounds 
by placing the lips and tongue into the necessary positions, it is not an insurmount- 
able one, and that a very complete alphabet of sounds may be formed, so that as the 
pupil progresses with tliis alphabet, he is taught in a short time by joining together 
two sounds to articulate a word. As soon as this step has been accomplished, the 
attention of the child is directed to some object or picture which represents the word 
pronounced, and this object soon becomes associated in his mind with the sound he has 
made to correspond to it. Let us take an example : — The mouth of the child being 
opened, he is made to effect an expiration. This is done, firstly, by his imitating the 
teacher, and secondly, by the latter exerting at the same time a little pressure on the 
pit of the child's stomach. Tims, the sound which corresponds in the phonetic 
alphabet to the letter h is evoked, and it is to be further noticed that this is un- 
attended by any vibration of the larynx. By opening the mouth widely and making 
a slight noise, without the expiratory movement, the sound " ah " for the letter a is 
evoked ; this being attended by a vibratory movement of the larynx which can be 
felt to be communicated to the fingers pressed upon the front of the throat externally. 
At first, the loud inharmonious noises that are made in attempts at speech require to 
be modulated. This is effected in two or three ways. The teacher himself, speaking 
in a low tone, calls the attention of the child to the quiet, subdued motions of the 
chest, and of the muscles around his mouth. He tightly holds the child's hand in 
his own, and by depressing it the child learns to connect this movement with a 
lowering of the voice. By placing the hand of the child on his (the teacher's) throat, 
and by placing his (the teacher's) hand on the child's throat, he draws its attention 
to the slighter vibration of the larynx when the voice is lowered. By enforced 
attention of this kind the child, as his education advances, soon learns that his pro- 
gress depends on his attentively cultivating his powers of imitation, and by copying 
these movements, produces in this way a fall in his voice. 

Suppose the child to have produced the sound for a. By filling out the cheeks 
and making a puff, the sound corresponding to the letter p is elicited. Let these two 
17 



258 THE TREATMENT OF DISEASES. 

movements be performed consecutively and the word ape is produced. The child's 
attention is then called to the object, a picture of, or better still, a stuffed ape. From 
that time forward he connects in his mind the idea of an ape with the sound he has 
learned to make. Again, after making the sound for a, he is shown the letter 
written down ; he then learns to write it, and is thus able first to recognise the word 
when spoken by his teacher; secondly, to speak it himself; thirdly, to understand its 
meaning ; fourthly, to recogifjse it when written ; and fifthly, to write it himself. It 
is obvious that this system has very great advantages over that of speaking by the 
use of the fingers and artificial signs. Children who have acquired the power of 
talking by the deaf and dumb alphabet are still deprived of all intercourse with their 
fellow-creatures, except when they happen to meet with some one who is able to 
converse in the same way as themselves. By the modern system of lip-reading they 
are enabled to converse with any one and every one. Ninety-nine per cent, of deaf 
mutes have the organs of speech normal, and, provided they have good sight and 
touch, they may all be taught to talk, the amount of success depending solely on the 
greater or less capacity of the master. A school for the instruction of the deaf and 
dumb has been established in New York, and the address can readily be obtained by 
reference to the advertising columns of any of the medical papers. 

General Hints on Affections of the Ecvr. — A frequent cause of disease of 
the ear, is neglect to thoroughly dry the parts after washing. At the same 
time it is a very bad practice to screw the end of a towel into the ear. All 
that requires washing and drying may be reached with the finger. .The internal 
ear is quite capable of taking care of itself. An instrument consisting of a small 
piece of sponge attached to a bone handle, known as an aurilave, is often seen 
for sale in chemists' shops. It is capable of doing a very great deal of injury, 
and should never be employed. By its use the secretions are packed in the 
ear, and inflammation is very likely to be set up. Another very bad practice is that 
of boxing children's ears. A blow on the side of the head has been known in many 
cases to rupture the tympanic membrane, inflicting on the child an irreparable injury. 
We have already seen that this accident may also arise from loud and sudden 
noises, such as the discharge of artillery. The precaution of applying the hands 
to the ears for the moment will obviate any risk. A doctor is often asked by 
his patients if it is a good plan to wear wool in the ears. For a person who is 
not suffering from any disease of the ear it is certainly an absurd practice; 
there is no more reason for stopping up the ears than there is for obstructing the 
nostrils. For those who suffer from occasional attacks of deafness, or who have 
at times a discharge from the ear, a little cotton wool may serve as a protection 
from draughts, as in riding in an open carriage, or in the train, but we should 
not advise its habitual use. It is to be feared that in the case of children 
deafness is often mistaken for stupidity. " Very sad is it to think how often 
a child is thus punished for his misfortune, and, it may be, irremediable injuries 
inflicted on the mind or temper of this poor victim of unintentional injustice. It 
is hardly necessary to insist upon the care which is requisite in examining the state 
of the hearing power in a child, or to refer to the fact that children will often 
say, and doubtless think, that they hear a watch when they do not." 



■C8TA8T. 259 



ECSTASY. 



Though closely allied to catalepsy, ecstasy differs from it in ieveral important 
respects. One of the main points of difference is that in ecstasy the vision 
or train of thought that has been going on during the seizure is remembered, 
whilst in catalepsy there is complete oblivion. It often happens that the two 
diseases alternate or co-exist. 

In ecstasy the limbs are motionless, but not rigid. The eyes are open, the pupils 
fixed, the livid lips parted in smiles, and the arms extended to embrace the beloved 
vision. The body is erect and raised to its utmost height, or else is extended 
at full length in recumbent posture. A peculiar radiant smile illuminates the 
countenance, and the whole aspect and attitude is that of intense mental 
exaltation. Sometimes the patient is silent, the mind being apparently absorbed 
in meditation, or in the contemplation of some beatific vision. Sometimes 
there is mystical speaking, prophesying, or singing, or the lips may be moved 
without any sound escaping. Various attitudes are assumed in consonance with 
the ideas passing through the ecstatic's mind. Spots of blood sometimes appear 
on the hands and other parts of the body, and are said to represent the wounds 
of the nails in the hands and feet of Jesus, or the thrust of the spear in His 
side. Usually there is complete insensibility to external impressions. 

Ecstasy is often associated with religious monomania. It was formerly quite 
common among the inmates of convents, and is now not unfrequently met with at 
camp-meetings and other gatherings of a similar nature. Many truly devout 
persons are ecstatics, the reason being that since the diffusion of Christianity, 
religion has exerted a more powerful influence upon the mind and emotion than 
anything else. 

Ecstasy is not a common complaint, but still many cases have been recorded 
even during the last five or six years. One of the best known is that of Louise 
Lateau, who was born at Bois de Haine, a small village in Belgium, in the year 
1850. Even as a child she exhibited symptoms of nervous derangement. We are 
told that she loved solitude and silence, and spent most of her time in meditation 
and prayer. She was subject to paroxysms of ecstasy, during which she spoke on 
the subjects of charity, poverty, and the priesthood. She fancied that she saw 
St. Ursula, St. Roch, St. Theresa, and the Holy Virgin. Bleeding, or " stigmatisa- 
tion," as it is called, appeared soon after the onset of these seizures. One Friday 
she bled from the left side of her chest; on the following Friday the flow was 
renewed and, in addition, blood escaped from the backs of both feet ; whilst on 
the third Friday not only did she bleed from the side and feet, but also from the 
backs and palms of both hands. This continued for a long time, and finally other 
bleeding points were established between the shoulders and on the forehead. The 
evidence seemed to show that there was bond fide bleeding, and that it was not the 
result of a wound made artificially. In addition to these phenomena, Louise 
declared that she never slept, that she had had nothing to eat or drink for four 
years, that she had not had a faecal evacuation for three years and a half, and that 
the urine was utterly suppressed. This was undoubtedly untrue. On being 



260 THE TREATMENT OF DISEASES. 

closely interrogated she admitted that, though she did not sleep, she had short 
periods of forgetfulness at nights — a distinction without a difference. One of the 
doctors who investigated the case, on suddenly opening a cupboard in her room, 
found that it contained fruit and bread. It was also shown that her chamber 
communicated directly with a yard at the back of the house, so that it was 
perfectly possible for her to have slept, eaten, defalcated, and urinated to her 
heart's content without any one being a bit the wiser. Quite a number of books 
have been written about this interesting young lady, the theologians endeavouring 
to prove that she was the subject of miraculous intervention, and the doctors 
regarding her simply in the light of a curioua case of ecstasy. "We have very 
little doubt that bromide of potassium would soon have put a stop to the phenomena. 
Systematic watching would have been attended with the same result as in the case 
of the Welsh fasting-girl, or with a sudden restoration of appetite. 

Sometimes ecstasy occurs as an epidemic ; the strange spasmodic epidemics of 
the Middle Ages were undoubtedly of this nature. A few years ago an epidemic 
of ecstasy or emotional exhibitions occurred in several parish churches in one of 
the most northerly of the Shetland Islands. It was brought to an abrupt con- 
clusion by a rough fellow of a kirk officer, who carried out a troublesome patient 
and "tossed her into a wet ditch." From that time forth no more cases occurred. 
This is not the only instance in which epidemics of this nature have been arrested 
by arguments addressed to the fears of the subjects. Making preparations to 
cauterise the region of the spine with a red-hot iron has often a most beneficial 
effect. 

A great deal can be done in the way of treatment, by giving as little notoriety 
to ecstatics as possible. They glory in the idea that they are of sufficient import- 
ance to excite attention and discussion, and they are accordingly stimulated to 
yield to their attacks, so long as they find that an air of mystery is attached to 
them. Removal from all associations calculated to continue the exciting and 
morbid train of thought which has developed the disease is of importance. The 
drug from which most benefit is usually derived is bromide of potassium. The 
mixture (Pr. 31) should be given in three table-spoonful doses three times a day. 
Should this fail, half a tea-spoonful of the ammoniated tincture of valerian should 
be added to each dose. A five-grain compound assafcetida pill given twice or three 
times a day often does good A useful prescription is a tea-spoonful of fetid spirit 
of ammonia, a table-spoonful of lime-water, and a table-spoonful of peppermint- water 
every four hours. It is the nastiest mixture we know. The general health should 
be improved by cold baths, out-door exercise, and the administration of iron, quinine, 
and cod-liver oil. The systematic use of galvanism in conjunction with these remedies 
is often of service, 

ENLARGED GLANDS. 

Enlarged glands in the neck, associated with a condition of more or less marked 
debility, are of frequent occurrence amongst the children of the New York poor. When 
we consider their mode of life, either in the metropolis or in any of our large manu- 
facturing towns, w© can hardly wonder that such is the case. They live in an 



EPILEPSY — FITS — FALLING SICKNESS. 261 

atmosphere stagnant and contaminated in a thousand ways, and in little dark 
ill-ventilated rooms in narrow streets. They are badly clothed, and insufficiently 
protected from the injurious effects of cold and wet. They are ill-fed, their diet 
being frequently, and indeed generally, of a kind quite unsuited to their growing 
years. 

The glands often begin to enlarge during the condition of debility left by some 
illness, such as whooping-cough or scarlet-fever. Often enough the skin breaks 
over them, giving rise to the formation of a number of little abscesses, which may go 
on discharging week afte rweek and month after month, and are very difficult to heal. 

In these cases much may usually be done in the way of treatment. The diet 
must be specially attended to, none but the lightest and most nourishing food being 
given. It is a great mistake to overload the stomach, for it must be remembered 
that the little patient's digestive powers are usually none of the best. The use of 
stimulants, whether wine or beer, should be very sparing, and the milder and 
weaker should be preferred to the heavier and stronger kinds of malt liquor. The 
patient should be made to take plenty of exercise in the open air, not however 
carried to the point of fatigue ; and it would be very desirable, if funds could be 
obtained for the purpose, for him to have a change of air from time to time, 
alternating a sea with an inland climate. The clothing should be warm, and should 
cover the whole of the body, no part being left unprotected. Bathing also, whether 
in sea or river, with the habitual use of the tepid or cold sponge bath, and friction 
of the skin with horsehair gloves or a rough towel, should be frequently practised. 
The bowels must be kept regular, but only the mildest aperients should be 
administered, anything like active purgation being scrupulously avoided. 

The best medicine for this condition is sulphide of calcium. One of the little 
sulphide of calcium pills (Pr. 68) should be taken every hour or every alternate 
hour for a couple of weeks, and then less frequently for some time longer. They 
at once arrest the formation of fresh lumps in the neck, and abscesses if present 
usually dry up and disperse, the wounds quickly healing. Even in those very bad 
cases where there is disease of the bones of the fingers or wrists, this mode of 
treatment will do a great deal of good. After the second or third week some 
form of tonic may be administered in conjunction with the sulphide of calcium. 
Cod-liver oil, quinine, and iron — all do good in this condition. The dose of cod- 
liver oil should not exceed a tea-spoonful to begin with, and it may be taken 
alone or in combination with steel wine or an equal quantity of the syrup 
of iodide of iron. Often enough Parrish's Chemical Food answers as well as 
anything. In prolonged cases the syrup of hypophosphite of lime taken in a 
tea-spoonful dose night and morning does good. But the treatment on which most 
reliance is to be placed in these cases is the sulphide of calcium. 



EPILEPSY — FITS — FALLING SICKNESS. 

This complaint has been known from the earliest times. The ancients super- 
stitiously ascribed it to the malice of demons, or to the anger of their offended deities. 
If a person had a fit in the forum, it was considered an ill omen, and the meeting 



262 THE TREATMENT OP DISEASES. 

was at once dissolved, all public business being suspended for that day, and from this 
circumstance the disease was called morbus comitialis. 

Nothing can be more startling than the onset of an epileptic seizure. It comes 
on suddenly, often when least expected by the sufferer or those about him. In a 
moment, with a loud cry or groan, he falls struggling, foaming, and insensible upon 
the earth. He strains and struggles violently; his breathing is embarrassed or 
suspended ; his face, which at the very instant of tike fall had assumed a corpse-like 
pallor, soon becomes turgid and livid ; he foams at the mouth ; a choking sensation 
is heard in the windpipe, and for the moment he appears to be on the point of death. 
In a little while these alarming symptoms abate, and at length cease, leaving the 
patient heavy, exhausted, and stupid After an interval this, too, passes away, 
and he to all appearance is perfectly well. 

As we have said, the attack occurs suddenly. Sometimes there is a distinct 
warning, but even then it is of the shortest possible duration. The symptoms con- 
stituting the warning, when it does occur, are widely different in character and 
intensity. One patient had always before an attack the idea of a man shooting 
pigeons. He said distinctly that he saw nothing of the kind, but simply the idea 
came into his head, and then he knew that he was on the point of having a fit In 
another case, the patient stated that when a fit was approaching he fancied he saw 
a little old woman in a red cloak advance towards him, and strike him a blow on 
the head, when he at once lost all recollection, and fell down. A gentleman who 
was epileptic said that just before a fit he always heard " an infernal noise something 
like the outside of a booth at a country fair," whilst another had a vision of " a 
hideous donkey." Sometimes there is a distinct " aura," as it is called. The patient 
experiences a sensation of blowing, or something like it, which commences in the 
extremities and passes upwards to the head, insensibility ensuing when it reaches 
that point. The aura varies somewhat in character in different individuals. In one 
it is a distinct pain in the limbs, which runs up towards the head ; in another there 
are twitching movements, and the legs are drawn up, or the arm becomes contracted ; 
whilst in a third there is a vague uneasiness about the pit of the stomach, which 
seems to pass up through the chest. One very peculiar circumstance about the aura 
is the facility with which it may be removed and the attack averted. When it 
consists of pain, it may be stopped by rubbing, or by the pressure of the hand, or by 
a piece of string or tape drawn tightly round the affected part. When there are 
contractions, they may be removed by getting some one to draw the affected limbs 
out straight. When it assumes the form of uneasiness in the stomach, it is advisable 
to take a little sal volatile, or spirits of chloroform, or spirits of ether, or some similar 
aromatic draught. Suddenly dashing cold water in the face, or pressing the thumb 
forcibly backwards, will often succeed in averting the aura better than anything. 
The duration of the aura is always short, never if left to itself exceeding a few 
minutes. Sometimes, however, if stopped in the manner we have indicated, it may 
keep coming and going for hours, being arrested each time by appropriate measures. 
Some people, although they have no distinct warning, are dull, heavy, and depressed 
in spirits before each attack, so that their friends often guess what is going to happen. 
Very often this dulness and heaviness is removed by an attack, so that it seems 



EPILEPSY — FITS — FALtlNG SICKNESS. 263 



almost to have done the patient good. Many people are unusually vivacious before 
a fit, and then when it is over they suffer from the most horrible depression for many 
days. Such are some of the different ways in which an attack may give notice of 
its approach. In some people there is absolutely no warning of any kind ; in others 
it occurs with such regularity that the patient is enabled to move from a position of 
danger. 

As we have said, at the commencement of an attack the patient gives a ery. 
This cry, which we should mention is often abserit, is sometimes a groaning sound, 
seemingly squeezed out of the chest, but more frequently it is a piercing and terrifying 
scream. Women have been thrown into hysterics on hearing it, and it is said to 
have caused pregnant women to miscarry. Even the lower animals appear to be 
alarmed by it, and we are told that "a parrot, himself no mean performer in 
discords, dropped from his perch seemingly frightened to death by the appalling 
sound." 

Usually at the outset of an attack the spasm twists the head round so that the 
patient seems to be trying to look over his shoulder. The limbs are rigidly 
contracted, the hands firmly clenched, the thumbs bent towards the palms, the toes 
curved downwards, and the feet arched. When the convulsive struggles begin the 
face becomes frightfully distorted, the brows are knit, the eyes quiver and roll 
about, or are fixed and staring, or they may be turned up, the whites only being 
visible ; the mouth is drawn on one side, the tongue is thrust out between the teeth, 
and often severely bitten, so that the foam that collects around the lips is tinged 
with blood. The arms and legs are thrown about, striking the body, or bruising 
themselves against the floor or furniture. When the struggle has reached its crisis, 
the convulsions subside, and the sufferer looks at those around him with a bewildered, 
stupid, or sad expression, and perhaps essays to speak. He has a jaded, exhausted 
look, and seems tired and disposed to sleep. When the convulsive paroxysm is over 
the after-stage of stupor sets in. The patient after awhile awakes, and is often 
confused and incoherent for a time ; by degrees, however, he resumes his ordinary 
appearance and condition, but he remembers nothing of what passed during the fit. 
Vomiting often follows the attack, and with some people it is a constant sequence. 
Large quantities of urine are passed in many instances. 

In many cases the symptoms are much milder than we have described. There 
may be no convulsion at all, nothing but a momentary loss of consciousness. The 
patient may be in the midst of talking, when suddenly a blank occurs which may 
last three or four minutes. There is a fixed, absent gaze, a totter perhaps, a look of 
confusion, and that is all. Consciousness returns, the patient goes on talking, or 
resumes his work where he left off, and is not always aware of what has happened. 
These absences or blanks may occur several or many times a day, perhaps for years. 

These slight attacks are called by the French petit mat, while the severer form, 
previously described, is named grand mal, and these names have passed into general 
use. The slighter attack is sometimes spoken of as epileptic vertigo, to distinguish 
it from the ordinary epileptic fit. The best proof that these apparently dissimilar 
affections are in reality one and the same is afforded by the fact that they may both 
occur in the same individual. Sometimes a man will for a long time be affected with 



264 . THE TREATMENT OF DISEASES. 

epileptic vertigo; and will then suddenly become the subject of ordinary epileptic 
fits. The two forms may intermingle, the milder happening sometimes, and sometimes 
the more severe. Between these two extremes there are many links of gradation. 
Sometimes the patient does not fall, but there is a momentary loss of consciousness, 
accompanied by slight spasm. Sometimes the sufferer sinks or slides down quietly 
and without noise, is simply pale, is not convulsed at all, but is quite insensible. It 
will readily be imagined, from what we have said, that it is no easy matter to speak 
very definitely as to the duration "of epileptic seizures. Sometimes the attack is 
slight and does not occupy more than a moment of time ; at others it is more severe, 
and may last two or three minutes. An epileptic fit lasting more than five minutes 
is a rarity. It may seem to you to be much longer, but if you take out your watch 
and time it you will find that it is not. When an attack is said to last an hour or 
more it probably consists of a series of fits separated by incomplete intermissions. 

Next, as to the frequency of the fits. Many people have distinct bouts of fits — 
that is, they have two or three in a day, and then go a week or two without 
having any more. It is rare to find that there is any accurate periodicity in epilepsy, 
but you may often notice that the recurrence of the attacks has some kind of 
relation to time as marked by its natural division into days or weeks. It is not 
meant that the attack occurs exactly to the day — that is very rare — but rather that 
the fits occur about once a fortnight, or once a month, or whatever it may be. Most 
people who are subject to epilepsy have an attack oftener than once a month. The 
actual number of attacks in the year varies very much in different cases — there may 
be two or there may be two hundred. A high rate of frequency is not determined 
by an enfeebled state of health, for, on the contrary, it often happens that those 
whose general physical condition is excellent have a great many fits, whilst those 
who are weak and poorly have them at longer intervals. 

Between the attacks the patient may be perfectly well, but such is not often the 
case. Very commonly the memory is bad, the patient forgets his engagements, and 
cannot even remember where he dined yesterday. Lowness of spirits is of frequent 
occurrence, and this may continue for a long time, and finally run on into a state 
bordering on imbecility. Sometimes the patient suffers from headache and giddiness, 
or from noises in the head, or perhaps he sees specks floating before his eyes. 
Epileptics usually have but little power of resisting cold, their circulation is feeble, 
and they have cold, damp, frog-like hands. The face often wears a peculiar 
expression, which is difficult to describe. Very often there is a curious immobility 
of the countenance, and a strange staring appearance about the eyes. 

Epilepsy is not hereditary, or, if at all, but slightly so. It occurs with equal 
frequency in men and women. The first attack in the majority of cases makes its ap- 
pearance between the ages of thirteen and seventeen. Sometimes the first attack occurs 
about the time the second teeth are cut. Often enough it is not repeated, arid probably 
is then rather of the nature of a convulsion than of a true epileptic seizure. In young 
people fits are sometimes induced by a sudden fright. A child, for instance, breaks 
something, and is greatly alarmed at the thought of a scolding. In one case, a little 
girl slipped from the top of a large stone staircase to the bottom ; she was apparently 
unhurt, and was congratulated on her escape ; but a few days after epilepsy set in, 



EPILEPSY — FITS — FALLING 8ICKNES8. 



and was to her a source of life-long- misery. It is said that long-continued anxiety- 
may be the cause of epilepsy, but it is not a common cause. Sometimes epilepsy is 
brought on by seeing another person in a fit. Not only will a patient who has 
already suffered such attacks often fall into one upon seeing another so affected, but 
people will even sometimes do so who have never before shown any symptoms of it. 
Such instances, however, are rare, and practically there is not the slightest danger in 
attending a person with fits. 

Just as we know very little about the cause of epilepsy as a whole, so we know 
very little about what brings on each individual attack. They very often come on 
at night, and at the commencement often occur solely at night. It has* been 
noticed that when the fits are growing less frequent in their occurrence they come 
on chiefly or only at night, so that this must be regarded as a favourable sign. 

There is no disease which is more frequently feigned than epilepsy. Many 
people think that nothing can be easier than to throw your arms and legs about and 
pretend to have a fit. Soldiers and sailors sometimes endeavour by this means to 
obtain their discharge from the service, and in France it is often employed with the 
view of avoiding the conscription. Feigned epilepsy is not uncommon in the street, 
the performer hoping to excite compassion and obtain money from the bystanders. 
It is, of course, very important to distinguish the sham from the real disease. This 
is often rendered difficult from the fact of the impostor being unwilling to perform 
in the presence of any one at all likely to detect the fraud. Pretended epileptics 
sometimes get admitted into our hospitals, and then they take care to have their fits 
just before the hour of the visit, or directly the physician has gone his rounds. You 
cannot assert positively that a patient is not really suffering from epilepsy, if you 
have never seen him in a fit, and he knows this perfectly well. But still you may 
find out a great deal by asking him questions, by, in fact, a system of cross-examina- 
tion. The real sufferer does not mind a bit how often you ask him about his complaint, 
he is only too glad to tell you, and hopes you will be able to do something for him ; 
but the impostor does not like it at all, and says as little as possible, being always 
afraid of committing himself. A man who is telling you the truth gives the same 
account time after time, but not so one who has to rely on his powers of imagination. 
He tells you one thing to-day, and his memory being short, another to-morrow. 
Moreover, he will tell different people different stories, and a comparison of notes 
often serves to detect the fraud. By putting leading questions to an impostor, you 
can often get him to make the most astonishing statements. For instance, you say 
to him, "Now, during a fit, do you see everything of a sky-blue colour?" and he, 
thinking this is a symptom of the disease, promptly answers, "Yes;" whilst the 
true epileptic would regard you with astonishment, and reply in the negative. Then 
there is another point that is worth attending to. The impostor naturally chooses 
for his exhibitions places which are most suited for his purpose, as a crowded 
street, the promenade, and so on. The true epileptic does not care much for walking 
in the streets, especially about the time of an expected paroxysm, and when he does 
take the air, prefers some retired spot where, should a fit come on, there will be less 
chance of his being observed. Again, the real epileptic often gets seriously injured 
by his falls, and his face and body are covered with marks and scars; but the 



266 THE TREATMENT OF DISEASES. 

impostor generally selects some soft spot where he is not likely to sustain much 
injury by tumbling down. He takes good care, too, not to fall in the fire, or with 
his head on the stones. 

"When one has the opportunity of seeing a fit, the difficulties are not so great, 
although even then the problem is not always an easy one to solve. In the first 
place, in epilepsy the muscular power is very great, so that it requires three or four 
people to hold the patient down ; the impostor can, of course, command no more 
than his natural strength. In epilepsy the fits are seldom both long and violent, 
whilst the impostor usually falls into the error of supposing that the longer he can 
keep it up, and the more violent he is, the better. The result is that he very much 
overdoes it. In epilepsy the eyes are partly opened, and the eyeballs are visibly 
rolling and distorted. In feigned epilepsy the performer generally prefers to 
close his eyes, but sometimes he cannot resist the temptation to open them for a 
moment to see what success is attending his efforts, and to watch the effect on the 
bystanders. In epilepsy the pupils are very large, and are insensitive to light ; but 
in the feigned disease they are, of course, perfectly natural in size. If you pull 
up the eyelid and hold a candle just in front of the eye, you will find in the feigned 
disease that it is perfectly sensitive. The pupils contract, and the eyes of the 
malingerer blink in a manner that gives unmistakable evidence that he is not 
insensible. In epilepsy the pulse is often irregular, but this is beyond the power of 
the actor's art. Then, again, in a real fit the skin is usually pale and cold, but the 
impostor gets hot and red with his exertions, and perspires freely. The true 
epileptic often bites his tongue severely, but this is rather painful, and your impostor 
generally finds it advisable to omit this symptom. Foaming at the mouth is no 
criterion, for a piece of soap placed between the cheek and gums will furnish any 
amount of foam. In epilepsy the patient is of course quite insensible, and feels 
no pain. A very popular mode of detecting a shammer is founded on this fact. A 
little hot sealing-wax dropped upon the hand or leg of a person who is not insensible 
causes an involuntary start, whilst a man who was really in a fit would no more feel 
it than if he was dead. A touch with a red-hot poker, or a drop of gin in the eye, 
is said to answer admirably. A very good way of detecting an impostor is to 
propose gravely in his hearing to pour boiling water on his legs, and then actually 
to pour cold water on them. A favourite plan with police-constables and others 
who see a good deal of the worst side of life, is to press their thumb-nail under that 
of the supposed impostor. This, if done suddenly, gives rise to the most exquisite pain, 
and few people can bear it without an exclamation. It is a test that can be applied 
without any trouble and without inflicting the slightest injury on the sufferer or 
performer, as the case may be. We do not recommend the method, but still we 
must admit that its employment is perfectly justifiable when we suspect that a 
person is trying to deceive us. A very ingenious plan was adopted with a soldier 
who was pretending to have a fit. In the midst of his convulsions he was 
laid on the upper of two tables placed one on top of the other. He was so 
afraid of falling off that instantly his movements ceased. In another instance some 
fine Scotch snuff was blown up the nostrils with a quill. In a moment the man 
was sneezing violently and the imposture was detected. In true epilepsy no 



EPILEPSY — FITS — FALLING SICKNESS. 



267 



amount of snuff would induce sneezing during a fit. We are told that there 
was once a beggar in Paris who often fell into epileptic fits in the streets; one 
day some compassionate spectators, fearing that he might injure himself in his 
struggles, got a truss of straw, and placed him on it ; but when he was in the 
height of his paroxysm, and performing remarkably well, they set fire to the straw, 
and presently he took to his heels. 

Epilepsy has sometimes to be distinguished from hysteria. An hysterical fit ia 
usually preceded by sobbing, crying, laughing, and gesticulation, and does not come 
on so suddenly as epilepsy. A young lady in hysterics seldom falls down suddenly 
aa if she were shot, but takes care to slide down gracefully, usually in a soft place, 
or where there is somebody near to catch her or support and comfort her. There 
may be a shriek, but it is repeated over and over again, and is a very different 
thing from the epileptic cry. Then in the attack there is not that hideous distortion 
of the features, neither is there the meaningless eye, nor the dilated pupil, nor the 
bitten tongue. In epilepsy insensibility is profound, but in hysterics the young 
lady knows perfectly well everything that is going on, as you may find to your cost 
if you happen to say anything uncomplimentary about her. After the attack there 
may be a good deal of exhaustion, but there is not that deep sleep that one gets 
after epilepsy. 

A fainting-fit is sometimes mistaken for an attack of epilepsy. As a rule, there 
is little difficulty in distinguishing between them. In epilepsy the heart beats well, 
and the pulse can be felt at the wrist, whilst in a faint the patient is for the 
moment almost pulseless. It is sometimes no easy matter to distinguish between a 
faint and an attack of petit mal. It must be remembered that people do not faint 
without any cause, although often enough that cause is very trivial. It may be 
simply the heat of the room, or long abstinence from food, but there is always some 
reason. An attack of petit mal, on the contrary, comes on momentarily, and without, 
so far as you can tell, any exciting cause. If any one apparently in good health is 
sitting quietly in a room not too hot, and, without receiving bad news or anything 
of the kind, suddenly becomes insensible, it is probably an attack of epilepsy and 
not a simple faint. If, on the other hand, the room is hot and close, the patient is 
delicate, and has been excited, and then suddenly becomes pale and falls, it is 
probably only a fainting fit. 

Epilepsy may usually be distinguished from an attack of convulsions without 
much trouble. Convulsions occur chiefly in infancy, and especially when the child 
is cutting the first set of teeth. It is rare for epilepsy to come on at so early an 
age. Convulsions as a rule set in less suddenly than does an epileptic fit, the 
paroxysm is of shorter duration, there is no absolute loss of consciousness — at all 
events, at the beginning of the attack — and there is no subsequent stupor. 

Now, as to the probable issue of the complaint. This is a point on which every 
one is naturally most anxious. As regards immediate danger — danger, that is, to 
life — there is little or none. The patient always comes out of the fit, and death 
during an epileptic seizure is infinitely rare. This is a point on which no anxiety 
need be felt. But what about the chances of getting well ? Will the patient in 
time get rid of his fits, and be as good a man as he was before ? This is a question 



THE TREATMENT OP DISEASES. 



not so easy to answer, and for its solution there are a good many things to be taken 
into consideration. In the first place, how long has the patient been suffering from 
epilepsy 1 If he has had it for a very long time — for years and years — we can 
hardly hope for a perfect and permanent cure, although of course we may be able 
to do him a great deal of good. But when the disease has been recently established — 
when the patient has had only a few fits — we are much more hopeful about it. It 
should always be remembered that the longer the patient has been suffering, the 
greater the difficulty and improbability of cure. Then there are other questions to 
be considered. Is the epilepsy hereditary — did either the father or mother suffer 
in the same way ? If so it is a bad omen. When the fits set in early in life, the 
chances of cure are better than when the sufferer is well on in years before they 
begin. Then the condition of the general health is not without its influence. 
Contrary to what might be expected, some of the most obstinate cases are those in 
which the general health is good ; some of the most tractable are those in which 
there is a disturbance that may be corrected. Again, when the intervals between 
the attacks are much prolonged they are less amenable to treatment than when they 
exhibit a more rapid recurrence. 

Now as to the treatment of epilepsy. What should you do when a person is in 
a fit 1 Lose no time in loosening his collar and necktie, so that his throat may be 
quite frea A little care will prevent him from injuring himself by striking the 
floor or furniture. Put a piece of cork or india-rubber between the teeth, as it will 
prevent the tongue from being bitten. The windows should be opened, and all 
crowding round the patient should be avoided. Cold water thrown on the patient 
does no good. If you have a bottle of nitrite of amyl, hold it under the nose until 
the face flushes. Beyond this there is nothing to be done. After the attack is over, 
get the patient on to the bed, and let him sleep with his head and shoulders well 
supported. 

When there is & distinct aura, it may be possible, as we have seen, to arrest the 
coming paroxysm by making pressure on the part ; or by constricting it by means 
of a ligature. 

What is to be done to prevent the recurrence of the fits — in other words, what 
should you do in the intervals of the attacks ? The great . remedy for epilepsy is 
bromide of potassium. It must be given in good large doses to do any good — from 
ten to thirty grains three times a day. The bromide of potassium mixture (Pr. 31) 
contains fifteen grains in two table-spoonfula It is usually best to give it on an 
empty stomach — say half an hour before meals — as it is less likely to produce 
flatulenca Bromide of potassium nearly always does good in epilepsy. In some 
instances it has completely cured the patient, there never having been another attack 
after taking the medicine. In others it has arrested the attacks so that none have 
occurred for periods varying from a few months to two or three years. It is a most 
wonderful drug, and we should strongly advise every epileptic who has not tried it 
to do so without a moment's loss of time. In some cases its effects are little less 
than marvellous. Even when small doses have failed, large ones m?y succceed. It 
sometimes happens that the administration of five grains will diminish the frequency of 
the attacks, or prevent their occurrence for a long time, and that then, the medicine 



IPILEPSY — FITS — FALLING SICKNESS. . 269 

being still taken, the seizures revert to their previous rate of frequency. An increase 
of the dose is followed by a similar succession of events ; a further increase by a 
second succession of temporary improvement and subsequent deterioration ; and so 
on until a larger dose of from thirty to forty grains is given three times a day, when 
the attacks cease altogether. The bromide of potassium should not be pronounced 
a failure until large doses have been given frequently. Many epileptics derive no 
benefit from bromide of potassium, simply because they do not take enough of it. 
We should advise that the medicine should be taken regularly for some weeks, or even 
months, after the fits have ceased Many people no sooner get rid of their fits than 
they forget all about their medicine, and never think of it again until they are 
reminded of its value by a return of their old enemy. Another thing is that when 
the bromide is taken it must be taken regularly. It is of no use taking it for a day 
or two and then omitting it for a week, or anything of that kind. You must simply 
go straight on with it as steadily as clockwork. The bromide is said to prove most 
beneficial in those cases in which the attacks occur chiefly in the day-time ; but the 
fact is, it answers admirably in all cases. 

In some people bromide of potassium produces little hard red spots on the face and 
shoulders. Sometimes, too, it gives rise to drowsiness, dulness of apprehension, and 
muscular weakness, especially in the legs. These symptoms fortunately all disappear 
on temporarily discontinuing the use of the drug. In some persons they never occur, 
even when the drug is taken in large doses, day after day, and week after week. 
These symptoms may be obviated by a very simple precaution : — Take your bromide 
of potassium only six days in the week instead of seven — have a Sunday's rest in 
this as in everything else. This will prove successful, and the bromide will act 
equally efficaciously in controlling the fits. When the bromide is taken for a very 
long time it may be useful to discontinue it occasionally for about a week, or the 
system gets accustomed to it, and it may lose its effects. 

Bromide of sodium is sometimes preferred to bromide of potassium. It may be 
given in the same dose, and in the same way. Some people mix it with an equal 
quantity of common salt — put it in the salt-cellar and use it at meals. This saves 
trouble, and you cannot forget to take your medicine ; but by this plan you get a 
very variable dose. 

Bromide of ammonium is sometimes used instead of the bromide of potassium, 
and is found to answer equally well. Some doctors use a mixture of the bromide of 
potassium and ammonium- — thus, instead of giving fifteen grains of bromide of 
potassium, they give ten grains of bromide of potassium and five grains of bromide 
of ammonium mixed. 

Other remedies for epilepsy are employed, but we believe that none of them are 
equal to large doses of the bromides. Belladonna is, with many people, a great 
favourite, and it undoubtedly often answers admirably. It is indicated when, in 
addition to the fit, the following symptoms are present : — Sparkling of the eyes, 
dilated pupils, intolerance of light, flushes of heat, and redness of the face, and start- 
ing at the least noise. It may begin in three-drop doses of the tincture, or the 
belladonna mixture (Pr. 39) may be employed if more convenient. If administered 
as soon as the indications of the fit are observed, it may succeed in arresting it. 



270 THE TREATMENT OF DISEASES. 

Where the case is urgent, a dose may be given every ten minutes for an hour, and 
subsequently hourly ; but when it is more chronic, a dose every three or four hours 
will suffice. 

Sulphate of copper is given in preference to belladonna when the face, during an 
attack, is pale and the convulsions are very severe. It should be given in small 
doses frequently. 

Oxide of zinc sometimes does good in epilepsy ; two of the oxide of zinc pills 
(Pr. 66) may be given three times a day. 

Inhalations of nitrite of amyl often prove useful in epilepsy. A few drops may 
be poured on a pocket-handkerchief and cautiously inhaled. The full effects of the 
drug are not obtained until the face flushes and a sense of pulsation is felt in the 
head. Until you learn exactly how to manage the drug it is as well to lie down 
whilst inhaling, but when you get accustomed to it you may take your inhalation 
wherever you happen to be. The best way is to take a good sniff at the nitrite of 
amyl bottle directly you feel any warning of a fit. Even when the convulsions have 
commenced, nitrite of amyl will sometimes arrest them. On several occasions nitrite 
of amyl has rescued patients from that desperate plight called status epilepticus, a 
condition consisting essentially of a succession of fits linked together by intervening 
unconsciousness, the fits recurring with increasing frequency till, at last, no sooner 
is one fit ended than another begins. Sometimes nitrite of amyl succeeds better 
when given internally instead of in the form of inhalation. 

In conclusion we must say that bromide of potassium is undoubtedly the best 
remedy for epilepsy. We should always begin with it, and should not be in a hurry 
to give it up in favour of another drug. 

Attention to diet and regimen during the intervals of the attacks is important. 
The patient should strictly avoid indigestible food, and should have his meals with 
regularity. Plenty of exercise should be taken in the open air, although excessive 
fatigue should be avoided. There is no reason to interdict horse-exercise, if the 
patient has been accustomed to ride, for, curiously enough, a fit very rarely occurs 
on horseback. Many epileptics have been relieved of their nocturnal attacks by 
being made to sleep with the head and shoulders well supported. It is a good plan 
to have a bed-rest which can be adjusted to any angle, instead of being contented 
with an ineffectual arrangement of pillows and bolsters. Then about baths — they 
should be taken for the purpose of cleanliness and to produce a healthy action of the 
skin, but they will do no more. Baths will not cure epilepsy, and shower-baths, 
sitz-baths, and so on, usually do more harm than good. It is very important not to 
let the feet get cold, especially at night. Thick woollen socks, a fire in the bed-room, 
plenty of blankets, and a hot-water bottle to the feet, will obviate all difficulty on 
this score. Then about mental work. The parents of an epileptic child are often 
told that he must not do anything of any account — he mustn't go to school, he 
mustn't learn anything, and mustn't read, and so on. This advice, we are sure, is 
very bad advice. Excessive mental work might, of course, prove injurious, but it is 
of no use running to the other extreme. A boy must have something to occupy his 
time, or he will be sure to get moody and morose, and to worry about himself and 
his misfortunes. A couple of hours' lessons in the morning, and as much in the 



ERYSIPELAS. 271 



afternoon, cannot possibly hurt anybody ; and if you can only get him to take an 
interest in his work and like it, it may do him a great deal of good. In epilepsy, as 
in other chronic diseases, cod-liver oil, quinine, and other general remedies may be 
given, when there are special indications for their employment. 

ERYSIPELAS. 

This is the disease which is commonly known in England as "St. Anthony's 
fire," and in Scotland as " the rose." Two different forms of erysipelas are usually 
recognised — " idiopathic " erysipelas, arising from constitutional causes, and attacking 
chiefly the head and face ; and " traumatic " erysipelas, which follows a wound or 
injury, and may occur on any part of the body. The former variety, of which 
chiefly we shall have occasion to speak, is to all intents and purposes a fever, and 
belongs to the same class of diseases as small-pox, measles, and scarlet-fever. There 
is reason to believe that erysipelas is catching, although its contagiousness is un- 
doubtedly of a low order. It not ^infrequently occurs as an epidemic ; but it is far 
more common to find it haunting certain localities, and becoming what is called 
" endemic." 

The causes which are usually said to produce erysipelas are both numerous and 
diverse. Certain individuals, and even certain families, appear to be more liable to 
suffer from the disease than others. What is the cause of this special susceptibility 
it is impossible even to conjecture. Erysipelas is common in newly-born children, 
but from the first to the twentieth year it is by no means common ; after this period 
to the fortieth year it is frequent as an acute disease ; but in more advanced age it 
occurs chiefly as a chronic and less important malady. It is often said that women 
suffer from it more frequently than men, and that it is especially liable to make its 
appearance at the time of the monthly periods and at the change of life, but these 
statements are not altogether borne out by facts. Gouty people have been found to 
suffer from it more frequently than others. Errors in diet, and especially eating 
certain indigestible substances such as shell-fish, and improperly smoked, dried, 
salted, or preserved meats, are said to act as exciting causes. Violent mental 
emotions are also accused of being occasionally the cause, and it is said to have been 
brought on by both anger and fear. Sometimes no cause can be assigned for its 
onset, but its occurrence is promoted by all circumstances that tend to debilitate the 
body — by intemperance, by previous disease, by low spirits and anxiety, by insuffi- 
cient nourishment, and by foul air. Formerly, when less attention was paid to 
cleanliness and ventilation, it was much more common in hospitals and infirmaries 
than at present. Injuries to the skin, such as abrasions, scratches, wounds, burns, 
or blisters, wherever they are situated, may be the starting-point of the inflamma- 
tion. Sometimes even the presence of gout in a particular joint, or the irritation 
caused by diseased teeth in either the upper or lower jaw, may determine the seat 
of onset. It is probable that the most common cause of an attack of erysipelas is 
its communication from one person to another. In erysipelas the constitutional 
symptoms may precede the local, or redness of the skin may make its appearance 
before the fever commences. The former course is the more common. 



272 THE TREATMENT OP DISEASES. 

Usually the disease begins with malaise, aching of the limbs, loss of appetite, 
thirst, nausea or vomiting, diarrhoea, sore throat, increased heat of skin, frequency 
of pulse, headache, giddiness, depression of spirits, and perhaps bleeding from the 
nose. There are, in fact, all the ordinary symptoms of fever ; but there is no such 
special prominence of any symptom as would enable us to give an opinion as to the 
probable nature of the complaint. After a few hours, the patient may suffer from a 
well-marked rigor, or he may experience only a little feeling of chilliness. 

After a few hours, or it may be a day or two, of these undefined symptoms, the 
special phenomena of erysipelas make their appearance. The inflammation usually 
first attacks some part of the head or face. It is most frequently seen about the 
nose, or ear, or mouth, or eyelids. 

To the patient the part affected feels hot and burning, and on touching it, it is 
found to be sore, stinging and smarting. It is of a red and shining aspect, and is 
usually hard and swollen. The inflammation gradually extends, most commonly in 
only one direction, but sometimes in several different directions. At the advancing 
edge the skin is so distinctly hard and swollen, that it can be not only seen but felt, 
whilst at the receding margin it is far less distinct. Sometimes the amount of 
swelling is not considerable, but at others it is enormous. Sometimes the lips swell 
enormously, the cheeks enlarge, the eyes are closed by the puffiness of the eyelids, 
and all traces of the natural countenance are effaced. A medical writer says : — " I 
know no disease, except perhaps confluent small-pox, by which the human face 
divine is so completely and speedily deformed and disguised. A stranger seeing a 
young female in the height of the disorder, and revisiting her after her recovery, 
is astonished at the change. It seems as if, by some magic process, such as we read 
of in our nursery tales, a hideous monster has been metamorphosed into a comely 
damsel." In some cases, in addition to the redness and swelling, little bladders are 
formed, like those produced by a blistering fluid, or a scald. These bladders may 
attain a large size, and when they burst they leave dry and thick crusts, which 
render still more hideous the face they have covered. Yery frequently the inflam- 
mation is quite superficial, but sometimes it dips, as it were, through the skin, and 
affects the subjacent tissues, giving rise, perhaps, to the formation of matter. This 
is often the case in the loose tissue of the eyelids, and it is more common on the 
scalp than on the face. 

There is considerable variety in the course of the symptoms. In some cases there 
is a speedy diminution in their severity, both locally and generally ; whereas in 
others the reverse is observed. The amount of swelling about the face may be suffi- 
ciently great to give rise to the most annoying, and even alarming complications ; 
such, for example, as temporary blindness, deafness, and impossibility of breathing- 
through the nose. Sometimes the sufferer lies patiently still, yet apparently con- 
scious and rational, till the tumefaction diminishes, and he is once more able to open 
his eyes. In many cases, however, the result is less fortunate, and the patient 
becomes first delirious and then comatose, and may die at the end of a few days. 
Sometimes the disease extends to the throat, and the patient may die suddenly from 
suffocation. In all cases of erysipelas of the head and neck it is necessary to 
carefully examine the throat, count the number of respirations, and note the tint of 



ERYSIPELAS. 273 



the skin. This is more especially needful because from the vitiated state of the 
blood the sensations are blunted, and the patient may have a very bad throat 
without experiencing any pain or distress in that region, An occasional hurried 
respiration, or a little blueness of the lips ot finger-nails, may, if looked for, call 
attention to the nature of the impending mischief. In general the temperature, as 
ascertained by the thermometer, rises rapidly at the onset of the disease, reaching 
104°, or more, in the course of a few hours. So long as the inflammation of 
the skin continues to spread the temperature increases, and may attain 106°. 
Any sudden elevation of temperature is to be regarded as an indication of the spread 
of disease. During the period of convalescence, a sudden increase in the fever may 
be an accompaniment or the herald of a relapse. Such a relapse might possibly bo 
temporarily overlooked were it not for the use of the thermometer, for the symptoms 
are often almost imperceptible to the patient, and they may occur in a situation not 
necessarily exposed to the eye of the physician. The fever, as measured by tho 
thermometer, is very variable in duration, and the temperature, after having 
returned to the normal, may exhibit several re-elevations coincident with extensions 
of the inflammation. Usually the highest temperature is reached on the third day 
of the eruption, and the decline commences oa the fifth or sixth day. In fatal cases 
death takes place with very high temperature 

The pulse is generally full, beating at the rate of from 100 to 120 in the minute, 
ft may revert to its normal rate at the end of the third or fourth day of the 
eruption, not again to rise far above this, unless indeed there be a relapse, indicated 
\>y elevation of the temperature. 

That form of erysipelas which attacks only the skin is much less dangerous than 
fchat which involves the deeper parts. Cases which occur in patients with an open 
wound are of much more serious import than those which originate spontaneously. 
The termination of the disease is also less likely to be favourable when it occurs in 
an epidemic form. 

The disease is always more serious in old people and children than in young 
vigorous adults. The habits and health of the patient previous to the attack greatly 
Influence the result. Erysipelas, like many other diseases, proves especially fatal 
to drunkards and those whose health has been undermined by excesses of any 
kind. 

The extent of the inflammation is usually of not so much importance as the 
severity of the constitutional symptoms. When there is a rapid, weak pulse, with a 
dry, brown tongue, or low muttering delirium, with marked prostration of strength, 
the case is very serious, even though the local changes may be limited both in 
distribution and severity. 

The occurrence of delirium, and especially of delirium at night, is of no great 
importance, but marked drowsiness alternating with delirium is a serious symptom. 
Sometimes the membranes of the brain become involved, but delirium is not of 
necessity an indication of the occurrence of this complication. 

"We now pass on to the consideration of the best methods of treating erysipelas. 
The attendance of a medical man is in all but the very slightest cases absolutely 
necessary. The patient should be confined to bed, and attention should be paid to 
18 



274 THE TREATMENT OF DISEASES. 



all those hygienic measures — such as good feeding, fresh air, and quiet — which 
will be found fully discussed under the head of Fever. 

In erysipelas lowering treatment is seldom or never admissible. The disease is 
essentially an exhausting disease, and tonic and supporting treatment is necessary. 
In some cases stimulants are required from the very first, and the indications for 
their employment are the same as those given whilst speaking of the treatment of 
fever generally. The strength may be supported by the administration of bark and 
ammonia (Pr. 13), or quinine (Pr. 9). 

One of the most useful medicines in the treatment of these cases is the tincture 
of the perchloride of iron, or tincture of Bteel, as it is not unfrequently called. So 
marked is its action that it has been regarded by some as a specific for this disease. 
It is essential for its success that it should be given in large and frequently repeated 
doses. Ten and fifteen drop doses given three times a day do no good, and to obtain 
a favourable result it is absolutely necessary that it should be given in doses of forty 
minims or more every four hours. It may be conveniently taken in about a wine- 
glassful of water. The beneficial effects of the medicine are sometimes seen after 
the first or second dose ; the local inflammation ceases to ^extend ; the inflamed part 
becomes paler, less tender, and less swollen ; the feeling of exhaustion is diminished ; 
the pulse becomes less frequent ; the temperature falls, and frequently a sound and 
refreshing sleep ensues. As soon as these changes are observed the dose of the 
medicine may be reduced. The iron treatment may be combined with the use of 
stimulants, if there are indications for their employment. 

Aconite (Pr. 38) is of marked service in erysipelas. Administered quite at the 
commencement it often cuts short the attack ; and even when in spite of it the disease 
continues, aconite will reduce the swelling and hardness, lessen the redness, and 
prevent the inflammation from spreading. 

One of our most eminent authorities on treatment has recommended aconite in 
the following cases : — " In children, after vaccination, perhaps when the spots have 
nearly healed, an erysipelatous redness occasionally appears, spreading over the arm 
and a greater part of the trunk, usually ceasing in one part, then successively 
attacking contiguous parts, and leaving a yellow discolouration and desquamation. 
The redness is often intense, the tissues being very hard, painful, and shiny, and 
this inflammation may continue for weeks. It may run down the arm, involve the 
hand, and implicate the greater part of the chest ; or it may appear in the leg, and 
gradually spread to the foot ; or again, it may spread from the hand up to the arm, 
and once more down to the hand, and this may be repeated many times. Sometimes 
the inflammation terminates in small abscesses. In cases like these aconite generally 
at once arrests the inflammation ; and even when it persists the redness is rendered 
less intense, and the swelling less hard and painful. The troublesome inflammation 
often arising after the vaccination of adults ordinarily yields to aconite, especially 
if supplemented by the local application twice daily of the belladonna ointment." 
In all these cases the aconite may be given in the form of the aconite mixture 
(Pr. 38), a tea-spoonful every ten minutes for the first hour, and subsequently 
hourly. 

Belladonna certainly proves efficacious in many cases of erysipelas. It usually 



EXPECTORATION. 275 



does most good in the simpler forms where no vesicles or bladders have made their 
appearance on the surface. It is especially indicated when there is violent headache 
with thirst, constipation, or brownish-red thick urine. It is also useful when either 
delirium or lethargy is a prominent symptom. In the early stages of the disease 
it may be given alternately with aconite, first a dose of one and then of the other. 
It may be conveniently administered in the form of the belladonna mixture 
(Pr. 39), a tea-spoonful every quarter of an hour for the first hour, and subse- 
quently hourly. 

So much then for the internal remedies. We must now consider the best method 
of local treatment. It is very desirable to avoid exposing the affected part to 
variations of temperature, and with this view it may be lightly covered with dry 
cotton wool so as to protect it from draughts. Ointments and cooling lotions, by 
interrupting the natural functions of the skin, often do mischief. 

A solution of nitrate of silver has been strongly recommended as a local appli- 
cation in erysipelas. The success of this mode of treatment depends entirely on the 
mode of conducting it. In the first place the skin of the affected part must be well 
washed with soap and water so as to remove greasy matters, then again with simple 
water, and then it must be wiped quite dry. Finally a solution of four scruples of 
the brittle stick of nitrate of silver in four drachms of water is to be applied twice 
or three times to the inflamed surface, extending for two or three inches in each 
direction beyond the margin. 

Collodion is not unfrequently used as a local application in cases of erysipelas. 
It usually proves far less efficacious than the solution of nitrate of silver, and when 
painted over large surfaces it often not only fails to do good, but in consequence of 
its cracking and leaving rough edges, not unfrequently does positive harm. 



EXPECTORATION. 

Expectoration is merely a symptom, and is not in itself a disease. It seldom 
occurs except as an accompaniment of cough. The secretion of the lining membrane 
of the bronchial tubes in a perfectly healthy person is almost entirely destitute of 
matter to be expectorated. In the normal state, the secretion of the bronchial 
mucous membrane, though continually present, scarcely ever exists in superfluous 
quantity, for a certain proportion of it is carried off by exhalation or absorption. 
The moisture secreted by the lungs should contain nothing that the expired aii 
cannot carry away in vapour, nothing that would leave any residuum which by itt 
accumulation would at length require to be expectorated. A perfectly healthy person 
living in a pure atmosphere has no expectoration whatever. We say living in a 
pure atmosphere, for town-dwellers commonly hawk up a little black phlegm the 
first thing in the morning. This, consisting as it does chiefly of " blacks," is not 
to be considered as any indication of a departure from the normal condition ot 
health. In disease there is a secretion of unhealthy mucus which cannot be got 
rid of in the usual way, and must be expectorated. Hence it is that persons in 
whom a chronic condition of congestion of the bronchial tubes has been generated 
by repeated colds have a secretion of superfluous matter always going on, and are 



276 THE TREATMENT OF DISEASES. 

constantly expectorating. This may continue for years without causing much incon- 
venience, the principal annoyance from which the patient suffers being in getting up 
the phlegm in the morning. It is a remarkable fact that, though a person may cough 
violently in his sleep, he never expectorates. 

An examination of the expectoration is useful not only in enabling us in many 
cases to determine the nature of the disease, but as affording many a use- 
ful hint for treatment. The sputa in pneumonia or inflammation of the lungs, 
for instance, is very characteristic. It is of a brick-dust colour, and is so viscid that 
the vessel in which it is contained may be inverted without spilling the contents. 
In bronchitis, you may get many different kinds of expectoration. If the patient 
do not expectorate till after a long fit of coughing, during which the air has been 
many times inspired and expired, and has thus become intimately mingled with the 
mucus contained in the air passages, the expectoration will contain numerous little 
air-bubbles, and will be veiy frothy. After a time the mucus loses by degrees its 
transparency, is mixed with masses or pellets that are opaque and of a yellow- white 
or greenish colour, and these masses, few at first, increase more and more in number 
until they constitute the whole of the sputa. Such expectoration as this is com- 
monly marked by a remission in the symptoms. It will sometimes happen that the 
expectoration, having thus become opaque and parti-coloured, will go back again to 
its former condition of temporary stickiness and froth, and this is to be regarded as 
a sign of a return or extension of the complaint. By the character of the expectora- 
tion alone we are in the majority of cases enabled to distinguish between bronchitis 
and pneumonia. In one kind of bronchitis pieces are expelled which are complete 
casts of the bronchial tubes, and when spread out in water look like little trees. 
This complaint is known as "plastic" bronchitis. Many different kinds of expecto- 
ration are met with m consumption, but there is no form which to the naked eye 
can be regarded as a positive indication of the existence of that diseasa 

As we have said, the character of the expectoration may sometimes be employed 
as a guide to treatment. Thus, when there is profuse easy expectoration with 
nausea or vomiting, small doses of antimony wine are indicated. When it is tough 
and stringy and expelled with difficulty, bichromate of potash often does good. 
When loose and worse on lying down, pulsatilla may be given, especially in the case 
of women and children. Nitric acid is useful in old-standing cases, especially when 
the more active lung symptoms have subsided. Brown-coloured expectoration is 
considered by many to be an indication for the use of phosphorus. Sulphur is given 
when the mucus is yellow or white, and when there is any concomitant skin erup- 
tion. Arsenic is used when there is much debility and a tendency to asthma. 
Details as to the mode of administration of these medicines will be found under the 
head of Cough and in other parts of this work. 



FAINTING. 

A fainting-fit arises from sudden failure of the heart's action. It is met 
with most frequently in young adults, especially in young females. Its occurrence 
U favoured by general debility or ill-health, and more particularly by anaemia, or 



FiiNTiya 277 



poorness of the blood. It is very common in young ladies who take very little 
out-door exercise, and spend most of their time on the sofa reading novels. 
"Want of active occupation powerfully predisposes to fainting. People who are 
not very strong are most likely to faint after some unusual fatigue, or after long 
abstinence from food. A liability to fainting seems almost to be hereditary, so 
common is it in some families. Sometimes it is associated with heart disease, but in 
the vast majority of cases it is purely functional, and there is nothing wrong with 
that organ. 

The determining causes of a faint are very variable in character. In susceptible 
subjects it may be brought on by any sudden impression on the nervous system. 
This need not of necessity be painful or unpleasant, for people may faint from 
excitement or excess of joy. For instance, the sudden announcement of the 
return of some long-lost relative, or of the favourable termination of a protracted 
lawsuit, may be the exciting cause. The sight of certain aiiimals, such as a frog, 
or a black-beetle, or even a mouse, is quite enough to send some people off, 
whilst others faint immediately at the sight of blood, and even feel sick and 
faint if they read of an accident in the papers. We have all heard the story 
of the young curate who fainted on having to read the account of one of the 
sanguinary battles in the Old Testament. Medical students sometimes faint at 
their first operation. Such a trivial accident as pricking the finger will make 
some people feel sick and faint. 

A fainting-fit is so sudden in its occurrence that it is not easy to describe 
it. Usually there is at first a feeling of faintness, then of sickness and giddiness, 
there is a blank before the eyes, and everything seems as if it were swimming 
about or going round and round, the face becomes deadly pale, the hands and 
feet get cold, the teeth chatter, and the patient feels as if she were sinking 
backwards, or going down and down ever so far. As the faint passes off and 
consciousness returns there may be a deep sigh. 

There are one or two complaints from which a fainting-fit has to be distin- 
guished. In the first place, from epilepsy. There is not the slightest difficulty 
in distinguishing it from an ordinary epileptic fit, but from attacks of epileptic 
vertigo or petit mcd, as we call it, there is often very great difficulty, for they 
run so very closely together. In attacks of petit mcd the fit comes on more suddenly, 
and the loss of consciousness is distinctly marked. In fainting the insensibility 
is not absolute, and when it is over the patient can often tell what occurred, 
although at the time she was unable to speak. Then again, people rarely faint 
without some definite cause. If a young woman sitting or lying down in a 
room with plenty of fresh air suddenly becomes insensible, without having received 
bad news or anything of that kind, it is something more than a mere faint, and 
is probably a fit. 

There is usually little difficulty in distinguishing a faint from an attack of 
hysterics. In the latter case the patient will be found sighing, laughing, or crying, 
or endeavouring to attract attention in some way or other. Moreover, if you feel 
her pulse you will find that it is beating strongly, affording positive proof that 
the heart has not ceased beating. Of course a person who is habitually hysterical 



278 THE TREATMENT OF DISEASES. 

may have a fainting-fit, but this is a circumstance which, if borne in mind, would 
give you no trouble as regards diagnosis. 

You are not likely to confound apoplexy and fainting. Apoplexy may of 
course occur in young people, but is far more commonly met with in the middle- 
aged, or those advanced in life. A fainting-fit, moreover, is never followed by 
paralysis. 

The danger of a fainting-fit is usually slight. In the great majority of cases 
the patient comes-to in a few minutes. If a person faints from a very trivial 
cause, it shows that there is some constitutional weakness, or at all events that the 
health is very much below par, and energetic treatment will have to be resorted to. 

Next, as to the treatment of fainting. What are you to do for a person who is in 
a faint 1 If the patient has fallen on the floor, you should leave her in that position, 
and should on no account raise the head. If she has not fallen to the ground, but 
only back in a chair, put your hand behind her neck, and depress her head 
till you bring it right down between the knees. By this method, the blood runs 
down into the head, and this is just what you want : it is much better than lying 
the patient flat on the floor, for in that case, as the heart is not doing its work, 
you won't get the blood pumped up to the brain. You may sprinkle a little water 
over the face — a few drops will do as well as a larger quantity. "When the face is 
pale and cold, use tepid water. A little ammonia or sal- volatile, or a bottle of 
smelling-salts, held under the nose, will often restore consciousness. Musk or 
camphor will answer almost equally welL It is a good plan to keep the hands and 
feet warm, and to chafe the chest over the region of the heart with a little spirit or 
eau de Cologne. As soon as the patient can be got to swallow, you had better give 
some brandy and water, or sal- volatile, or chloric ether, or any other stimulant that 
may be at hand. 

To prevent further attacks, the great thing is to pay attention to the general 
health. Live as well as you can. Spend most of your time in the open air. Give 
up novel-reading, and go in for lawn tennis, croquet, or something of the kind. If 
you can, learn to ride, and take a good gallop every day. If you haven't a horse, 
don't forget that you have a pair of legs, and that a good brisk walk is one of the 
finest tonics in the world. A cold sponge-bath in the morning is good for you, 
but you may have the chill off just at first. Pay attention to your bowels, and see 
that they are open every day regularly. If not, you will learn from the article on 
constipation (see Constipation) what to do. If you are suffering from poorness of 
blood or anaemia, you will have to take iron (Pre. 1 — 7). If you are thin and weak, 
and badly nourished, cod-liver oil will be your remedy, or you may derive benefit 
from the hypophosphites (Pr. 55). If you are a town-dweller, try and get away 
in the country. A week or ten days in a country-house, or at a farm, will do you all 
the good in the world. If you go to the sea-side, try and get some sea-bathing. If 
you live in the country, get some one to invite you to come up to town for a bit, 
and do not hesitate to enjoy yourself as much as possible. .A course of balls, and 
theatres, and concerts, or whatever your special form of dissipation may be, will do 
you no end of a lot of good — even more good than our medicines, and that is saying 
a great deal. 



FLATULENCE OB WIND. 279 



FEET — SWEATING OF THE FEET. 

Offensive perspiration of the feet is a complaint from which many people 
suffer. It is often the cause of the greatest mental anxiety. We will give a few 
directions for its treatment. In the first place, the condition of the general health 
should be investigated. Should any fault be detected it must be set right. For 
anaemia or poorness of blood, iron (Prs. 1, 2, or 3) is the remedy ; for loss of appetite, 
quinine (Pr. 9) ; for general debility, cod-liver oil ; for mental anxiety or over- 
work, the hypophosphites (Pr. 55). The bowels should be kept regular. Out-door 
exercise should be taken daily. Stimulants are allowable only in the strictest 
moderation. Scrupulous attention should be paid to cleanliness. A cold bath 
should be taken every morning. The feet should be washed in tepid water night 
and morning, and oftener if possible. The addition of sea-salt to the water may 
do good, but when the perspiration has a sour acrid odour a little vinegar is better. 
The socks should be changed as soon as they get soiled, and they should be 
thoroughly washed each time, and not merely dried. The boots should have broad 
soles and square toes, so as not to cramp the feet ; patent leather is to be avoided, 
and the same pair should not be worn every day. A dusting powder composed of 
equal parts of oxide of zinc and starch often proves useful ; it should be sprinkled 
freely inside the socks. Belladonna liniment rubbed into the feet three or four 
times a day often effects a cure. Sometimes it fails, but on the whole it is a very 
reliable mode of treatment. Liquid extract of ergot in fifteen-drop doses three or 
four times a day sometimes does good. Some doctors employ an ointment composed 
of equal parts of lead plaster and linseed oil, spread on linen and wrapped round 
the feet, the application being renewed every third day for nine days. Ten drops 
of tincture of jaborandi in a table-spoonful of water three or four times a day will 
sometimes give relief. 

These remarks are equally applicable to sweating of the hands, a complaint 
which is of frequent occurrence with those who have much writing to da 

FLATULENCE OR WIND. 

Flatulence, wind, spasms, or belching — for this affection is known by all these 
names — is one of the commonest symptoms of dyspepsia, and is often the one of 
which the sufferer is most anxious to be cured. Dyspeptics nearly always complain 
loudly of the " wind in their stomachs," and frequently enough regard it as being at 
once the essence and cause of all their discomforts. The gas that produces all this 
trouble is usually derived from undigested food, detained in the stomach and 
undergoing a process of fermentation or of simple putrefactive change. It is thought 
that sometimes it is formed by the stomach itself, for the flatulence may come on 
when that organ is quite empty. Many people always suffer from this disorder if a 
meal happens to be delayed beyond the accustomed hour. Sometimes the flatus is 
quite tasteless, whilst at others it is attended with both the flavour and odour of 
rotten eggs. Flatulent dyspepsia occurs far more frequently in women than in men. 
Nervous and hypochondriacal women, who partake freely of tea, are very liable to 
suffer from it, especially when there is a general relaxed condition, and want of tone 



280 THE TREATMENT OF DISEASES. 

of the system. Frequently the gas accumulates so quickly in the stomach and 
intestines, and leads to such an amount of distension of the abdomen, that patients 
have to loosen their clothes from inability to bear their tightness. In many people 
flatulence is always produced by the use of any food which is liable to undergo rapid 
fermentation. 

Fortunately, we have many drugs at our command which prove useful in the 
treatment of this complaint. When it is dependent on indigestion, the rules ap- 
plicable to the treatment of that condition may be advantageously followed. When 
not obviously associated with dyspepsia, it may often be cured by the avoidance of 
vegetable food, and tea and beer. Sugar and starchy foods must be avoided or 
sparingly eaten ; and thin, well-browned toast may be substituted for bread. The 
meals should be very moderate, the food well masticated, and drinking postponed 
till the meal is nearly finished, or better still, till an hour or so after its completion. 
A due regulation of the periods for taking food will often suffice to obviate the 
flatulence which belongs to emptiness. It should be remembered that tea is especially 
obnoxious to flatulent people. Half-fed seamstresses, who subsist chiefly on weak 
tea and bread-and-butter, are frequent sufferers from this complaint. 

A very common remedy for flatulence is a dose of sal-volatile — from thirty to 
forty drops in a little water. It seldom effects a cure, and at the best can be 
regarded only as a palliative. One of the best remedies with which we are 
acquainted is oil of cajeput — three drops occasionally on a piece of sugar. We 
have given it hundreds and hundreds of times, and had every reason to be satisfied 
with it. It does not prevent the formation of wind, but it brings it off the 
stomach and eases the chest. Any one suffering from flatulence would do well 
to try this. Sometimes oil of cloves or oil of carraway is given in the same dose 
and in a similar manner. Horseradish often proves very useful — from half a 
tea-spoonful to a tea-spoonful of the compound spirits of horseradish being taken 
three or four times a day in a little water. Drop doses of pure chloroform taken 
in a little water often succeed in dispelling the wind. Brown's Essence of Ginger, 
an old-fashioned remedy, often does good in flatulence. 

Charcoal is of great value in many cases. Sometimes the wind is produced 
In enormous quantities and with great rapidity, giving rise to distension, eructation, 
and mental depression, the sufferer complaining only of these symptoms, and not 
of pain or acidity. This enormous production of gas, irrespective of other 
symptoms, prevails chiefly among middle-aged women, especially at the change of 
life. It may be met with during pregnancy or suckling, or less frequently in the 
victims of consumption. This condition is usually met by the administration 
of wood charcoal in from five to ten grain doses. When, after a few mouthfuls 
of food, the wind is formed in a quantity so large that the sufferer is constrained 
to cease eating, the charcoal should be taken immediately before each meal. When, 
on the other hand, the patient is» not troubled with the wind until half an hour 
or so after food, the charcoal should be taken soon after the meal. Sometimes 
profuse formation of wind is accompanied by acidity, and then the charcoal will 
generally remove both these symptoms. Charcoal is best taken in the form of 
a powder, but may be obtained made into biscuits, which often succeed well enough. 



FLUSHING OP THE FACE. 281 



The Scotch custom of eating a crust of bread burnt brown is not a bad one. Some- 
times the efficacy of the charcoal is enhanced by mixing with it an equal quantity 
of carbonate of bismuth. Should charcoal or charcoal and bismuth fail to remove 
these symptoms, the substance known as sulpho-carbolate of soda should be tried. 
It dissolves readily in water, and may be given in doses of fifteen or twenty grains 
three or four times a day. We often meet with people, generally women, who 
suffer from what is ordinarily called " spasms." The patient complains of consider- 
able flatulence and distension, often limited to one part, or at all events most 
marked at one part of the abdomen, generally on the left side under the ribs. It 
is accompanied by considerable pain, which is temporarily relieved by the eructation 
of a little wind, but soon returns, and may last for many hours. This condition 
is usually relieved by sulpho-carbolate of soda in twenty-grain doses, or, should 
this fail, some preparation of phosphorus may be tried — say five drops of phos- 
phorated oil on a piece of sugar every four hours. 

Sulphurous acid taken in water, in from five to ten drop doses, often prevents 
flatulence produced by fermentation, and is especially useful when the gas is 
abundant. Ten or fifteen drops of dilute hydrochloric acid, taken a quarter of an 
hour or thereabouts before meals, will often prevent the occurrence of the form of 
flatulence which follows food. 

Very frequently nothing succeeds in flatulence like assafcetida. For adults a five- 
grain compound assafcetida pill may be taken three times a day, or every four hours. 
In the flatulence of young children unconnected with constipation or diarrhoea, a 
tea-spoonful every hour of a mixture containing a drachm of the tincture of 
assafcetida to half a pint of water, will relieve the distension speedily, and is usually 
taken without any difficulty. When the flatulence is due to constipation or 
diarrhoea, assafcetida does little good. 

In some forms of flatulence occurring in children, the perchloride of mercury 
mixture proves useful (Pr. 48). One of the best remedies for the flatulence of 
children is the old-fashioned dill- water. A tea-spoonful may be given occasionally 
when the wind is troublesome, or two spoonfuls with a drop of cajeput oil may be 
administered every four hours. When the child's health is bad, and the digestion is 
imperfect, generally with annoying flatulent distension, three or four pale, clayey, 
pasty, stinking motions being passed in the day, a tea-spoonful of the above- 
mentioned perchloride of mercury mixture given every hour, or, what is even 
better, one of the sugar and grey powders (Pr. 71) every hour or two hours, will 
usually quickly effect a cure. 

Nux vomica is more or less serviceable in flatulence of all kinds. A tea-spoonful 
of the nux vomica mixture (Pr. 44) may be taken every two hours for twenty-four 
hours or more. 

FLUSHING OF THE FACE. 

This may occur as a symptom of dyspepsia, but it is often met with without 
any derangement of the digestive organs. Many women, from the sudden arrest 
of menstruation, or depraved health, or nervous depression, suffer from heats and 
flushes. The flush usually starts from some particular spot, such as the pit of the 



282 THE TREATMENT OP DISEASES. 

stomach, and then spreads all over the body, even the backs of the hands becoming 
of a bright scarlet colour. The sensation of heat may be so urgent that the patient 
undoes her clothes or throws off the bed-clothes, and even opens the windows in the 
coldest weather. These heats last for a variable time, from a few minutes only 
to an hour or more. They usually come on without any warning and without any 
attributable cause. "We have known cases in which they have occurred fifty or a 
hundred times in the day. Sometimes there is a sensation of heat without any 
flushing of the skin. Frequently they are followed by " chills " or by perspiration, 
which may be very profuse. These symptoms are often associated with coldness 
of the extremities, the feet and hands being often icy cold. They occur most fre- 
quently in women about the time of the change of life, but younger women are 
occasionally sufferers. We never remember meeting with this condition in men. 
The best treatment is nitrite of amyl. Eight minims of nitrite of amyl are dissolved 
in half an ounce of rectified spirit, and of this mixture three drops are to be taken 
on sugar every hour, or whenever the heats are troublesome. By this method we 
have relieved or cured dozens of people. Benefit may be experienced immediately, 
or not till the expiration of some days, or even a week. As the patient grows 
accustomed to the remedy the dose should be gradually increased. "We need 
hardly say that the mode of treatment is perfectly safe, and that in a somewhat 
extensive experience we have never known it produce even the slightest incon- 
venience. "We think it right to mention this, as some people seem to imagine that 
nitrite of amyl is a remedy which should be used only with the greatest caution. 

Sometimes the occurrence of these heats and flushes is associated with consider- 
able nervous depression. The patient may be so despondent as to feel as if she 
would go out of her mind. She may be so irritable as to be unable to fix her 
attention on anything, and the slightest noise causes the greatest distress. There 
is often considerable restlessness at night, the sleep being broken by harassing 
dreams. This condition is often the result of over-work, grief, worry, or too long 
residence in towns, and want of change of air and scene. When the heats and 
flushes are the predominant symptoms, nitrite of amyl given as above will nearly 
always effect a cure ; but when mental depression, nervousness, and sleeplessness 
predominate, bromide of potassium proves even more successful. The best way 
to give it is in the form of the mixture (Pr. 31), two table-spoonfuls three times a 
day. Sometimes, however, all medicinal treatment fails to effect a cure, the symptoms 
recurring again and again, and then the only thing to be done is to get a thorough 
change of air and scene. Probably the best remedy is to travel on the Continent 
for from three to six months, but this few people can afford to do. 

The flushings of the face, and hot and cold perspirations, are often relieved by 
nux vomica, particularly when one or two drops of laudanum are added to each 
dose. This treatment often controls the distressing flatulence associated with this 
condition, and removes the sensation of heat and weight on the top of the head. 

Valerianate of zinc is a useful remedy for many of those numerous, distressing, 
and changeable symptoms to which we have referred. It will sometimes remove 
not only the flushings of the face, and the hot and cold perspirations, but also 
restlessness, nervousness, depression of spirits, sensation of suffocation in the throaty 



©ALL-STONES AND BILIAHY COLia 283 

throbbing of the temples, and fluttering at the heart It will even succeed when 
these symptoms are associated with derangement of the womb, piles, dyspepsia, or 
constipation. It must be admitted, however, that sometimes it fails in the very 
cases in which we should have expected that it would do good. The dose is five 
grains three times a day, and it may be taken in the form of pills or dissolved in 
water as a mixture. Should the valerianate of zinc fail, tincture of valerian taken 
in water in tea-spoonful doses three or four times a day may be employed with a 
fair prospect of success. 

Oxide of zinc given as a pill (Pr. 66) one, two, or three times a day has been 
highly recommended in the treatment of these distressing symptoms. 



CALL-STONES AND BILIABT COLIO. 

Gall-stones are usually formed in the gall-bladder, but occasionally in the sub- 
stance of the liver. Sometimes they occur singly, and sometimes in considerable 
numbers. When they are solitary they are usually globular or oval, or pear-shaped. 
When there are several, they commonly have numerous polished facets, the result of 
mutual pressure and friction. Sometimes they are found accurately fitted to each 
other, and then they are said to be articulating. They vary in size from a small 
seed to a hen's egg. Their weight is inconsiderable ; when fresh they are heavier 
than bile or water, but when dried they readily float They vary in colour from a 
pearly-white to a deep black, but most commonly they are of reddish-brown tint. 
They consist of a substance known as cholesterine, with a certain amount of colouring 
matter. On cutting them open, they are usually found to have a nucleus or core. 
In exceptional cases, this nucleus may be some foreign body, such as a dead round- 
worm,, a piece of a needle, or even a plum-stone. The body, or that part of the 
concretion between the nucleus and the crust, is marked with lines or furrows, 
consisting of radiating crystals of cholesterine, or it presents concentric rings or 
laminse, or is formed of an irregular mixture of cholesterine and colouring matter. 
The outer crust can often be separated from the body like a shell ; it consists of 
concentric layers of different thickness, made up chiefly of cholesterine. 

The tendency to gall-stones is rarely manifested before the age of thirty, though 
in rare instances they have been known to occur in children. Women are more 
liable to suffer from them than men, probably from their sedentary habits. Excess 
in eating often predisposes to the formation of these bodies, and so does the habit of 
taking only one meal in the twenty-four hours, in consequence of which the gall- 
bladder is not emptied with sufficient frequency. 

As long as a gall-stone remains in the gall-bladder, it as a rule does no harm ; 
but should it be forced into the narrow bile-duct, it causes the most exquisite pain, 
and the patient suffers from what is known as biliary colic. The pain that attends 
the passage of a gall-stone through the duct is agonising. Perhaps there is no pain 
to which the body is subject that is more severa Women who have had families 
say that the pains of child-birth are nothing in comparison. We can hardly wonder 
at this when we reflect that through a tube, of which the natural size scarcely exceeds 
that of a goose-quill, there sometimes passes a stone as big as a walnut 



284 THE TREATMENT OP DISEASES. 



The attack usually comes on after the principal meal of the day, or after some 
severe muscular exertion or shaking of the body. Sometimes the patient is fore- 
warned of his approaching trouble by a feeling of sickness, with much flatulence and 
an unusual disturbance of the nervous system. In many cases he is seized suddenly 
with violent pain, but more commonly it is moderate in its onset, and gradually 
increases in severity. The pain usually starts from the pit of the stomach, and 
spreads upwards perhaps to the shoulders, but never downwards. It is usually of 
two kinds — a dull, aching pain, which is constant, and an acute, agonising pain, 
which comes on by fits and starts. The pain is often so excruciating that a strong 
man rolls on the ground in his agony. Sometimes he bends himself nearly double, 
changing his position every moment in the vain endeavour to obtain some relief from 
his sufferings. The pain may be so intense as to cause strong convulsions. At the 
onset it is relieved by pressure, and the patient keeps his hands applied to the pit 
of the stomach, or rests perhaps the weight of his body on some hard substance 
placed beneath his stomach. Subsequently there may be intense tenderness of the 
abdomen, probably in part due to the repeated straining and retching. The paroxysms 
if frequent and protracted induce great lassitude and exhaustion, the face being pale, 
the pulse slow, and the whole body covered with a profuse sweat. With the pain 
there is generally much nausea and vomiting, and sometimes hiccup, and the 
matters vomited are usually very sour. The patient is flatulent and dyspeptic, 
languid and gloomy. Sometimes inflammation arises, and then the pulse becomes 
frequent, and the skin hot, and thirst and headache are complained of. Most 
commonly there is jaundice, but not always, for the stone may be angular in 
shape, and permit the egress of bile. At length, however, the concretion passes 
into the bowels, the pain suddenly ceases, and all is soon well again. When 
onco a large calculus has forced its way through the duct, this remains per- 
manently dilated, and smaller stones may afterwards be voided without pain or 
trouble. Some people get rid of scores of gall-stones in this way in the course of 
their lives. Generally the stones are voided with the stools, and they should always 
be looked for. It is a great satisfaction to find your enemy, and make sure that 
you have got rid of him. If you don't see the calculus, you can never be absolutely 
sure that it has not fallen back into the gall-bladder, instead of getting through the 
duct. You must remember that in some cases the stone may not be passed for 
some days after the sudden subsidence of the pain. You will have to exercise a 
certain amount of care and attention in looking for the gall-stone in the motions. 
As we have seen, gall-stones when dried readily float on water, but they will not 
do so in their natural condition. It is not enough, therefore, to mix the faeces with 
water, and trust to the calculus floating up to the top, for it won't. It is necessary 
that the whole of each alvine evacuation should be carefully passed through some 
kind of fine sieve. It may be a disagreeable thing to have to do, but it is a great 
satisfaction to find the stone, and make sure of it. In one case, a man collected 
fifty-five small biliary calculi, which he voided within the space of five weeka 

When concretions pass which are small and angular, having several flat surfaces, 
the trouble is probably not over, and more may be expected. If a single stone come 
away, large, smooth, and roundish, we may trust that there are none left behind. 



GALL-STONES AND BILIARY COLIC. 285 

Now, as to the treatment of an attack of biliary colic. What are you to do 
when you are seized with the pain ? Take a draught containing twenty-five drops 
of laudanum, fifteen drops of chloric ether, half a tea-spoonful of sal-volatile, and 
twenty grains of carbonate of magnesia, in a wine-glassful of water. Should you 
not have all the ingredients at hand, put in &* many as you can. Anything that 
ordinarily relieves spasm may do good. A stiff glass of hot gin and water is alwayi 
readily obtainable. 

A hot bath should be prepared as quickly as possible, and the patient should 
stay in it as long as he can bear it, or until he feels some relief. As a rule the 
pain is so great that he cannot remain quiet for any length of time, and soon 
wants to come out. 

Hot poultices, or fomentations sprinkled with laudanum, or belladonna liniment 
may then be applied to the abdomen. A mixture of equal parts of belladonna 
liniment and chloroform liniment applied as a fomentation over the liver, or the 
seat of pain, under oiled-silk, will often give great relief. 

Immediate relief is sometimes afforded by large draughts of hot water, con- 
taining two drachms of bicarbonate of soda to the pint. The soda counteracts 
the distressing symptoms produced by the acidity of the stomach, while the hot 
water acts like a fomentation to the seat of pain. The first portions of water 
are commonly rejected almost immediately, but it may be repeated, and after 
some time it will usually be found that the pain will become less, and the water 
will be retained. Another advantage is that the water abates the severity of 
the retching, which is usually most severe and dangerous when there is nothing 
on which the stomach can react. This plan does not supersede the use of laudanum, 
and in some cases a few drops may be advantageously added to the bicarbonate of 
soda solution, if it have been once or twice rejected. 

Should these measures fail to afford relief, a hypodermic injection of morphia 
will have to be given, and it would be as well to send for the doctor. Half a 
grain of morphia — that is, six minims of a one-in-twelve solution — injected under 
the skin of the forearm will usually afford relief. This is the full dose, and should 
not be exceeded. When much laudanum or opium in any form has been adminis- 
tered, rather less morphia should be injected, say four or five minims. The great 
advantage of the hypodermic injection of morphia is that it acts so promptly. 
It must not be given to children or young people. When a hypodermic syringe 
is not at hand, a pill containing a grain of solid opium, or a quarter of a grain 
of morphia, may be given every two hours till three doses have been retained, 
or the pain subsides. If the patient is at all drowsy he is not to have any more 
opium or morphia in any form. 

Belladonna is another very excellent remedy, and is indicated when there is 
any reason for not giving opium. Four pills may be ordered, each containing 
half a grain of extract of belladonna, and one of these may be given every 
two hours. A subcutaneous injection containing one-sixtieth of a grain of atropia 
— the active principle of belladonna — with a quarter of a grain of morphia may 
be administered, and repeated if necessary every two hours. We should advise 
that such remedies as these should be given only by a doctor ; but a patient is 



286 THE TREATMENT OP DISEASES. 

often placed in circumstances in which it would be impossible to obtain skilled 
medical assistance, and jet it is felt that something must be done to relieve the 
pain. 

The inhalation of a little ether or chloroform will, even in very severe cases, 
afford almost immediate relief. We prefer ether to chloroform. About twenty 
drops should be placed on a piece of lint or on a handkerchief, which should 
be held some three or four inches from the nose, and the vapour gently inhaled ; 
it may be repeated after a short interval. The object is not to render the patient 
insensible, or to get him under the influence of the anaesthetic — that should be 
carefully avoided — but simply to relax the spasm and ease the pain. The patient 
is not to use the ether or chloroform himself, but some one is to do it for him. 
Four or five drops of nitrite of amyl inhaled in a similar way will often prove 
efficacious. When the patient flushes in the face, he is under the influence of the 
amyl, and requires no more. It often produces a peculiar sensation of pulsation in the 
head, but never insensibility. At first there will be no occasion to check vomiting if 
present, but when there is frequent and severe retching attended with pain, it will 
have to be stopped. The bismuth mixture (Pr. 18), with or without the addition 
of three minims of dilute hydrocyanic acid to each dose, soda water, or sucking ice 
will often succeed. Purgatives are of little use in expelling the stone, and simply 
exhaust the patient. 

What means must you take to dissolve or prevent this formation of gall-stones] 
What are you to do when your attack is over to guard against another? The 
great thing is to take saline purgatives and alkalies dissolved in large quantities 
of water. If you can afford it and spare the time, go to Carlsbad, Marienbad, 
Homburg, or Vichy, and drink the waters there ; if you cannot get away you 
must use the Carlsbad salts at home. They should be dissolved in a large quantity 
of water — two or three pints — and taken tepid ; you will soon be able to deter- 
mine the dose for yourself. It should be taken in the morning before breakfast, 
the drinking being prolonged over an hour or more, and if possible combined 
with out-door exercise. It is very essential to adopt a dietary similar to that 
in use at Carlsbad. Breakfast, which is taken about an hour after the waters, 
consists merely of weak tea or coffee, with milk and a little sugar, and small, 
well-baked rolls, or stale bread. Dinner is taken at one, and consists of soup free 
from fat or spices, and thickened with barley, rice, or vermicelli ; meat, such as beef, 
mutton, lamb, poultry and game, with boiled fresh vegetables ; and a light, simple 
pudding, or compete of stewed fruit. A cup of coffee may be taken in the 
afternoon, or a light supper at eight. The following articles of diet are forbidden : 
fat, butter, cream, pastry, cheese, pork, goose, sausages, salmon, mackerel, herrings, 
anchovies, entrees of all kinds, spices, pepper, onions, garlic, dressed salads, 
cucumber, uncooked fruit, and spirits. Nothing stronger than light claret is to 
be taken to drink, and even this should be avoided if possible. Smoking is 
allowed, but in the strictest moderation. The treatment is to be continued for 
thirty days. This plan can be carried out just as well in America as in Bohemia, 
although there are of course decided advantages in obtaining change of air and 
•cene. 



GIDDINESS. 287 



In addition to these measures it will be necessary to attend to the digestion and 
general health. Small doses of blue -pill are sometimes useful ; it seems to increase 
the quantity of bile, and at the same time to render it more healthy, and certainly 
it improves in a striking manner the general health. 

Lastly, it is necessary to avoid those habits which experience has shown to 
conduce to the formation of gall-stones. The patient must sleep in an airy bed-room, 
rise early, and take plenty of exercise in the open air. 

GIDDINESS. 

Giddiness or vertigo, as it is technically called, occurs in two different forms : in 
one the patient feels giddy, but objects about him remain stationary ; in the other 
external objects assume various abnormal positions — for example, articles of furniture 
in the room, or the patterns on the paper, seem to chase each other round the 
apartment, or in rare cases the vehicles in the street appear upside down, or the 
pavement undulates or feels elastic. The patient on attempting to walk sways from 
side to side, and can preserve his balance only by a strong effort of the will. There 
is a perpetual fear of falling down, and of coming in contact with other people or 
surrounding objects. In slight cases vertigo occurs only on movement; in severe 
ones when at rest also, and even during sleep. 

The sufferer from giddiness often experiences other anomalous and distressing 
sensations. Sometimes he sees only halves of things, or everything may seem 
double. One woman assured us that she always saw two cabs or two omnibuses in 
the street instead of one. The images were so distinct that she was often unable to 
distinguish the real from the imaginary. This was inconvenient, for she sometimes 
hailed the wrong omnibus by mistake. She said that if she were going up a hill, 
and a cart were in front of her, she saw a long line of them. This patient was some- 
what prone to exaggeration, but we have no doubt that her statements were in the 
main correct. Sometimes this double vision is a precursor of paralysis. We are 
told of a sportsman who one day, when out shooting, disputed with his gamekeeper 
as to the number of dogs they had in the field. He asked him how he came to 
bring so many as eight with him. The servant assured him that there were but 
four, and then the gentleman became at once aware of his condition, mounted his 
horse, and rode home. He had not been long in the house when he was attacked 
with apoplexy, and died. This, of course, is an extreme case. Some people who are 
subject to vertigo are also deaf, whilst in others the hearing is abnormally sensitive. 
With some the noise of passing vehicles assumes the intensity of thunder, whilst 
with others ordinarily loud sounds appear clear, but soft and distant. Sometimes 
in addition to the giddiness there is singing in the ears, it may be low like the 
hissing of a tea-kettle or loud like the working of machinery, or perhaps rumbling 
like the passing of a distant train. These noisas may be always present more or 
less, but usually they are loudest during an attack of giddiness. Vertigo may be 
due to brain disease, but in a great number of cases it arises from disorder of the 
stomach or liver. Sometimes it occurs quite suddenly, the sufferer being at the time 
apparently in a state of perfect health. Often enough an attack may be distinctly 



288 THE TREATMENT OP DISEASES. 

traced to an imprudent indulgence in some particular article of food. When it 
comes on at night a heavy dinner or a hasty supper will often account for it In 
the case of a gentleman who was suddenly seized with giddiness whilst walking in 
the street, the attack was attributed, probably correctly, to his having eaten very 
heartily of sausages and very rich cream at breakfast. It would seem that in 
many cases digestion progresses satisfactorily up to a certain point, when owing to 
some temporary excitement or worry the process is suspended, the stomach is upset, 
this causes disorder of the circulation in the brain, and the result is an attack of 
giddiness. Even when no special exciting cause can be detected the attack is often 
stomachal in origin. It may happen that the patient feels assured that his digestion 
and liver are in perfect working order, and yet for all that treatment directed to 
those organs will effect a cure. Stomach giddiness differs in several important 
respects from giddiness resulting from brain disease. Thus it is never associated 
with loss of consciousness, and at times the patient is perfectly free from it. It is 
increased by excitement, by long fasting, and usually the severe attacks occur when 
the stomach is empty. A stimulus in the form of wine or brandy affords relief, 
and so does food taken in moderation. Sometimes, though not always, closing the 
eyes, or gazing steadily at some fixed object, mitigates the intensity of the sensation 
or affords temporary relief. In some cases the giddiness is slight but almost 
constant, but more frequently it comes on in paroxysms lasting from a few minutes 
to an hour or mora 

Another cause of giddiness is over-work. It occurs chiefly in those who, in 
addition to being over-worked, are not too well blessed with this world's goods. Those 
who are in comfortable circumstances and well fed may do many things with im- 
punity which soon tell on those who are ill-clothed, badly lodged, and have not 
enough to eat. This kind of vertigo is common enough in hospital practice, the 
victims of it being very often poor seamstresses and others in a similar position of 
life. The attacks are usually of short duration, they occur at intervals of some hours 
or days, and especially after prolonged exertion, or poorer diet than usual. People 
in a rather better social position sometimes suffer from this form of vertigo, and it is 
then usually associated with a want of clearness of intellect, and an incapacity for 
sustained mental exertion. Sometimes irritability of temper, restlessness, a sense of 
impending evil, and more rarely sleeplessness are complained of. Sometimes the 
giddiness is induced by the appearance of objects in motion, and this may occur 
with such frequency that the patient is practically confined to the house. It is 
probable that in many of these cases there is a general state of debility or want of 
vitality, of which the giddiness is only one of the exponent symptoms. 

Sometimes swimming in the head depends entirely on disease of the ear. These 
cases are comparatively rare, but we have met with two or three very striking 
instances. There is usually an association of vertigo on movement, with singing in 
the ears and partial deafness. This combination of symptoms is sometimes known 
as Meniere's disease, after the French doctor who first described it. Persons in fair 
average health, and without any stomach or other obvious disorder, usually suffer 
most. 

Giddiness occurring in the aged often arises from the stomach, but is frequently 



6IDDINES8. 289 

met with independently of any disturbance of that organ. As years go by the 
vessels, of the brain lose their elasticity, and the circulation becomes irregular, so that 
there is congestion in one part and deficiency of blood in another. 

In persons under fifty years of age, giddiness is not a complaint that need give rise 
to much anxiety. There is no danger to life — the fear of apoplexy or paralysis is as 
a rule unfounded. Sudden and violent attacks of vertigo, however unpleasant they 
may be, are seldom dangerous, and in the vast majority of cases depend on some 
disorder of the digestive organs. In persons over fifty the occurrence of vertigo for 
the first time calls for strict investigation. A constant sense of uncertainty in 
movement, a susceptibility or inclination to giddiness from the motion of passing 
objects, especially if combined with a cloudiness of intelligence, is not a favourable 
omen. When a severe attack without obvious cause occurs to a person advanced 
in life, the greatest care must be taken, the more so if it be associated with 
vomiting, or constant nausea, tingling of the extremities, or pins and neeilles in the 
hands or feet. It may be laid down as a rule that the longer the complaint has 
existed in any given case, the less likely is it to prove dangerous. 

Giddiness occurring in people below the age of forty often yields readily to 
remedies directed to the liver and stomach. It is a good plan to begin treatment 
with a blue-pill at bed-time, and a black draught or dose of rhubarb in the morning. 
If the bowels show any tendency to become constipated, they may be kept in order 
with Friedrichshall water. For correcting acidity and improving the tone of the 
stomach, the gentian and soda mixture (Pr. 14) should be taken in two table-spoon- 
ful doses three times a day, half an hour before meals. The addition of five minims 
of tincture of nux vomica to each dose often increases its efficacy. Food should be 
taken in small quantities, and should be well and frequently masticated. Should 
the teeth be decayed they should be seen to at once, and the skill of the dentist must 
be resorted to for supplying any that may be wanting. A man often dates his 
restoration to health from the time he had a set of false teeth. Probably the best 
thing to drink is Vichy water, with a little brandy in it at meals. Malt liquors are, 
as a rule, to be avoided. The tub in the morning, regular hours, sleeping on a 
mattress in a large airy room, and out-door exercise, are great adjuvants to treatment. 
We need hardly say that freedom from the cares and anxieties of business is very 
desirable ; even should the vertigo prove to be not stomachal in origin, this pre- 
paratory treatment is likely to do good, and in the majority of cases it alone will 
effect a cure. Should ansemia be present, iron (Prs. 2, 3, 6, or 7) is indicated, 

In vertigo from mental anxiety or over- work, bromide of potassium (Pr. 31) often 
does a great deal of good. This remedy is also indicated in the giddiness occurring 
in women about the period of the change of life. When poor living and scanty food 
are the accompaniments of over-work, we gain more from measures directed to the 
improvement of nutrition. Generous living and a moderate allowance of a good 
full-bodied wine do more good than anything. In addition, Parrish's Chemical 
Food, ammonia and bark (Pr. 13), or the quinine mixture (Pr. 9), may be employed 
as adjuncts. In some instances very great benefit is derived from the syrup of 
hypophosphite of lime (Pr. 55). 

When there are threatenings of paralysis, caution must be employed in taking 
19 



290 THE TREATMENT OF DISEASES. 

stimulants, although we should certainly not advocate a lowering mode of treatment. 
We want to give tone to the system, and improve the general nutrition, and not to 
increase the debility. For the vertigo of old people nothing does better than cod- 
liver oil taken in tea-spoonful doses three times a day. 

There are other remedies which are of use in special cases. Thus, we have some- 
times obtained good results from the administration of tincture of gelseminum in 
five-drop doses in water, every three hours. Sometimes ten drops will succeed when 
the smaller dose has failed. In vertigo accompanied by congestion of the face, 
belladonna (Pr. 39) often does a great deal of good. It is to be given when the 
giddiness is worse on movement but relieved in the open air. Heavy drooping eye- 
lids, dimness of vision, and flashes of light before the eyes, are indications for its 
use, as are also a hot head and a sensation of burning in the eyeballs. The internal 
administration of belladonna may be accompanied by the application of a belladonna 
plaster over the region of the heart. 

For Meniere's disease carefully syringing the ears with tepid water does good. 
Sometimes the application of a small blister behind the ear is attended with good 
results. A combination of belladonna and gelseminum may sometimes be given with 
advantage. 

whiskey-drinker's liver (cirrhosis of the liver). 

The most frequent cause of this complaint is spirit-drinking. When alcohol 
is introduced into the stomach in the ordinary way, it nearly all passes through 
the liver. Undiluted spirits are much more injurious than when mixed with 
water, and produce greater irritation. Alcohol consumed as wine or beer is far 
less destructive to the liver than when taken in the form of ardent spirits. A 
hot climate intensifies all the vicious effects of alcohoL 

The symptoms of cirrhosis of the liver are in the early stages often obscure, but 
later they are sufficiently well marked. At first the liver gets slightly enlarged, and 
the patient suffers from pain in the right side, indigestion, wind, and costive bowels. 
He is occasionally feverish, his skin is hot and dry, and he has a peculiar unhealthy 
sallow look, which he probably fails to notice, but which is sufficiently obvious to 
his friends. The necessity for making a change in his habits is forced upon his 
attention, and for a week or two he is under the doctor's orders, and not feeling 
able to drink any more, he consents to follow a restricted diet, and to take a course 
of purgatives. Soon the most prominent symptoms are relieved, he fancies himself 
well again, and quickly returns to his old habits. Gradually, however, he notices 
tha,t he is getting thinner and weaker, and occasionally he has a good deal of pain in 
the side. He is nervous and out of sorts. He has no longer the pluck he used to 
have ; first his friends notice it, and then he gradually becomes aware of it himself. 
He finds that he is not " fit for business," and he is afraid to see people. If a trades- 
man, he no longer displays his old energy. He is anxious about his business, for it 
is falling off, and things don't work as well as they used to, and yet for the life of 
him he cannot pull himself together. Things go on like this for months and months, 
or even for a year or two. The patient has occasional attacks of diarrhoea, his 
appetite fails, his urine gets thick and scanty, and the emaciation and debility 



GOUT. 391 

increase. He tries all kinds of treatment, but never sticks to one for long at a iame, 
He consults every one cf any note in the city, but derives little if any benefit from 
their advice. The majority of them express no opinion as to the nature of the 
complaint, but hint in a guarded way that he should take nothing but light claret. 
Finally, some one bolder than the rest tells him it is all drink, and that he will 
get better if he will only become more abstemious. The advice is considered an act 
of impertinence, and is promptly disregarded, although the patient feels in his heart 
of hearts that it is right. He would give up the drink if he could, but he can't 
His self-reliance is gone, the alcohol .has stolen away his will, and he is utterly 
incapable of giving up the dangerous fascination. He will take an oath to-day that 
he will never touch another drop of spirit, and will probably break it to-morrow. 
Sometimes he wishes that some one would lock him up in an asylum, or that by 
some chance or other he could have six months' imprisonment, but he never feels 
able to put himself under restraint. After a time the liver gets smaller, and this, 
instead of being a good sign, is a bad one, for it is contracting. The belly begins to 
swell, and gradually fills with a dropsical effusion. He now feels that he cannot get 
about any more, and has to take to his bed. Doctors come to see him, he has the best 
of advice, but they can do little or nothing for him. He would willingly enough 
consent to knock off drink now, but it is too late ; the mischief is done, the liver is 
in a state of cirrhosis, and no medicine can restore it to its natural condition. The 
fluid in the belly gradually increases in quantity, and after some months of suffering 
the patient dies from exhaustion. Is there any remedy for this horiible complaint? 
Yes, one, teetotalism — absolute abstinence from alcoholic liquors of all kinds. This 
remedy must be applied early. If you wait till your liver has undergone serious 
organic change, it is too late. No half-measures will suffice ; you will have to give 
up drink of all kinds. Do this, and you will recover ; go on on your old plan, and 
you will quickly die a painful and degrading death. If you feel that your will is so 
weak that you cannot be trusted, get your friends to put you in an institution for 
dipsomaniacs for a month or two. It would probably save your life. There is 
never any danger in cutting off drink quite suddenly. For a day or two you will 
feel terribly depressed, but this will soon pass off. The craving for stimulants may 
often be allayed by some bitter infusion, say of gentian or cascarilla, containing 
three or four drops of tincture of nux vomica or ten drops of sal volatile or tincture 
of ginger to the dose. The perchloride of iron mixtures (Pr. 1 or 2) often serve 
this purpose better than anything. 

Attention to the diet is also of importance. This ought to consist of such articles 
as milk, eggs, plainly-cooked white fish, meat, poultry, and game. Rich sweets and 
greasy dishes, as well as hot spices and indigestible foods of all kinds, are strictly 
interdicted. Regular exercise in the open air and attention to the bowels are to be 
enjoined. 

GOUT. 

The phenomena which constitute gout are, we fear, only too familiar to many 
of our readers. 

In many cases the first attack comes on without any previous warning, but 



292 THE TREATMENT OF DISEASES. 

sometimes it is preceded by some disorder of the stomach, such as diminished appe- 
tite, flatulence, heartburn, or nausea. As a rule, the patient who may have gone 
to bed and to sleep in his usual health, and without any suspicion of the sufferings 
in store for him, awakes about three in the morning with a severe pain in the 
foot, usually in the ball of the big toe. He attempts to get out of bed, but 
finds that he cannot put his foot to ths ground, or if he succeeds in so doing, the 
act is accompanied with very great pain. On examining the affected joint, it is 
found to be hot, red, swollen, and exquisitely tender. The veins proceeding from 
the toe are turgid with blood, and the joint is stiff. The pain is so great that 
the weight of the bed-clothes is insupportable, and the mere vibration of the room 
causes discomfort. The pain is usually spoken of as being of a most agonising 
description. It is described as a grinding, crushing, wrenching pain, and is some- 
times likened to a red-hot iron being suddenly thrust into the joint The pain 
is attended with great restlessness, and the patient in his vain search for relief is 
perpetually shifting his foot from place to place, and from posture to posture. 

There may be no constitutional disturbance, but usually the pain is ushered in 
by more or less cold shivering, followed by heat of skin, perspiration, thirst, loss 
of appetite, a white furred tongue, and confined bowels. The urine is small in 
quantity, high-coloured, and deposits on cooling a pinkish or reddish sediment. 

If moderate precautions are taken, and the foot kept up on the bed or couch, 
the inflammation subsides in the early part of the day, but it usually gets worse 
towards evening, and for the greater part of the night the patient is kept awake 
by the pain, which, however, again subsides as morning advances. 

In a few days relief is obtained, and the tension and swelling are diminished, 
as well as the heat and redness. The skin usually peels off in the neighbourhood of 
the joint, occasionally in flakes of considerable size, the process being attended with 
troublesome itching. The duration of the joint inflammation varies considerably 
in different cases, and is much influenced by the diet and mode of treatment adopted. 
Occasionally it lasts ten days, or even longer, but if care be taken it may usually 
be got rid of in from four to five days. After the attack is over the patient not 
uncommonly feels all the better for it, and says it has done him good. He very 
frequently enjoys greater ease and alacrity in the functions both of body and mind 
than he had for a long time previously experienced. 

The disorder which has thus departed almost inevitably returns. At first it 
may not recur oftener than once in every three or four years, but after a time the 
intervals get gradually shorter and shorter, till the attacks become annual, happen- 
ing about the same time every year, and finally they return several times during 
the course of the autumn, winter, and spring. As the fits increase in frequency 
their duration becomes protracted, so that in an advanced state of the disease the 
patient is, with the exception of a few months in the summer, scarcely ever free 
from it. 

As we have already said, the ball of the great toe is commonly selected as the 
first seat of the disease, but occasionally this joint escapes altogether. An old 
injury to a joint, as, for example, a stiff knee resulting from a fall from a horse, 
will attract gout to the damaged part, and will moreover cause it to linger there 



gout. 293 

longer than in other localities. It is often said the gout differs from rheumatism 
in implicating the smaller joints of the body. This is true, if reference be made 
solely to the earlier attacks, but after a time the larger and smaller joints are indis- 
criminately affected. In severe cases there may be scarcely a joint which has not 
been attacked at some time or another. The hips and shoulders are the least liable 
to be attacked, but even they do not always escape. After the earlier attacks the 
joints soon recover their former strength and pliancy, but when the disorder has 
recurred again and again, they are not so readily nor so completely restored to their 
previous condition, but remain weak and stiff, and sometimes they lose at length 
their capacity for motion altogether. It is a curious and at the same time a for- 
tunate circumstance, that however active the inflammation may be, it never runs 
on to the formation of matter. The only exception to this is in cases where there 
has been a chalky deposit in the joint, and then the matter arises from the irri- 
tation caused by the presence of the foreign body, and is not directly owing to 
the gout. 

As we have said, an attack of gout is sometimes ushered in by irritability of the 
stomach. In many gouty people, however, irritability of the temper is a more 
common symptom. You often hear a wife say of her gouty husband that she 
knows he is going to have one of his bad attacks, for "he has been like a bear with a 
sore head for the last day or two." Palpitation of the heart is experienced by some 
people on the eve of a gouty seizure, whilst others suffer from a kind of asthma- 
It is not uncommon to find some derangement of the bowels, and this may take the 
form either of diarrhoea or constipation. 

The amount of fever, or in other words elevation of temperature, which accom- 
panies the actual attack is always in direct proportion to the number of joints 
affected. It is always' secondary, occurring as the result of the inflammation. 

In old long-standing cases of gout, " chalk-stones " not unfrequently make their 
appearance around the joints. This chalk-like matter is deposited at first in a half- 
fluid state resembling cream or soft mortar, and it then gradually becomes dry 
and hard. These concretions are not really composed of chalk, but of a substance 
known as urate of soda. It is often deposited around the knuckles, and it is said 
that people who are inclined to make the best of a bad job have been known to 
utilise their affected joints to chalk or score the game upon the table whilst playing 
cards. These chalky deposits not uncommonly cause such deformity of the hands 
that their natural shape is completely lost, and they are for all ordinary purposes of 
life practically useless. Sometimes the fingers are swollen to such an extent that 
they look for all the world like a bunch of carrots with their heads forwards, the 
nails taking the place of the stalks. When these deposits are seen, no doubt can 
ever exist as to the nature of the complaint from which the patient is suffering. 
Curiously enough, a little chalk-stone is not uncommonly found on the ear just at 
the margin. In all doubtful cases of gout it is as well to examine this region, for if 
this deposit is detected, the nature of the complaint is clear. 

There are several varieties of what is called " irregular " gout, and of these the 
most common is gout in the stomach. The attack usually commences in the ordinary 
way with inflammation of one of the joints, but the pain — which is never very 



294 THE TREATMENT OP DISEASES, 

intense — quickly and abruptly subsides, its disappearance being accompanied with 
disturbance of the stomach, usually indicated by sickness, vomiting, and pain or 
spasm of that organ. There is a very prevalent opinion that if a person be exposed 
to a chill or catch cold whilst suffering from gout, the disease is " liable to be driven 
inwards," and there is no doubt that under these circumstances very disagreeable, or 
even dangerous, symptoms may arise. 

In certain rare cases, apoplexy, epilepsy, and mania have resulted from gout. 
Neuralgia and sciatica are far more common under these circumstances. Skin 
eruptions are very common in gouty people, and in many instances the skin and 
joint affection are suffered from alternately. Gravel and stone are also common ; 
but, possibly as a set-off against this long string of evils, the gouty very rarely suffer 
from consumption. 

There are few diseases which are more distinctly hereditary than gout. Its 
tendency to run in families must have been noticed by the most casual observer. 
It is certainly true, as regards this malady, that the sins of the fathers are visited 
upon the children to the third and fourth generation. It is said that gout frequently 
skips a generation, and that it more commonly attacks the grandchildren than the 
children. The explanation of this is in many cases sufficiently simple. Frequently 
the child of a very gouty father, having his bad example constantly before his eyes, 
would lead such an abstemious life as to keep the foe at bay ; but the grandchildren, 
being fully under the hereditary influence, but not having the advantage of the 
"frightful example," take no special precautions, and very soon fall victims to their 
ever- watchful enemy. 

Gout is almost exclusively a disease of the male sex. This exemption, or rather 
comparative exemption, is probably dependent more upon certain periodical func- 
tional peculiarities of the female sex than upon any essential difference in their 
mode of life. It has been frequently noticed that women who suffer from gout are 
robust, full-blooded, and of a masculine turn both of body and mind. Gout, when 
it does occur in women, very rarely makes its appearance till after the age of 
forty-five. 

Gout is rarely met with in either sex in people under thirty. To this rule there 
are, however, exceptions, for gout has been known to occur in boys of sixteen whilst 
at school. There can be but little doubt that in these cases a strongly inherited pre- 
disposition must have been fostered by a mode of life not of the most abstemious. 

It has never been conclusively shown that what we call temperament exerts any 
special influence on the development of gout, but still there is a very general opinion 
that it most commonly attacks men of robust and large bodies, and of full and 
corpulent habits. 

The disposition to gout may be engendered, and when inherited will be infallibly 
strengthened and developed, by certain habits of life. Excessive indulgence in 
alcoholic beverages must rank first and foremost amongst the circumstances which 
are directly under the control of the individual. Distilled spirits, such as gin and 
whisky and brandy, have less tendency to induce gout than either wine or malt 
liquors. Among the labouring classes in London, gout is by no means uncommon, 
whilst in the corresponding class in Edinburgh and Glasgow it very rarely occurs. 



GOUT. 295 

There can be but little doubt that the explanation is that amongst the former ale 
and porter are the popular beverages, whilst the latter confine their attention almost 
exclusively to whisky. In many of the large cities on the Continent, where the 
lighter kinds of claret form almost the sole alcoholic beverage, gout k very 
uncommon. 

It is a well-known fact that excessive indulgence in food, more particularly in 
animal food, is very favourable to the production of gout. It has been noticed that 
those who live upon an exclusively vegetable diet hardly ever suffer from this 
disease. Sedentary and luxurious habits are favourable to its development. 

Many people seem to imagine that it is a mark of distinction to have had the 
gout, something to be proud of and to boast about. This absurd notion evidently 
originated in the fact that it is essentially a disease of the upper and middle classes, 
and that it is peculiarly incidental to the wealthy and indolent. We sometimes 
hear of " poor man's gout," but this, in nine cases out of ten, means rheumatism. 
When we find a case of gout in any of our hospitals, the patient will generally prove 
to be a servant in a gentleman's family — people who are seldom total abstainers. 

There is a pattern of body which is believed to be favourable to the acquisition 
of gout. " It attacks (says Cullen) especially men of robust and large bodies, men of 
large heads, of full and corpulent habits, and men whose skins are covered with a 
thicker rete mucosum (the second layer of the skin), which gives a coarser surface." 

Painters, plumbers, and others whose occupations expose them to the influence 
of lead and lead-poisoning, often become the subjects of gout. It has even been 
found that the prolonged medical use of sugar of lead, as in cases of bleeding from the 
nose or stomach, or other part, may, in people of a gouty habit, occasion an attack. 

A fit of gout may be brought on by various circumstances. An unusually severe 
debauch may act as the exciting cause. Depressing emotions, and over-fatigue, 
particularly when produced by too long a walk, may be followed by the same result. 
In fact, anything which depresses the general bodily health favours in a gouty subject 
the production of an attack. 

The influence of climate and season on the production of gout is well marked. 
The complaint is far less prevalent in hot than in cold or temperate regions. A 
gouty individual may often escape his accustomed winter attacks by spending the 
colder months of the year in Arkansas or Florida. The increased functional activity 
of the skin in hot climates is in all probability the cause of this exemption. 

An acute attack of gout in one of the joints is probably never fatal, but when the 
disease becomes chronic it has an undoubted tendency to shorten life. The appear- 
ance of gout is always a serious matter, and should never, as some people seem to 
think, be regarded as a matter for congratulation. The earlier the age at which gout 
first makes its appearance, the. more serious are his future prospects, particularly 
when the complaint is hereditary. The appearance of chalk-stones, even in the most 
trivial form, is an unfavourable sign. 

Can gout be cured ? We believe that if the patient will only take warning by 
his first attack, and make a thorough alteration in his habits and mode of living, the 
disease may be entirely eradicated from the system, and will never return. We know 
of no drug or combination of drugs which, unaided, is capable of effecting this result. 



396 THE TREATMENT OF DISEASES. 

The only real remedy, abstemiousness, is in the patient's own hands, and if he refuses 
to use it, it is his own look-out. 

What should be done in an attack of acute gout t In the first place, the patient 
must be kept in a warm room, as quiet as possible, and should on no account be 
allowed to make any attempt to get about The diet must be of the simplest 
possible description, but milk, arrowroot, tapioca, sago, biscuits, toast, toast-and- 
water, and other similar articles may be taken without restriction. The affected 
member should be wrapped in flannel, and should be kept strictly in the horizontal 
position, never being allowed to hang down or support its own weight. 

When the pain is very severe, contractile collodion, which may be advantageously 
mixed with a little tincture of iodine, painted over the inflamed joint, will speedily 
give relief, although at first the pain may be temporarily increased. Care must be 
taken not to apply too many coats of the collodion, or the contraction produced may 
be too great, and it may do more harm than good. 

Colchicum is undoubtedly the best internal remedy both for acute and chronic 
gout A drachm of colchicum wine given in a little water will often remove the 
severest pain in the course of an hour or two. By some the administration of a 
drop of colchicum wine every twenty, thirty, or sixty minutes is preferred, but 
these smaller doses take much longer before they produce the desired effect When 
there is much acidity of the stomach, the colchicum may be advantageously given 
with a little carbonate of potash or other simple alkali In all cases in which the 
bowels are confined a free evacuation should be obtained. A compound colocynth 
pill (Pr. 60), or a seidlitz powder, or the white mixture (Pr. 25), will usually answer 
admirably. Mercury and its compounds should be given with considerable caution 
to gouty people, as in them it often produces very unpleasant effects. The hot 
air or vapour bath may prove useful in promoting the action of the skin. * 

In chronic as in acute gout, the remedy on which we place the greatest reliance 
is colchicum. The action of this drug in curing gout is as marked as that of 
quinine in curing ague. Some people appear to have an unfounded prejudice 
against the use of colchicum ; if judiciously administered it can never by any 
chance do harm. It must always be borne in mind, however, that colchicum is 
merely palliative, relieving for a time the patient's sufferings, but in no way 
protecting him from a recurrence of his attacks. Some people say that col- 
chicum whilst it cures one attack hastens the return of another, but we believe 
that there is no truth in this statement In chronic cases twenty drops of 
colchicum wine may be given in water every four hours until relief is obtained. 

In old-standing cases where colchicum has not succeeded so well as might be 
wished, a tea-spoonful of the ammoniated tincture of guaiacum given three times a 
day in a little milk may prove useful. 

When the pain is distinctly worse at night, or is experienced only at that time, 
the colchicum wine may be administered in combination with the iodide of potassium 
mixture (Pr. 32). Iodine liniment painted over and around a joint swollen from 
gouty inflammation will often do good. 

In China, oil of peppermint is used as a local application, and the relief is said 
to be almost instantaneous. 



goot. 297 

A cold wet linen compress, constantly applied and frequently renewed, will dc 
much to relieve & painful joint. 

The Turkish bath is particularly valuable in chronic gout, but, as might be 
expected, it is not always equally serviceable. In long-standing cases, where the 
attacks have occurred so frequently as to distort the joints by deposits, and the patient 
is, perhaps, liable to repeated relapses, and is scarcely ever free from pain, the 
efficacy of the bath, though striking, is less apparent than in milder and more 
tractable forms. 

Of late years lithia has been extensively used for the removal of the chalky 
deposits, particularly when the skin is broken. The urate of soda, of which they 
are composed, is readily dissolved by carbonate of lithia, and if a solution of this 
salt of the strength of five grains to the ounce of water be employed, they may in 
time be removed. The affected joints must be constantly enveloped in lint or rag 
kept moist with the solution. In many cases this method of treatment has proved 
very successful, and not only have considerable enlargements been removed, but 
suppleness and even free movement have been restored to previously stiff and 
useless joints. The treatment is necessarily somewhat tedious, and many weeks, or 
even months, may be required to remove large deposits. The local application may 
be supplemented by the internal administration three times a day of eight grains 
of carbonate of lithia dissolved in any aerated water, or the citrate of lithia may 
be given in the same or larger doses. 

We must now consider the treatment "which should be adopted by gouty patients 
in the intervals between their attacks. A few general rules will be given, and they 
will be found more especially applicable to those who suffer from chronic gout. 

A good plain solid diet should be adopted, but care should be taken to avoid 
excessive indulgence in animal food. It is hardly necessary to say that the patient 
should never eat anything which he knows disagrees with him, or causes unpleasant 
symptoms of any kind. As a rule, what are called " made dishes," and all rich 
and highly-spiced food, should be tabooed. Pork and veal, and all salted or 
potted meats are more or less indigestible, and must be regarded with suspicion. 
Beef and mutton, white fish, fowl, and game are nearly always admissible, so that 
the patient is in no danger of starvation 

There should be a due admixture of animal and vegetable food ; and potatoes, 
greens, peas, beans, and the like, may be taken with advantage. The softer kinds of 
fruit, such as strawberries, grapes, oranges, and baked or stewed apples and pears, 
will, if taken in moderation, do no harm, but plums and other stone-fruit should, 
when uncooked, be avoided. 

Sugar and sweets of all kinds lead to the production of acidity, and favour the 
development of gout. 

As to beverages, tea, coffee, and cocoa are in most cases admissible. Young 
people can usually get along very well without stimulants of any kind, and we 
should strongly advise any person in whom gout makes its appearance at an early 
age to become a total abstainer. In the case of old people with health broken by 
disease and long suffering, a certain amount of alcohol is necessary. All malt 
liquors are to be eschewed. The wines to be most carefully avoided by the gouty 



298 THE TREATMENT OP DISEASES. 

are port, sherry, and madeira. Sherry, however dry and pure, is by no means the 
innocent beverage, as far as the production of gout is concerned, that some people 
seem to imagine. The best wine to take is a good sound claret, free from sugar and 
without acidity. 

Probably the best drink for a gouty patient is brandy, taken in strictly limited 
quantities, and freely diluted with water. Whisky, hollands, or gin, may in some 
cases be substituted, but the change should be made with a certain amount of 
caution. The spirit-and- water should be taken solely at meal- times. The quantity 
consumed in the course of the day will vary in different cases from one to three 
fluid ounces, the exact amount being dependent to some extent upon the previous 
habits of the patient. 

Exercise should be regularly and habitually taken, and walking may be advan- 
tageously combined with riding. Excessive fatigue always does far more harm than 
good, and should be guarded against. 

Early and regular hours are of much importance, as is the avoidance of all severe 
mental application. The importance of plenty of fresh air in maintaining health 
and warding off attacks cannot be over-estimated. Removal to a warm, dry climate 
during the colder months of the year will in many cases enable the patient to escape 
his autumn and winter attacks. 

It is extremely difficult to lay down any general rules for the treatment of the 
irregular forms of gout, such for instance as gout in the stomach. The personal 
attendance of a medical man will, in most of those cases, be found necessary. The 
administration of colchicum wine is usually advisable in the irregular as in the more 
orthodox forms of gout 

GRAVEL. 

A patient is said to suffer from gravel when he passes solid matter with his 
urine, whether in the form of powder, grit, or sand. The term is not applied to 
those cases in which the water is clear when recently voided and still warm, but 
throws down a powdery sediment as it cools, which sediment redissolves on warming 
the urine before the fire or in any other way that may be convenient. There are 
several different kinds of gravel, but in the large majority of cases the deposit con- 
sists of uric acid, which is thrown down in the form of red or yellow sand. If 
carefully examined this deposit will be found to consist of little crystals, resembling 
in shape, size, and colour Cayenne pepper. The urine is, at the same time, bright 
and of a dark golden or coppery colour, like brown sherry. Sometimes it feels hot 
and almost scalding as it is being passed. It is more acid than perfectly natural 
urine, and turns blue litmus paper a bright red colour. Often enough the quantity 
passed is below the average, and the specific gravity or density will be found to be 
higher than natural This deposit must not be confounded with the pale pink 
sediment so often seen at the bottom of the utensil on a cold winter's morning. 
That is never deposited until the urine has had time to cool, and is immediately 
redissolved when the urine is warmed up to about the temperature Df the body. 
True gravel cannot be made to disappear in this way. Moreover, the latter does 
not render the whole of the urine turbid when shaken, but rolls over at the bottom 



GRAVEL. 299 

when the vessel is slowly tilted so as not to trouble the general transparency of the 
water. With a little care no difficulty will be experienced in distinguishing true 
from false gravel. 

There is no doubt that a tendency to the formation of gravel is hereditary. This 
hereditary tendency varies in force or strength in different families. Some people 
begin to pass gravel at thirty or sooner, others at forty, and again others not till 
they are sixty. As a rule, the earlier the age at which it makes its appearance, the 
stronger is the hereditary predisposition, and the more difficult will it be, in all pro- 
bability, to effect a cure. There is a curious relationship between gravel and gout. 
Sometimes these two complaint? seem to alternate, comparing one generation with 
another ; thus, gout appears in the one, gravel in the second, gout again in the third, 
and so on. And the same individual may have alternate attacks of gout and gravel, 
and this is by no means uncommon. The majority of people who suffer from this 
condition live an indolent and luxurious, if not an intemperate life. Adults are 
peculiarly obnoxious to it after the age of forty. They are usually in addition 
troubled with transient twinging pains in their limbs, and often during an " attack 
of gravel " suffer from pain in the back and a general sense of discomfort. Some 
people pass gravel daily and habitually, whilst others do so only every few weeks, 
but then in considerable quantity. These attacks occur at varying intervals, and 
usually increase in frequency and severity unless treatment is resorted to. 

The presence of gravel in the urine is not to be regarded as an indication of 
kidney disease. In the vast majority of cases it means simply that the liver is inactive. 
It fails to perform its duty as an excreting organ, and the result is that an extra 
amount of work is thrown on the kidneys. In the case of people who suffer from 
gravel it will usually be found that the bowels are sluggish, that the appetite is 
impaired, and the digestion is performed imperfectly. These may not be very pro- 
minent symptoms, especially if the diet be carefully selected, and the patient is able 
to take plenty of exercise and pass most of his time in the open air, but still they 
are always present more or less. 

It is obvious from what we have said that our treatment should be directed 
rather to the liver than to the kidneys. A most valuable drug in these cases is 
blue-pill. But still it must be remembered that gravel is essentially a chronic 
complaint, and one cannot indulge in blue-pill to an unlimited extent "We have 
consequently to look round for some drug or combination of drugs that will prove 
equally efficacious, but will be less likely to act injuriously on the system if continued 
for a considerable time. We find what we require in certain natural mineral waters, 
such as the Friedrichshall and Pullna, and of these the former is usually preferred, 
on the grounds that it does not purge too freely, that it does not gripe, and that it is 
not very disagreeable to take. The dose of Friedrichshall water is about half a 
tumblerful, and it should not be taken pure, but diluted with from a third to half 
of its bulk of hot water. A great advantage is that it may be taken for many 
weeks without losing its effect. It should be taken in the early morning, say an 
hour or so before breakfast ; and then, after the cup or two of hot tea or coffee 
accompanying that meal, there is usually a full, free action of the bowels. Some 
people prefer the Marienbad water, which contains enough free carbonic acid to make 



300 THE TREATMENT OF DISEASE* 

it an agreeable and slightly sparkling draught. Rather more than half a pint ia 
required to produce an easy motion. The waters both of Vichy and Yals have 
attained a high position in the treatment both of gout and gravel By many it is 
maintained that their action on the liver is slight, and that although patients are 
often better for a time after a visit to Vichy, they are not permanently benefited. 
There is no occasion to drink the waters at the spa, for the majority of them are 
imported, and may be obtained without difficulty. The course should extend over 
a period of from six to nine weeks. It may be said that this is an expensive mode 
of treatment ; but it must be remembered that gout and gravel are essentially the 
heritage of the rich and well-to-do, and not of the poorer classes. The artificial 
imitations of the natural waters are of comparatively little value. 

In addition to medicinal treatment the diet must be carefully regulated. In the 
first place, alcohol must be taken very moderately, and the lighter wines are to be 
preferred. Port, sherry, and champagne are unsuitable, and beer is absolutely for- 
bidden. Probably the best drink for the sufferer from gravel is a light, sound 
Bordeaux, or a Rhine wine of similar quality. Sugar is strictly tabooed, and fat, 
butter, cream, and pastry are to be taken, if at all, very sparingly. Abstinence from 
those articles of diet will greatly lighten the work of the liver, and lessen the 
unnatural strain thrown on the kidneys. In some kinds of gravel, rhubarb, from 
the amount of oxalate of lime it contains, is especially injurious. 

In many cases great benefit is derived from the simple expedient of taking 
a tumbler of cold water a couple of hours or so before dinner, and another on 
retiring to rest. It is found, too, as the result of practical experience, that a 
long interval should not elapse between meals, and that the period devoted to 
sleep should not be too prolonged. Many people suffering from gravel take a 
little bicarbonate or citrate of potash in a tumbler of water every night at bed-time 
and again on rising in the morning. This is simply a temporary expedient, and 
seldom does any permanent good. The great thing is to pay strict attention to 
diet. The following case forcibly illustrates the effects of good living on the 
production of gravel : — " A Dutch merchant had an ample fortune, and lived in 
accordance with his means, keeping a good table, and indulging in its pleasures 
freely. He was at this time tormented with gout and graveL Unexpectedly he 
lost all his fortune, through a political crisis, and was obliged to take refuge in 
England, where he lived more than a year, almost in poverty, amid numerous 
privations, but his gout completely disappeared. Little by little he succeeded 
in repairing his affairs; he resumed his old mode of life, and the gravel was 
not long in reappearing. A second reverse robbed him in a short time of 
all he had gained; he passed into France almost without resources, and his 
regimen was consonant to his means ; the gravel disappeared. Once again his 
industry restored him to a H,fe of plenty and ease, and he abandoned himself again 
to the indulgences of the table, and with them appeared once more his old enemy, 
the graveL" 



HAY FEVER — HAY ASTHMA. 301 



HAY FEVER — HAY ASTHMA. 

In the northern part of the United States of America there are two distinct 
forms of annually appearing catarrh — one known as the "rose cold," or "June 
cold," commencing during the last week in May or the first week in June, and 
continuing until about the first week in July. " Peach cold " is an affection of 
similar nature. 

The other and the most common, for which Dr. Wyman proposes the name of 
autumnal catarrh, returns about the 20th of August, varying but a few days from 
this date in different years. By some individuals it is believed to be remarkably 
punctual, being first noticed on precisely the same day of the month, and, it is even 
asserted, at the same hour of the day. 

It is first perceived as a slight itching in the palate and in the parts about the 
roof of the mouth, soon followed by similar sensations, apparently in the Eustachian 
tube, extending from the throat into the ears, and inducing the sufferer to attempt 
relief by swallowing, and rubbing his tongue against the back part of the hard 
palate, and by pressing and rubbing the external orifice of the ear to give motion 
to the parts within. Usually there is headache, which is often severe, together 
with suffusion of the eyes, sneezing, irritation of the nose and back of the throat, 
and a dry, harassing cough. Then, at intervals there may be experienced 
attacks of asthma, lasting for two or three hours, the shortness of breathing 
being sometimes so urgent that the patient experiences the most distressing 
sensations of impending suffocation. First attacks of hay fever are generally 
milder and less persistent than the subsequent ones, the susceptibility apparently 
increasing year by year. In the early stages sneezing and running from the 
eyes and nose are the prominent symptoms, but subsequently the asthmatic element 
is superadded. If the affection be left to itself the duration is usually from three 
to five weeks, and even in cases most carefully treated the attack may last for 
a month. 

It is a curious circumstance that hay fever should be almost exclusively confined 
to the educated classes, but so it is. As an American writer humorously remarks: 
— " The complaint is not met with in the plebs, the commune vulgus, the oi polloi, 
but is patrician and aristocratic, and occurs mainly amongst those high in rank and 
social position, and eminent for mental and literary attainments. William IY. 
of England, an English duke, Southey the poet, several learned divines, lawyers, 
medical men, and their wives, ex-mayors (!), bankers, and ladies of fashion are among 
the select few on whom it bestows its favours. The great Daniel Webster secluded 
himself every autumn at Marshfield to get through his season of trial, with what 
patience he could muster ; and the distinguished Henry Ward Beecher annually 
vacates his pulpit for a season from the same cause; and certainly, if ever a 
clergyman had a good excuse for so doing it is he. Preaching even such as his would 
fail in its effects if interrupted at intervals by a succession of sonorous sneezes, 
paroxysms of cough, and asthmatic utterance, and a persistent aspersion of eyes and 
nostrils." It would seem probable that the condition of the nervous system 
engendered by mental training is especially favourable to the development of hay 



302 THE TREATMENT OP DISEASES. 

asthma. Fanners, who are of necessity constantly exposed to the influence of pollen, 
rarely suffer from it It is difficult to account for this immunity ; by some it has 
been supposed that it is owing to the absence of the predisposition which mental 
culture induces, whilst others think tnat they are rendered insusceptible to the 
action of grasses by their constant exposure to its influence. However that may be, 
there is no doubt that an attack of hay asthma is a great trial of faith and patience, 
religion and philosophy, and enough at times, as some one once said, ' ' to make a 
man curse his mother and turn Turk," if that be the ultima thule of human turpitude. 
The man who could bear with equanimity the annoyances of hay fever would rival 
the fortitude of Guatimozin himself, who, when stretched upon live coals by his 
brutal conquerors, rebuked the complainings of his fellow sufferer by gently reminding 
him that "he, too, was not upon a bed of roses." The first attack often begins in 
childhood, and rarely occurs late in life. The complaint appears to be more frequent 
in men than in women, and there is reason to believe that the susceptibility to this 
troublesome affection runs in families. It is probably more common in this than in 
any other country. The disease happens only at the one particular season, and the 
persons so attacked may not be particularly subject to catarrh at other times, or 
from ordinary causes. " Peach cold" is an affection of similar nature. 

In many people an attack closely resembling that of hay fever is produced by 
dust in any form. A patient says: — "If in my walks I see men sweeping a street, 
and clouds of dust arising, I shun it as I would a rattlesnake ; and if I see a building 
in process of demolition, I go half a mile out of the way to avoid it. I always walk 
on the shady side of the street if there be one, and select a well- watered street if 
possible, or keep well to windward. I cannot express the agony I have on certain 
occasions suffered from this cause, and I therefore confine myself within doors as 
much as possible. Dusts and draughts are my particular aversions. I cannot smell 
a rose or eat a peach unpeeled — the hairs irritate my fauces — without suffering an 
attack, and a pinch of snuff would I believe make me sneeze my head off. Nothing 
that I have ever snuffed up my nostrils has failed to injure me." In conclusion 
he adds, " I pray for rain with all the fervour of the old Scotch clergyman, without 
caring whether or not it should eventuate in a deluge." 

An attack of hay fever may usually be cut short by removal from the exciting 
cause. A sojourn at the sea-side will palliate, and, for the time, often cure the 
complaint ; but it is not every sea-side district that gives the hay-fever patient 
relief. A sea-side town deeply indented in the land is not a good place to choose, 
for it partakes more or less of the character of a bay. One should rather look out 
for some place situated on a promontory or peninsula, so that there is very little 
chance of hay-fields being in the neighbourhood. But wherever a patient may be 
at the sea-side, if the wind is blowing from the land, and if hay-grass is in flower at 
the time, he will be liable to be attacked by his enemy. It is therefore a matter of 
importance in selecting a retreat for the hay season to find some place where the 
prevailing winds are from the sea. It is also better to choose a spot where the 
sufferer can be continually near the water, and if possible a place where the shore 
is backed with high cliffs, because these act as a kind of screen when a land breeze 
is blowing. There are several places in this country which are recommended as 



HAT fZVVR— HAT ASTHMA. 303 

being suitable for the residence of the hay-asthmatic during the summer months. 
First and foremost among these is Fire Island. This island is about twenty 
miles long by three-quarters broad, and is situated on the Atlantic side of Long 
Island : on one side a bay (the great South Bay) separates it from Long Island, and 
on the other is the broad Atlantic. Scarcely anything but a coarse, short grass 
grows there, and this is rarely seen in flower in any quantity. Many seek the 
White Mountains in which The Glen, Gorham, Randolph, Bethlehem Village are 
said to be equally safe. In Vermont, Mount Mansfield, one of the Green Mountains, 
and probably Stow Village, near its foot, although its elevation is said not to exceed 
700 feet. So also the Adirondack Mountains, in the north-eastern part of the 
State of New York. The Catskill Mountain House, 3,212 feet, affords relief to 
some. Still farther to the south, the Alleghany holds out places of refuge. Potters- 
ville, Essex County, New York on Schroon Lake, is said to be free from catarrh. 

A cruise in a yacht is almost a specific for hay fever, for it removes the sufferer 
from the cause of his suffering. Many gentlemen of wealth and leisure who are 
afflicted with hay fever take to their yachts early every summer, and remain afloat 
till the hay is all in, and they thus escape the complaint altogether. Unfortunately 
the majority of people can afford neither the time nor the money to avail themselves 
of this mode of obtaining relief, but even a day or two's cruise will do good^ 
provided always the vessel keeps well out from shore. For complete prevention, 
the place of refuge should be reached a day or two before the usual time of attack, 
especially if the journey is by rail on hot, dry, and dusty weather, for this combina- 
tion is very apt to hasten an outbreak If the disease has already commenced, 
relief can be obtained within forty-eight hours, and frequently sooner, after arrival. 
If it is far advanced, and local changes are produced — inflamed eyes, nose, throat, 
and air-tubes — these effects will remain for a longer or shorter period, according to 
their severity, or the general health. It is not safe to return to any catarrhal 
region north of New York until the last week of September, or until after two or 
three killing frosts ; those who are very sensitive should not return until the 
1st of October ( Wyman). A compliance with these conditions will secure, with rare 
exceptions, very great relief, if not complete immunity from the disease. 

When one cannot get away from home, the only thing is to trust to medicinal 
agents. One of these — tobacco — hardly merits that name ; but for all that it is 
of all probably the most trustworthy. There is nothing during a paroxysm of 
hay asthma that has anything like the effect of smoking tobacco, and although this 
is especially the case in the later stage of the attack, when the asthmatic element is 
most developed, still, in the earlier stage, when the sneezing and running from the 
eyes and nose are prominent symptoms, tobacco-smoking exerts a very marked 
influence as a sedative. During the hay asthma season — that is, in the majority of 
cases, from about the 20th of August to the 15th of September — the sufferer should 
regularly smoke a cigar the last thing before going to bed, or, better still, when in 
bed. This night cigar is taken as a preventive. Tobacco will cure the asthmatic spasm 
when it is fairly on, but it requires a larger dose, and it must be taken in a stronger 
form. The sedative influence of the cigar will usually ensure a fair night's rest ; 
but the powerful depression of strong shag tobacco is usually necessary to cut short 



304 THE TREATMENT OP DISEASES. 

the spasm when thoroughly established. Even when the night cigar is taken it may 
be necessary to get up about three or four in the morning and light another, and 
during the last week- of the attack this happens with many almost nightly. A hay- 
asthmatic should never smoke tobacco but for his malady. One soon gets accustomed 
to its influence, and it then loses its power of relaxing spasm. Distressing as are 
the sensations of collapse from tobacco-poisoning, they are unspeakable relief when 
contrasted with the sense of impending suffocation from asthma. A patient, in 
describing his feelings, says : — " I smoked one pipe, then another ; and as my face 
blanched, and my pulse failed, and the cold sweat stood on my forehead, miserable 
as were the sensations of collapse they were paradise to the agonies of suffocation. 
I shall never forget those moments of relief." Many people who have been ac- 
customed to smoke for years are not readily susceptible to the influence of tobacco, 
and they fail to obtain much benefit from its use unless they employ some device to 
secure its more potent effect. A good plan is the following : — Fill the mouth with 
tobacco-smoke, and then instead of blowing it out again at once as in ordinary smok- 
ing, retain it in the mouth for some seconds, perhaps a quarter of a minute, then 
take another mouthful and retain that, and so on. In this way the tobacco is more 
rapidly absorbed, and a state of depression quickly produced. 

In many cases great benefit has been derived from taking ten drops of the 
tincture of nux vomica in half a tumbler of water three times a day. 

Another good remedy is from three to five drops of arsenic solution (the liquor 
arsenicalis of the Pharmacopoeia) in a little water three times a day. This is the 
dose for an adult, and should not be exceeded. It should be taken after meals, and 
is then less likely to upset the stomach. 

Tincture of lobelia may be given during the asthmatic paroxysm with a fair 
chance of success. On any signs of an on-coming fit, ten drops of the simple tincture 
should be taken in water every ten minutes or a quarter of an hour, till relief is 
obtained. Sometimes it produces a little sickness or faintness, but this soon 
passes ofi. 

A few drops of chloroform placed in the palm of the hand and inhaled during the 
attack will often cut it short. As a matter of precaution some one else should be in 
the room when this treatment is adopted. 

In many cases of hay fever creasote inhalations have proved of service. The 
best strength is ten drops of creasote to a pint of hot water, the steam being inhaled. 
Sometimes a camphor inhalation does good. Ten drops of spirits of camphor, and 
twenty of rectified spirits, are to be added to the pint of hot water. 



HEADACHE. 

Headache is of necessity of common occurrence, since it is present as a prominent 
symptom in some part of the progress of most acute and many chronic illnesses. It 
would seem that the head is more given to aching than any other part of the body ; 
put all the breast pains, stomach pains, and colic pains together, and you do not 
make such an aggregate of suffering as is furnished by headache. There is no doubt 
that headache is a more common complaint than it used to be, and the explanation 



HEADACHE. 305 

of this is not far to seek. The most prevalent diseases of the present day are those 
affecting the nervous system. The strain to which we are all of us more or less 
subjected through the requirements of modern times renders us especially liable tc 
break down prematurely from over-work and want of rest Every branch of study 
is now pushed forward with a vigour unknown to our ancestors, and boys and girk 
are required to grapple with abstruse questions which a few years ago occupied the 
attention only of the advanced student or the man of science. Before civilisation 
had arrived at its present state of perfection the over-wrought brain was confined to 
philosophers and the laborious scholar in his solitary contemplation of human know- 
ledge. Nervous exhaustion was not the common disease it now is, and physicians 
were for the most part silent as to the cause of its production. In whatever direc- 
tion a man now turns, he is sure to find competitors striving for the same prize as 
himself. In trade, in commerce, in literature, and in art it is ever the same ; no 
man has the field to himself. The busy professional man probably affords the most 
striking example of over-strained exertion. He must strain every nerve to attain 
the special object he has in view, and dare not leave it till he has probed it to the 
minutest detail. Should he quit the field failing to discover some new stratum, he 
is soon followed by another who digs up the hidden treasure, which gives a name or 
builds up a future. 

Headache often depends not only on mere functional but on organic disease of 
the brain. Such disease may exist for a long time without giving rise to pain, 
provided only that its progress be slow. Although there may be paroxysmal exacer- 
bations, a certain degree of constancy characterises this more than any other form 
of headache. The patient goes to sleep with it ; it haunts his dreams, and he wakes 
up with it. Every movement of the body aggravates it, and the agreeable excite 
ment which will dissipate many headaches often only makes his worse. The pain 
may be sharp or dull, lancinating or throbbing. It is generally accompanied by 
giddiness, occasionally by fits of vomiting, sometimes by confusion of mind, and 
frequently by rumbling noises or murmurs in the ears. There is nothing peculiar 
in the seat of the pain, but when it is more or less continuous and always referred 
to one particular spot, there is reason to fear some serious disease. 

Plethoric or congestive headache is dependent on an excessive flow of blood to 
the brain. There is usually a sense of pulsation in the ears, together with giddi- 
ness on stooping. This variety affects chiefly robust middle-aged men who are 
making blood too fast ; but it is also met with in plethoric women with menstrual 
irregularity. Persons who live too freely, take but little exercise, and rise late in 
the morning, are often subject to it. In many cases it follows the congestion 
produced by mental emotion or excitement. The flush of the face and neck is a 
pretty accurate representation of what must be the condition of the vessels of the 
brain. Perhaps the circumstances most favourable to the production of this form 
of congestion are when passion and intellectual exertion are combined, as in the 
case of an orator in the full torrent of invective fury. "We find an example of this 
in the vivid sketch of "Preparing for the House" in the "Diary of a Late Physician," 
where the stout country squire with a rubicund face is in a condition of great 
excitement at the prospect of delivering a speech that will at once defeat hi* 
20 



306 THE TREATMENT OF DISEASES. 



assailants and establish his reputation as a politician. Strong intellectual appli- 
cation may induce sufficient congestion to leave its traces for many hours in those 
who are either plethoric or have an irritable circulation ; and when this is being 
incessantly repeated, as in the case of over-ambitious students, or in persons under 
the discharge of some inevitable duty, it may ultimately reduce the intellect 
considerably below its former leveL The counteraction of this congestion is often 
attempted by means of violent exercise. "With a man full-blooded, full-fed, and 
of active digestion it answers well — the equilibrium of the circulation is maintained, 
together with the due eliminative action of the kidneys and bowels ; but in the 
case of the pale weakly student, the best part of whose life is in his brain, it seldom 
succeeds, for no sooner is the congestive headache cured than it is replaced by the 
headache of exhaustion. 

The headache resulting from intoxication might at first sight appear to be a 
congestive headache, since there can be no question that in that condition the 
vessels are abnormally full ; but the fact is, that the retributive headache comes 
on only after the debauch is over, and it is probably of a composite character. The 
disordered function of the brain so wantonly tampered with, and the derangement 
of the liver and stomach, are probably more or less important factors in its 
production. 

A congestive headache not of the active nature we have just been considering 
is often met with, and is known as the headache of "brain-fag." It frequently 
results from long-continued, persevering, over-action of the brain, whether by the 
enthusiastic incautious student or the over-tasked professional man. -It is caused 
by the want of adequate rest, mental activity never ceasing for a sufficient length 
of time to allow the brain to return to its normal condition in repose and recreation. 
This headache is usually of a dull heavy character, and is most commonly situated 
in the neighbourhood of the forehead. It is often accompanied by a feeling of 
incapacity, and by that dejection of spirits that can hardly fail to accompany such 
feeling. But without any excessive intellectual strain, this form of headache often 
arises from mere continued anxiety, such as may be observed in some member of 
a family on whom devolves the chief responsibility of its guidance. Attention 
always on the alert, the necessity for provision against contingencies, the vexation 
of disappointed plans, the difficulties incident to domestic, as well as every form of 
government, the necessary employment of incapable, unwilling, or impracticable 
agents — such a life soon engenders this form of headache. 

The true active plethoric headache is unquestionably less frequent now-a-days 
than it used to be. The exciting lives in business and dissipation, the wear and tear 
of the nervous system, the railway travelling, the spareness, refinement, and delicacy 
of the dietary, sufficiently distinguish the lives of public and professional men from 
the sleepy squire, the plump pluralist, and the festive alderman of days gone by. 

Another variety of headache is known as the nervous headache, and it not un- 
frequently afflicts an individual at intervals through a long life. It belongs to all 
classes of society, attacking the rich luxurious lady amid the distractions of society, 
and the poor hard-worked sempstress in the solitude of her garret It, like many 
other nervous affections, is a product of civilisation, and is almost unknown among 



HEADACHE. 307 

savage races. The subjects of this disorder have an instinctive feeling that it is 
nervous, and can usually distinguish it from other kinds of headache. They recog- 
nise its approach, and succumb to it almost without an effort, and then when it is 
over they rebound as if nothing had happened. The duration varies : with most it 
continues till after a sound sleep, and in many, or in the same person occasionally, 
it will prevent sleep for one or two nights. It varies in degree : sometimes it is 
dull and heavy, admitting the subject of it to pursue the usual avocations of the day, 
though under discomfort, but more frequently it is so acute as to make any occupa- 
tion an additional suffering. The seat varies in different persons, and in the same 
persons at different times, according to the exciting cause. It may occupy the front 
of the head, one temple, the crown, the back of the head, or one side. It belongs to 
all temperaments and habits of body, but it occurs most frequently in persons of 
nervous diathesis, and in those with frames weak by organisation or exhausted by 
disease and other causes. The original constitution most prone to this form of 
headache is that in which nervous susceptibility is well marked. Those of lively 
emotions, delicate sensibility, and easily perturbed mind are frequent sufferers, and 
it prevails largely amongst those who have the aesthetical and imaginative elements 
highly developed. It is the frequent accompaniment and curse of great intellectual 
endowment, and it would appear that the liability to it is most marked when the 
functional activity of the brain, whether in perception, emotion, or intellect, is dis- 
proportionate to the organic vigour of the rest of the body. The condition which, 
irrespective of original constitution, is most favourable to the production of nervous 
headache may be described as one of debility. In the studious) this predisposition 
is the result of the consumption of nervous force in the brain, combined with neglect 
of the ordinary laws of health ; and the same may be said of those who over-exert 
themselves in professional work, in diplomacy, commercial speculation, or what not. 
In the rich and well-to-do there is often loss -of tone engendered by late hours, hot 
rooms, want of exercise, emotional excitement, the increasing torment of jealousy 
and ambition, and worse than all, the forced effort to appear gay in spite of ennui, 
worry, and disappointment. The operative classes are not exempt from it, for their 
social surroundings are often of the most unfavourable description, and their frames 
are weakened by hardship and privation. Often enough it arises from debility, 
ensuing on loss of blood or its deterioration, on excessive discharges, and on vicious 
habits and indulgences. The pale anaemic girl, the mother worn out by repeated 
pregnancies and prolonged suckling, the father blanched from piles, and the uon ex- 
hausted with vice — all suffer from this headache. Many of the exciting causes clearly 
show the nervous origin of the affection. In one it is produced by a prolonged fit 
of study, or a difficult arithmetical calculation, in a second by a dazzling light, a loud 
and grating noise, or a disagreeable odour, whilst in others it results from an a ttack 
of indigestion, or from long abstinence from food. Curiously enough, it may some- 
times be induced by certain atmospheric conditions, notably by that which precedes 
and accompanies thunder, and by that which ushers in a fall of snow. Sometimes it 
results from apparently the most trivial causes. The case is recorded of a lady who 
could at any time induce a fit of headache by turning her head suddenly to the right 
Bide, and in another instance it was always brought on by lying on the back. Of all 



308 THE TREATMENT OF DISEASES. 

the exciting causes probably fatigue in some form or other is the most common. Too 
long a walk, sitting up beyond the usual hour for retiring to rest, compulsory mental 
effort, whether in the course of conversation, or in study or business, the exhaustion 
following the excitement of a long journey, or of an evening party, may all act as 
exciting causes, especially if the fatigue and debility are from any cause associated 
with circumstances producing perturbing or depressing emotions. Excessive 
muscular exercise will often act in the same way. In delicate women subject to 
this headache, it often comes on before, and lasts during the whole of each menstrual 
period, although there may be nothing abnormal or unhealthy in the function. 

In addition to the varieties we have described there are many other forms of 
headache of more or less frequent occurrence. In what is known as " sympathetic " 
headache, irritation proceeds at a distance from the nervous centre, as in decayed 
teeth, arrested digestion, or some disorder of the womb. The case is related of a 
gentleman who had suffered from pain in the right side of his head for three or four 
months. It was sometimes acute, at others dull, and it had come on without any 
assignable reason. A great variety of remedial measures had been tried, including 
blisters, tonics, regulation of diet, change of air and scene, and so on, but without 
success. As a last resource he had been advised to seek relief at one of the German 
spas, but, fortunately for him, before setting out he had his teeth examined. They 
were all in wonderfully fine condition except the wisdom-tooth in the upper jaw on 
the right side, which was decayed. This was extracted, and from that moment the 
patient was cured. This is an exceptional case, but it is a remarkable instance of 
sympathetic headache. A more familiar example is the pain in the head which, 
with many people, supervenes on taking ice into the stomach. Headache is some- 
times produced by the presence of some special poison in the blood. The headache 
occurring in typhoid fever is probably the most decided instance of this variety ; the 
poison in this case being the poison of the fever. In the same category must be 
placed the headache of rheumatism, gout, ague, and some other affections. 

Megrim, sick-headache, blind-headache, or bilious-headache, as it is called, is of 
such importance that it merits a separate consideration (see Megrim). 

Speaking of headaches generally, it may be said that in the large majority of 
cases they are induced by excessive brain-work, combined with a deficiency of bodily 
exercise, short restless nights, and insufficient sleep. Excessive brain- work does not 
mean exclusively work of an intellectual kind, as in close application to study or 
literary composition, or to the business of chambers or the counting-house, but it 
also includes that strain of the affective or emotional part of our nature which is the 
result of prolonged mental anxiety, vexation, and disappointment, and is far more 
rapidly exhaustive of nervous power than any intellectual efforts that are free from 
such emotional complications. Headaches occur more frequently in persons of adult 
life than in youth or advanced old age, and a predisposition to them is undoubtedly 
in many cases hereditary. 

Habitual dwellers in town suffer more than residents in the country ; women 
more than men ; the nervous and delicate more than the robust, and the middle 
and upper classes of society more than the lower. All pains in the head especially 
affect those who neglect the many little attentions and cares that our civilised, and 



therefore in some measure artificial, mode of life requires. Among these may be 
instanced regularity in diet, carefulness in adapting the clothing to the requirements 
of our variable climate, attention to the action of the bowels, and sufficient exercise 
in the open air. 

We must now speak of the treatment of headache, beginning with that form 
which is dependent on organic disease of the brain. It might be thought that in 
these cases we should be powerless to giro relief, but such is not always the case, 
and we can often do a great deal of good. A permanent pain confined to one spot, 
and believed to be due to serious brain disease is often best met by the application 
of a blister over the part. Large doses of iodide of potassium taken frequently — 
say three or four tablespoonfuls of the mixture (Pr. 32) three or four times a day— 
often succeed admirably. This drug is especially indicated when there is any sus- 
picion of a syphilitic taint, or when the pain is worse at night. It is not uncommon 
to meet with patients, generally men, who complain of pain in the head, usually 
throbbing in character, sometimes accompanied by intolerance of light. This pain 
is worse or perhaps felt only at night, and is so severe that it seems as if it would 
drive the sufferer mad. It may be felt over the whole head, or may begin at the 
back of the neck, and pass over the vertex of the brow. The pain is very apt to 
be increased by alcohol. Iodide of potassium will nearly always effect a cure in a 
week or two. Should the patient in any case be restless at night it may be necessary 
to give a dose of bromide of potassium (Pr. 37) with or without chloral, at bed-time, 
to produce sleep. Should other measures fail, the hypodermic injection of morphia 
may have to be resorted to for the relief of pain. Many of the remedies used for 
other kinds of headache are applicable to the form due to organic disease. 

In congestive headache, rest is almost essential to successful treatment. An easy 
thing, it may be said, to recommend, but how difficult to obtain. Even when com- 
plete rest is out of the question, partial rest and additional relaxation may be 
attended with marked benefit. Often enough attention to little matters of detail as 
regards the habits of the sufferer may give marked relief. In the busy part of the 
day the thinker or writer may find advantage in standing at a desk instead of sitting 
down and leaning over a table. The diet should be spare, and beer and spirits 
should be avoided. Active exercise in the fresh air and habits of early rising should 
be enforced ; and these measures when rigorously carried out afford the best promise 
of relief. It is important to get the bowels to act well, and for this purpose two- 
thirds of a tumblerful of Friedrichschall water in a little warm water may be taken 
once or twice a week, the first thing in the morning. In plethoric young women 
the application of a few leeches to the groins may prove of service. In nervous and 
irritable subjects, who are upset by worry and over-work, bromide of potassium 
(Pr. 31) is a good remedy. 

In many cases of congestive headache nothing succeeds better than aconite. It 
is indicated when there is a violent compressive pain above the root of the nose, 
with heaviness and fulness in the forehead as if it would split ; when there is a 
flushed face on lying down, but pale on sitting up ; wh<m there is great restlessness ; 
when the tongue is furred, and the whites of the eyes are yellow ; when the urine 
is hot and scanty and high-coloured ; when the pulse is full and bounding, and the 



310 THE TREATMENT OF DISEASES. 

skin harsh and dry ; when there is giddiness on rising, with nausea and noises in 
the ears ; when there is a general soreness or bruised feeling about the whole body ; 
when there is dislike to food, light, and sound, then aconite may be given with 
advantage. A drop of the tincture may be taken in a little water every quarter of 
an hour for the first hour, and then hourly, or Pr. 38 may be used. 

When the face is flushed and the arteries of the head throb, when there is a 
sense of fulness and compression about the forehead, as if the skull would burst, and 
when the pupils are dilated and the eyes bright and glassy, belladonna is indicated. 
This form of headache is increased by lying down and is relieved by assuming the 
upright position, by leaning the head backwards, and by strong pressure of the head 
with the hands. There is also giddiness and occasionally dulness of sight. The 
face is usually puffed and red in the puffiness, and the water is scanty and high- 
coloured. Often enough there is sleeplessness alternating with unpleasant dreams. 
The tincture of belladonna may be given in the same way as the tincture of aconite 
(Pr. 39). 

Nitro-glycerine, or glonoine, is suitable for the form of headache which in women 
often follows the sudden cessation of the periods. The symptoms complained of are 
usually flushing of the face, throbbing of the vessels of the head and neck, quickened 
pulse, giddiness, a sense of fulness and oppression at the forehead and back of the 
head, occasional neuralgic twinges about the side of the head and in the face, and 
stiffness of the neck. Often enough the face and forehead perspire freely, and there 
may be singing in the ears, and sparks before the eyes. The medicine acts very 
rapidly, and in suitable cases a cure is effected in from five to twenty minutes. The 
dose is from half a drop to a drop of a one per cent solution in spirit, taken in a 
little water. 

Nervous headache is by no means an easy complaint to treat. When an attack 
is threatening, it is a good plan to lie down and observe the strictest seclusion and 
rest, and when this is done at an early stage it may possibly avert it Yery often, 
in addition to maintaining the recumbent posture, a glass of good wine or some 
other form of stimulant may be given with advantage. During the acute stage of 
a severe nervous headache there is little to be done, and the best thing is to leave 
the patient alone and quiet in a darkened room. Sometimes ice to the temples does 
good, but often enough warmth succeeds better. In some cases relief may be obtained 
by taking a warm bath, and then putting hot water bottles to the feet If the pulse 
is good and the face flushed, an emetic of mustard and water will rid the stomach of 
offensive matters, and may give relief When sickness is an accompaniment of this 
headache, we may try and relieve it by a bismuth draught (Pr. 18), to which three 
drops of dilute hydrocyanic acid may be added. Another good plan is to apply 
a mustard poultice to the pit of the stomach. Sucking small pieces of ice in some 
cases gives relief. Soda water and a little brandy or dry champagne sometimes 
answers well, but often it aggravates the symptoms, and does more harm than good. 

Valerianate of zinc in five or six grain doses every two or three hours is highly 
recommended in nervous headache. In the Gulstonian lectures, delivered before the 
Royal College of Physicians some twenty years ago, the following opinion was ex- 
pressed on the subject of the dose : — " If I may venture on such a remark, I should 



HEADACHE. 311 

say that, judging from the prescriptions I have met -with, this medicine is usually 
given in doses far too small. My own knowledge of the larger doses was in the first 
instance accidental. For a lady suffering from spasm of the larynx, I had prescribed 
a grain of valerianate of zinc in a powder (she was unable to swallow a pill), to be 
taken every three hours. Six grains had been directed to be distributed into six 
powders, but the dispenser had sent six powders, each containing six grains. In the 
morning I found that the powders had been taken with marvellous benefit, and no 
distress to the stomach. " The valerianate proves most serviceable when there is no 
sickness, and the pain is confined chiefly to the side of the head. 

Oxide of zinc is another remedy that often does good. Two of the pills (Pr. 66) 
may be taken every two or three hours, or an equivalent dose — five grains — may be 
taken in powder suspended in a little water or milk. 

When the headache is coming on, and the patient is irritable and can get no 
sleep, four tablespoonfuls of the bromide of potassium mixture (Pr. 31) may be 
given with advantage. It produces refreshing sleep, soothes the nervous system, 
dispels the other symptoms, and at the same time lessens the frequency and severity 
of the headaches. 

Large doses of chloride of ammonium — say thirty grains every four hours — 
.sometimes give relief. It is soluble in water, but is very nasty, and should any 
difficulty be experienced in taking it, the solution may be poured into a cupful of 
milk, and then tossed oft Black currant lozenges, each containing five grains of 
chloride of ammonium, are now kept by most chemists and afford an agreeable mode 
of administering the drug. The only objection is that six would have to be taken at 
a dose. Fortunately chloride of ammonium when it succeeds acts quickly. Should 
relief not be obtained in six or eight hours, it would be useless to take more. Some- 
times a dose of quinine does good (Pr. 9), and sometimes benefit is derived from 
taking together a dose of quinine (Pr. 9) and one of bromide of potassium (Pr. 31). 
Salicine may often be taken with advantage (Pr. 13). 

When there is great weakness ; when the pain is so great as to be aptly described 
by the term anguish ; when there is tenderness of the scalp ; when the face is pale, 
and when there is also chilliness and coldness of the whole body, indicating marked 
depression, arsenic should be administered. Two drops of the liquor arsenicalis may 
be given hourly to the extent of four doses, or Pr. 40 may be employed. 

In some cases gelseminum succeeds admirably. The great thing is to give enough 
and to give it frequently. The dose of the tincture is for an adult from five to ten 
drops in a little water every three hours (See Pr. 41). 

The cautious inhalation of a little chloroform in acute nervous headache may 
control the severity of the paroxysm, and induce sleep ; but when there is nausea 
it is rarely of service, and often provokes vomiting, distressing the patient and 
increasing the suffering. 

In many cases nothing does so much good as a hypodermic injection of morphia. 
It is especially indicated when the face is pallid and the pulse slow and weak, and 
the patient is beginning to feel the want of sleep. Even should it not completely 
relieve the pain, it gives that amount of repose which renders the patient in- 
different to all that goes on around him, and in this way the brain gets rest from those 



313 THE TREATMENT OF DISEASES. 

harassing thoughts and miserable speculations which continue to haunt him, and from 
which there is no other mode of escape. When means are not at hand for the 
administration of a hypodermic injection, benefit may often be derived from giving 
a good dose of opium by the stomach. Two five-grain compound soap pills, con- 
taining two grains of opium, may be given to an adult with perfect safety. It is 
necessary that the patient should lis down and remain perfectly quiet, and an effort 
should be made to get to sleep. Opium will often afford relief when applied exter- 
nally. A mixture should be made of warm water and laudanum, and then a piece 
of lint should be soaked in this and folded into a pad, which should be applied to the 
temples and forehead. 

Many people find that nothing so quickly relieves a nervous headache as a cup 
of strong tea or coffee. The treatment of sympathetic headache depends chiefly on 
the detection and removal of the cause. In many cases of headache resulting from 
stomach derangement, mix vomica (Pr. 44) is invaluable. When the patient com- 
plains of giddiness on first rising from bed ; of nausea early in the morning, brought 
on especially by the sight or smell of food ; of a feeling of weight in the headache 
made worse by stooping or moving, and of pains in the temples or forehead, this 
drug is indicated. If, in addition, the tongue is furred, and there is a bitter 
taste in the mouth; if the complexion looks muddy, and the whites of the eyes 
are yellow ; if the bowels are confined, and the water is high-coloured and scanty, 
mix vomica will succeed almost to a certainty. This form of headache is worse 
in the morning on waking; it is increased by mental work, by being in the 
open air, or in the sunshine, and by the use of tobacco or alcohol in any form. 

A good deal of care and tact will be required for the treatment of headache 
arising from menstrual disturbance. In delicate young women whose periods are 
deficient in quantity, actsea racemosa often does good, whilst in the case of a robust 
girl suffering from the effects of cold, damp, or change of climate, aconite, 
belladonna, or glonoine, will prove more useful. Pulsatilla often succeeds in 
restoring the flow and removing the headache. 

The headache of gout must be treated according to the prominent symptoms, 
but in many cases the administration of colchicum does good. Quinine (Pr. 9) 
sometimes succeeds admirably in these cases. 

For headache resulting from rheumatism, attention to diet is of primary 
importance. Milk and vegetables will often agree better than animal food, and 
a little dry wine should be taken instead of beer or spirits. Iodide of potassium 
(Pr. 32) often proves of service. Bryony (Pr. 49) is also of great service in rheu- 
matic headache, especially when the pains are relieved by warmth ; if rheumatism 
has attacked other parts of the body, and indigestion is an old-standing trouble, 
it is very likely to succeed. Actsea racemosa often does good in those forms 
of headache which would appear to be a connecting link between rheumatism 
and neuralgia. Actsea as a rule succeeds better with women than with men. 
It is serviceable in that common and distressing headache which affects nervous, 
hysterical women at the menstrual period, or when the flow is too frequent and 
too profuse, or at the change of life. 

There are other remedies for headache which occasionally prove useful, and 



HEADACHE. 31 3 

deserve a word of passing notice. For instance, holding the arms above the 
head will often relieve the severity of that peculiar morning headache with which 
some persons constantly awake. Again, compression of the temples with a couple 
of pads and a bandage sometimes affords marked relief. The effect of pressure 
did not escape the observation of Shakespeare. When Othello, after listening 
to the insinuations of Iago, tried to conceal his feelings from Desdemona by 
the plea of headache, she replies :— 

** Faith, that's with watching ; 'twill away again : 
Let me bind it hard, within this hour 
It will be well." (Act iii., Scene S.) 

And again in King John, in the scene between Hubert de Burgh and Arthur, the 
latter, when petitioning for the preservation of his sight, says 5— 

" When your head did but ache 
I knit my handkerchief about your browi 
(The best I had, a princess brought it me) 
And I did never ask it you again : 
And with my hand at midnight held your head." 

(Act ir., Scene 1.) 

Sometimes the application of ice to the head, cold lotions, or eau-de-cologne wft* 
do good. A recent writer recommends brushing the hair and "shampooing." He 
says : — " Amongst other accessories for the relief of headache, I would mention the 
value of having the hair sharply and vigorously brushed by a hair-dresser during the 
coming on of a headache; and the circular brush that is prompted to action by 
machinery is more soothing in its influence than the ordinary brush when controlled 
solely by the hand of man. For a neuralgic headache and for rheumatism of the 
scalp, the circular brushing by machinery is only equalled by the comfort of sponging 
the head with hot water ; and it outvies the sponge inasmuch as the patient has 
nothing to fear from catching cold after the operation. The so-called " shampooing," 
will afford relief in some cases ; but then it requires a very nice and delicate adjust- 
ment of hot and cold douches ; for though the warm douche will sooth the poor, 
irritated nerves, yet, if the officiating priest of the bath is too sudden and too violent 
in his outpouring of cold water, he will nullify the good effects of his warm waterfall 
by giving the nerves a shock for which their strength is barely equal. These details 
may appear trivial to some readers, but I appeal to a headaching audience, and they 
will, I know, bear me out in my assertion, that it is one thing to be coaxed and 
soothed by circular brushes and intelligent splashings of warm and cold water, and 
it is quite another to have a shor1>bristled brush rattled over your aching head with 
a charming disregard to the sensitiveness of the nerves of the scalp, and to the com- 
parative value of bristles or boxwood in smoothing people's hair and temper. I have 
sometimes shuddered for my turn to come in a hairdresser's room, when I have seen 
the brush handled by a clumsy apprentice, and heard it tap and rattle against the 
scalp of some confiding customer." Galvanism occasionally proves useful in headache, 
and sometimes benefit is derived from freezing the skin of the forehead by means of 
the ether spray, although the latter mode of treatment^ we are inclined to think, is 
more applicable to true neuralgia. 



314 THE TREATMENT OF DISEASES. 

The preventive treatment of headache consists chiefly in avoiding those conditions 
which are known to predispose to or excite a paroxysm. Many people who suffer 
from headache, tremors, and restless nights, derive benefit from giving up tea. 
Coffee is not equally injurious, and in some forms of headache it undoubtedly often 
does good. Tobacco, too, is, as a rule, not beneficial when there is a tendency to 
headache, but in some instances a mild cigar appears to ease or even dispel the pain. 
When a sufferer from nervous headache awakes in the morning with those un- 
mistakable symptoms that usher in a day of pain, he would do well to forego his 
accustomed cold bath, for his standard of health is obviously low, and no reaction 
will follow the application of cold. 

HEART — DISEASES OP THE HEART. 

There are three great causes of heart disease. Either it is congenital, or it is 
the result of rheumatic fever, or it is due to degeneration. "We remember a great 
medical teacher used to say — " If you have not heart disease now, and don't get 
rheumatic fever, you are safe till you are over fifty." Children are sometimes born 
with malformation of the heart, but their lives are short, and those cases need hardly 
enter into our consideration. In this country rheumatic fever is the most common 
cause of heart disease. Thanks to our changeable climate rheumatic fever is a very 
prevalent complaint, and its great danger is that it may affect the heart. Many a 
man has suffered from years of misery as the result of an apparently slight attack of 
rheumatism of which at the time he probably thought little. In children, rheumatic 
fever is very apt to be overlooked, especially when the joints are but slightly affected, 
and the whole brunt of the attack falls upon the heart. Sometimes heart disease 
comes on after scarlet fever, but these cases are exceptional In athletes, gymnasts, 
labourers, and those who have heavy weights to lift, heart disease is not uncommonly 
the result of a severe strain. In these cases the onset is often very sudden, the patient 
perhaps at the moment suffering from severe pain and shortness of breath, and he 
may even experience a sensation of something having given way in his chest. 

We have, so far, spoken of heart disease as a whole, but it must be remembered 
that there are many different kinds of heart disease. These varieties are perfectly 
distinct, but they can be distinguished only by a skilled examination of the chest by 
a medical man, and it is impossible for us to lay down any rules for their recognition. 

Among the general symptoms of heart disease may be enumerated, pain in the 
chest, palpitation, blueness of the face and lips, difficulty in breathing, cough, dropsy, 
and an irregular pulse. It must be distinctly understood that it is the combination 
of these symptoms that would lead us to suspect heart disease ; and that the presence 
of only one or two would mean nothing. Pain in the left side is a symptom from 
which most of us suffer at some time or other, but it alone is not to be regarded as 
indicating the existence of heart affection. In the majority of cases it is purely 
muscular in origin, resulting from general debility and over-exertion. Weak, ill-fed, 
badly-nourished, sickly women, exhausted by frequent pregnancies and long-continued 
suckling, often suffer from it terribly, and their general debility often gives rise to 
palpitation of the heart, but there is no actual disease, and the proof of this is that it is 



HEART — DISEASES OP THE HEART. SI 5 

readily cured by good feeding, freedom from worry and anxiety, out-door exercise, 
and a moderate allowance of stimulant. In nine cases out of ten, pain in the side 
means general debility, and not disease of the heart. This is a point of some 
importance, for it is one on which a great deal of misapprehension exists. Then 
palpitation alone is never to be regarded as evidence of heart disease, although many 
people get very much alarmed about it. It usually arises from the stomach and not 
from the heart. A common cause of palpitation in young men is excessive smoking, 
and if they will only consent to give up their pipes for a few weeks it gradually disap- 
pears, to return perhaps on resuming the tobacco. We know of an instance where 
a gentleman suffers from severe palpitation for days after indulging in even a single 
cigar or pipe, and yet he is perfectly free from any heart affection. In women tea 
often acts in the same way. We quote the following case as an example of the 
mode in which palpitation often arises. " A friend of mine, a barrister, used to be 
very anxious about himself, because a fluttering sensation frequently occurred at his 
heart ; an intermission of one or two beats, and then a violent throb when the organ 
again resumed its play. This is a sensation very familiar to my own consciousness, 
and probably most persons have occasionally experienced it. However, it happened so 
often to the gentleman I speak of that it made him very unhappy. He persuaded 
himself that he had disease of the heart, and that he should some day suddenly drop 
down dead. But there was no other symptom of cardiac disease, direct or indirect, 
general or physical He was accordingly told that the intermission depended upon 
some fault in his digestive organs ; and he was advised to leave off different articles 
of food and drink in succession, in order to discover whether any one particular 
thing offended the stomach and gave rise to the symptom. He began by abstaining 
from tea, of which he had been in the habit of drinking a large quantity ; and 
thereupon the fluttering of the heart ceased. A fter a while he- took to tea again, 
and then the fluttering returned. He repeated the experiment many times, and 
always with the same result, till at length his mind was satisfied ; and by renouncing 
tea altogether he got rid of his palpitation and of his apprehensions." This is an 
instructive case, well worth the attentive study of those who suffer from palpitation, 
and think they have heart disease. We shall have more to say on this subject 
presently (vide Palpitation). 

Shortness of breath and cough may arise from many diseases other than those of 
the heart, as, for example, winter cough and asthma. It is only in combination 
with other symptoms that they are of any value in indicating disease of the heart. 
Dropsy, as we have seen, is a frequent concomitant of heart disease, but it is also 
a symptom of Bright's disease and many other affections, and may even arise from 
pronounced anaemia, or poorness of the blood. It is often said that inability to lie 
on the left side, combined with palpitation of the heart, is to be regarded as an 
indication of serious mischief, but this is not strictly true, for patients with neuralgia 
of that side can rarely endure the posture in question, and there are many other 
exceptions to this rule. 

It might be supposed that the amount of pain and distress experienced in the 
ehest would form some guide to the condition of the heart, but such is not the 
case, for, singularly enough, the amount of suffering entailed by mere functional 



316 THE TREATMENT OF DISEASES. 

disturbance is, in the majority of cases, infinitely greater than that produced by 
actual disease. A patient with a serious heart affection that may kill him at any 
moment often experiences so little trouble from it as to express petulant annoyance 
at having his chest examined, whilst another individual suffering from nothing but 
indigestion and flatulence refuses to be persuaded of his freedom from some mortal 
malady. If you think you have heart disease, it is ten chances to one that you 
have not The majority of people who really have some heart affection know- 
nothing about it till they are told by the doctor. 

Many persons suffer from habitual feebleness of the heart's action. This con- 
dition may occur in conjunction with disease, but usually it is a mere functional 
disorder of but little significance. The symptoms to which it may give rise are 
coldness and clamminess of the hands and feet, a little swelling about the ankles and 
insteps, shortness of breath, frequent inclination to faintness, sensations of languor 
and ennui, low spirits, loss of appetite, disagreeable breath, and confined bowels. 
This state of affairs often occurs in young women, frequently in association with 
some disorder of the menstrual function. As regards treatment, such medicines as 
iron (Prs. 1, 2, 3, 4, 6, and 7), quinine (Prs. 9 and 11), and cod-liver oil should be 
given. The patient should be made to take a fair amount of exercise in the 
open air. 

Many people suffer from pain in the left side, the chief seat of which appears 
to correspond to a limited spot a little above and to the left of the nipple. It is 
apparently situated at some little distance below the surface. Remaining limited 
to this spot for a variable time, it may eventually extend downwards to the elbows, 
or even to the tips of the fingers. The pain may be in character shooting or 
grinding, and the sensation may be merely one of uneasiness, or it may give rise to 
the greatest anguish. These symptoms are not to be regarded as affording indications 
of heart disease, although it is to be feared that the more severe forms are allied to 
that disorder which we have described as angina pectoris (vide Angina Pectoris). 
In slight cases relief may be obtained by a course of tonics, by attention to the 
general health, and by wearing a belladonna plaster over the region of the heart. 

The act of bending forwards, especially in the sitting posture, and if accompanied 
by some effort, as in drawing on a boot, is often followed by a peculiar pain, usually 
referred to the heart. It is relieved more or less quickly by stretching out the 
chest wall and pressing on the surface. Once produced it is often readily re-excited, 
and many people are obliged to exercise the greatest caution, in order to prevent 
its recurrence. The pain is muscular (vide Myalgia), and is not an indication of 
heart disease. Wearing a bandage round the chest, or the application of a bella- 
donna plaster over the affected region might prove useful. 

Many people worry themselves very unnecessarily on the subject of a fatty heart, 
for it is a complaint that is rarely detected Although occasionally met with in 
young people, the disease is essentially an appanage of middle and advanced life. 
Women suffer from it much more rarely than men. It occurs in all ranks of 
society, though, to a certain but undetermined extent, more in the upper and middle 
classes than among those who earn their daily bread by manual toil. It does not 
appear that indulgence in the good things of this life especially favours its production. 



WKX3UT, oa Hiccouex. SI 7 



One sees it in men whose rule for years has been to consume at least their 
daily bottle of wine, in gross beer-drinkers, and in spirit-drinkers ; but it is almost 
as frequently met with in persons who have led a life not only of soberness, but 
almost of abstinence. The symptoms to which fatty heart gives rise are by no 
means characteristic. We would say that tH« §*ct of your thinking that you are 
suffering from this complaint is to be regarded as presumptive evidence that you 
are not 

HICCUP, OIL HICCOUGH. 

Hiccup is a complaint — if it may be dignified by the name of complaint — which 
seldom gives rise to any anxiety, or calls for active treatment It usually passes off 
in a few minutes, or in the course of half an hour, even if nothing be done for it. 
One of the commonest and most convenient modes of arresting it is to close the 
mouth and hold the nose as long as possible, Some people prefer tossing off a 
tumbler of water, whilst others run up-stairs as fast as they can. A sudden shock 
will often stop it more effectually than anything ; a friend comes up and gives you 
an unexpected dig in the ribs or slaps you on the back, and your hiccup is gone. 
Sometimes in hysterical young women it persists for days, to the great annoyance of 
everybody. The treatment in such cases should be directed to the hysteria rather 
than to the hiccup. Occasionally it occurs in the course of acute illnesses such as 
fevers, and is not to be regarded as a good sign, although, of course, too much import- 
ance must not be attached to it In the case of a corpulent man suffering from 
typhus fever it continued for eighteen hours out of the twenty-four on several 
consecutive days. 

We may mention a few remedies that might be resorted to in case of need. 
Obstinate and even dangerous cases of hiccup are reported to have been cured by 
drinking an infusion of mustard made with a tea-spoonful of mustard steeped in 
four ounces of boiling water for an hour, and then strained. Camphor has been 
recommended, and so has a mixture of chloroform and laudanum, but we are unable 
to say in what doses they are most likely to do good. A hypodermic injection of 
morphia sometimes succeeds when other measures have failed. Chloral often effects 
a cure when given in ten-grain doses (Pr. 37), and a few drops of sweet spirits of 
nitre on sugar have been knowu to arrest the spasm. Three or four drops of dilute 
sulphuric acid in water every ten minutes or a quarter of an hour might be tried. 
Gelseminum (Pr. 41) may sometimes be given with advantage. Musk is a remedy 
which proves of value, especially in hysterical young women. A useful draught 
may be made by mixing together a tea-spoonful of fetid spirit of ammonia, a table- 
spoonful of lime-water, and a table-spoonful of peppermint-water. 

For the hiccup of drunkards, reliance may be placed on tincture of nux vomica 
given in five-drop doses every hour for three or four hours, or even longer. Ten- 
minim doses of tincture of capsicum often succeed admirably in these cases. This 
treatment not only cures the hiccup, but obviates the morning vomiting, and 
removes the sinking at the pit of the stomach and the intense craving for stimulants, 
from which these people so often suffer. The medicine may often be continued with 
advantage to the general health after the hiccup has been relieved. 



/ 



318 THE TREATMENT OF DISEASES. 



HYDROPHOBIA. 

Few complaints have attracted greater attention or have been more carefully 
studied than hydrophobia. It is a disease of considerable antiquity, an unmistakable 
account of its phenomena being found in the works of Aristotle. It is also men- 
tioned by many of the ancient authors, poets, and historians, among others by Homer, 
Xenophon, Horace, Ovid, Plutarch, and Pliny. 

It is a disease due to the introduction into the system of a special poison existing 
in the saliva of the affected animals. It occurs most commonly in dogs, but cats, 
horses, pigs, goats, sheep, wolves, foxes, hyenas, jackals, and horned cattle occasionally 
suffer from it. Its production in man is nearly always caused by the bite of a 
mad dog. 

It was at one time supposed that the disease originated spontaneously in dogs 
and other flesh-eating animals, but there are reasons for believing that this view is 
erroneous. It is often said that in dogs it is produced by certain accidental circum- 
stances — such, for instance, as the intense heat of the " dog days," severe cold, and 
want of drinking-water; also by such causes as domestication, training, and the 
physical deterioration induced by their artificially-acquired modes of life. In reality, 
however, there is not the slightest evidence in favour of the correctness of this view. 
It must be admitted that these abnormal conditions of life may predispose dogs to 
mental and nervous disturbances, and may even favour the production of madness, 
but they in themselves never sufhce to originate the disease. We may feel assured 
when a dog becomes rabid that it has either been bitten by another mad dog, or has 
contracted the disease from some wild animal of a kindred species. It is said that 
in the mountains of Switzerland the dogs are frequently infected by the bite of rabid 



It is a curious circumstance that some dogs appear to have the power of resisting 
the action of the poison which produces hydrophobia. In the veterinary school at 
Lyons, a pointer, which had been bitten experimentally no less than seventeen times 
by dogs suffering from rabies, remained unaffected. Other dogs resist two, three, or 
even four attempts at inoculation, and are finally infected at a subsequent trial. 
Whether the bite of a mad dog is followed by infection or not depends, apart from 
the individual predisposition, upon accidental conditions, especially upon whether 
the bitten part is protected by hair or other covering, which would wipe off the 
saliva before the teeth came in contact with the skin. 

It is usually supposed that madness in dogs is more common during " dog days " 
than at any other time of the year. In reality rabies occurs nearly as often in the 
spring, in the autumn, and even in the winter as it does in summer. Statistics 
show that January, which is the coldest, and August, which is the hottest month in 
the year, are the very months which furnish the fewest examples of the disease. 

The symptoms of hydrophobia in dogs are well worthy of consideration, as by 
the early detection of the disease prompt measures can be taken for the isolation or 
destruction of the animal, and a great danger may be averted. Persons are liable 
to be bitten by mad dogs under two sets of circumstances : firstly, when a rabid 
animal escapes from home, and is at large ; and secondly, when a dog, not known to 



HYDROPHOBIA. SI 9 



be affected, is caressed by Ms master or some of the family. It is, consequently, 
quite as important to be aware of those slight indications which should afford 
ground for suspicion that the disease is impending as to know the characteristic 
signs by which it may be recognised when it has fully declared itself. The pre- 
monitory symptoms of rabies in a dog consist almost entirely of changes in its 
demeanour, and although they may be too trifling to be noticed by a casual observer 
they are fortunately sufficiently striking to arrest the attention of any one who is 
familiar with the animal's habits and individual peculiarities. 

A dog about to become rabid loses its natural liveliness, and mopes about as if 
preoccupied or apprehensive, and frequently seeks to withdraw into dark corners. 
A change is noticed in his temper, and he becomes either unusually confiding and 
friendly, or, on the contrary, extremely irritable, morose, and easily enraged. From 
the first there is a foreshadowing of that most constant symptom of the disease — 
depraved appetite. Mad dogs not only devour filth and rubbish of every kind with 
avidity, but will even eat their own excrement, and that immediately after it has 
been passed. This tendency usually appears early, and when a dog refuses his 
accustomed food and swallows ravenously such substances as hair, straw, dung, 
rags, earth, bits of leather, and the like, his conduct, to say the least of it, is very 
suspicious. Along with this peculiarity in behaviour it is of equal importance to 
notice that an affected dog from the first snaps at other dogs without provocation. 
This snappishness in most dogs is very striking. If a dog previously known to have 
no such habit snaps indiscriminately at the first dog it meets, it is in all probability 
not safe. 

A dog which is at large may also be recognised as being in a dangerous state by 
its general demeanour. A healthy dog in its progress along a street or elsewhere 
shows at every step that its attention is awake to the sights and sounds by which it 
is surrounded. The rabid dog, on the contrary, goes sullenly and unobservantly for- 
wards, and is not diverted by objects obviously likely to attract its attention. This 
statement, however, is subject to the important exception already referred to that it 
is excited both by the sight and sound of an animal of its own species. 

These premonitory symptoms may last one or two days or only a few hours. 
Gradually the animal displays increased restlessness and uneasiness, and if chained 
up he usually endeavours to break away or to tear his kennel to pieces. If he 
succeeds in getting loose, he will either wander about in an objectless kind of way, 
or he will start off running as fast as his legs will carry him, sometimes performing 
considerable distances in an almost incredibly short space of time. The desertion of 
his home by a previously faithful dog is a circumstance which should always excite 
suspicion. The animal frequently returns after a short absence, and then almost in- 
variably exhibits a decided propensity to bite, a propensity manifested to a less 
degree in good-natured dogs than in those naturally ferocious. It is a well-known 
fact that rabid animals retain a certain affection for people thev know, and with 
whom they are brought in frequent contact. A dog will at first not bite his 
master, but rather seeks to avoid his presence. It has been frequently noticed 
in fox-kennels that a mad dog will attack only the males of his own species 
and spare the females. Sometimes the animal manifests a decided insensibility 



320 THE TREATMENT OF DISEASES. 

to pain, remaining quiet under blows and treatment which would call forth ft 
vigorous protest from a healthy dog. It is said that a mad dog will seize a 
red-hot poker, and in some instances they have been known to bite off the end 
of their own tail. A decided alteration in the sound of the voice is usually de- 
tected. The bark entirely loses its ring and acquires a peculiar hoarseness 
which is readily recognised by the most unobservant. Attention is sometimes 
drawn to the condition of an animal supposed to be healthy by observing that 
it tries to scratch the corners of its mouth as if attempting to get rid of the 
ropy mucus which is freely discharged from it. As the disease progresses the 
discharge increases, the lower jaw hangs as if paralysed, and the animal has evidently 
a difficulty in swallowing. With the extremely small quantity of nourishment taken 
the animal rapidly emaciates, and in a few days from the onset of the illness a very 
striking alteration is noticed in his general appearance. The flanks fall in, the eyes 
become dim and sunken, and the general weakness is so great that the animal can 
scarcely stand. His powers of biting are now very feeble, and he curls himself up as 
if trying to sleep, and in this manner gradually and tranquilly dies. Death usually 
ensues on the fifth or sixth day, rarely later, and life is never prolonged beyond the 
tenth day. 

We must especially call attention to the fact that in dogs suffering from hydro- 
phobia no special dread of water is manifested. In exceptional and extremely rare 
instances only do the animals suffer from spasm of the throat in their attempts to 
drink. They tolerate the sight of water without any sign of excitement, and will 
splash about in it and drink freely. There is a case on record of a man who died 
from hydrophobia arising from a bite on the hand, received whilst endeavouring to 
rescue a dog from drowning. Rabid dogs seldom display any special aversion to lights 
air, or the glare of the sun In many cases, from the first to the last that wild fury 
which is commonly supposed to belong to the disease is conspicuously absent In 
one particular form of canine hydrophobia, known as dumb rabies, the lower jaw ia 
early paralysed, and the peculiar howl is then lost 

The symptoms occurring in other animals suffering from hydrophobia are similar 
to those described in the case of dogs. When foxes are under the influence of the 
disease they lose their natural shyness, and follow men and animals, biting them ii 
they get an opportunity. Wolves are more to be feared than foxes, from their 
greater strength and ferocity. They attack human beings without the slightest 
hesitation, and generally succeed in inflicting severe wounds about the face, neck, 
and hands. Cows, horses, sheep, and deer, from their limited powers of biting^ 
seldom succeed in communicating the disease to man. 

As the actual inoculation of the system with the saliva of the rabid animal is 
necessary for the production of the disease, it may readily be imagined that it is not 
everybody who is attacked by a mad dog that contracts hydrophobia. By some it is 
said that the disease is produced in only five per cent of the cases, whilst by others 
the proportion is placed as high as fifty per cent. It is possible that some people 
are more susceptible to the disease than others, but the situation and character of 
the wound in all probability exert a great influence on the result It is obvious that 
when the injuries are situated on the hands and face the danger of the supervention 



KTMtoraosu. 931 



of hydrophobia is much greater than when they have been inflicted on the covered 

portion of the body or limbs, for in the latter case the clothing protects the wound 
from the action of the saliva. 

The symptoms produced by hydrophobia in man are somewhat different from 
those we have described as occurring in animals. Let us suppose that a man 
is bitten on the hand by a mad dog, what happens 1 At first nothing ; the wound 
behaves, to all appearance, just as it would have behaved if the dog which 
produced it had not been rabid — that is, it gradually heals up. After an uncertain 
period, which may vary from three or four weeks to as many months, or even 
longer, the patient experiences an uneasy sensation in the situation of the bite. 
The scar tingles, or aches, or feels numb, or it may even become inflamed, and 
the wound break out afresh. In a few hours or days, during which the patient 
feels uncomfortable, and "ill all over," the constitutional symptoms make their 
appearanca Pain and stiffness are experienced about the head and neck, and 
then the most characteristic symptom of the disease, inability to swallow fluids, 
sets in. The patient is thirsty, but is unable to swallow, every attempt bringing 
on a fit of choking and sobbing of a most distressing character. This continues 
for a few days, and then the patient gradually dies of exhaustion. 

Sir Thomas Watson has given a graphic account of a case of hydrophobic 
which came under his observation. It is too long to transcribe in full, and we must 
consequently content ourselves with giving an abstract of the chief features, believing 
that such a course will be more conducive to a correct appreciation of the nature 
of the disease than a mere enumeration of the symptoms. The patient was 
a coachman, whose right hand had been struck ten weeks previously by the 
teeth of a terrier dog. He was brought to the hospital on a Tuesday. On 
the preceding Thursday his hand became painful and swollen. On Friday the 
pain extended into the arm, and became more severe. On the morning of this 
day he had refrained from taking his usual cold bath on account of some 
feeling of spasm about his throat. His own remark about this was that " he 
could not think how he could be so silly." On Saturday the extent and severity 
of the pain had still farther increased, and on this and the preceding night 
he got no sleep. He felt ill and drowsy on the Sunday, and the pain extended 
to the shoulder. The next day he complained of feeling " ill all over," and 
told his medical attendant that he could not take his draughts, because of the 
spasm in his throat. That gentleman, concealing his own suspicions as to the 
true nature of the disease, said, " Oh, you don't like the taste of your physic 1 
drink some water." But he declared that he had the same difficulty with 
the water. The next day he came to the hospital, when there was water 
brought and placed before him in a basin, for the alleged purpose of allowing 
him to wash his hands. It did not seem to disturb him, nor to excite any 
particular attention. Water was then offered him to drink, which he took and 
carried to his mouth, but drew his head from it with a convulsive shudder. 
Subsequently water was again brought him, which agitated him, and he became 
exceedingly distressed and unquiet, complaining of the air which blew upon him. 
In the evening he made an attempt to take some gruel. Ho sat up, and 
11 



322 THE TREATMENT OF DISEASE8. 

after a moment's look of serious terror took half a spoonful of the gruel in a 
hurried gasping manner, and then said he would not take more at a time lest 
the sensation should come on. He was desired to drink the last portion of the 
gruel from the basin. He accordingly seized it with hurry, carried it to his mouth 
with an air of determination, and then a violent choking spasm of the muscles 
about the throat ensued, and most of the gruel was spilt over his chin. He 
observed that he had been in too great a hurry about it, or he should have 
managed it. On the Wednesday, at noon, he was in nearly the same state, 
but said he was better. Jn the course of the night some morsels of ice had 
been given him. With considerable effort he swallowed two or three of these ; 
the third and fourth caused so much spasm, however, that he was obliged to 
throw them out of his mouth, but so great was his resolution, that he seized them 
again, and by a strong exertion succeeded in swallowing them. He complained 
now that his mouth was and had been clammy; and he champed much, and 
spat out a good deal of tough mucus. At his own request, and (as he said) 
that he might injure no one, a straight-waistcoat was brought, which he assisted 
in putting on. He subsequently made an attempt to take some arrowroot, 
the effort being preceded by hurried inspirations and sobbings precisely resembling 
those which occur when one gradually wades into deep water. He swallowed 
small quantities of arrowroot eight or nine times with hurry and difficulty, 
and with sighs that succeeded each other rapidly. By the evening of that 
day the disease had not made much further progress. He again sat up and 
tried to eat some thinnish gruel. While taking the basin into his hand he drew 
back his head to a distance from it, apparently involuntarily. He took one half- 
spoonful with effort and distress, then sighed deeply and rapidly, or rather 
his breathing consisted of a succession of sighs at short intervals; he gave up 
the basin and sank back on his pillow, still sighing. The next day he was still 
composed, though more easily irritated, his pulse was 140, and much weaker 
than before, and his mental powers were failing. He gradually sank, and died 
in the evening, having repeated the Lord's Prayer an hour previously. During 
the last hours of his life he had been moaning and tossing from side to side ; his 
bowels were purged ; fluid stools ran from him, and distressed him greatly. 
His feet and legs first became cold, and the coldness extended by degrees up 
to his chest. He hawked up in the course of the day a considerable quantity 
of ropy mucus, and much frothy saliva came from his mouth towards the close. 
The duration of this case was unusually protracted, and on the whaie the symptoms 
were less violent than usual 

It is almost needless to say that there is not the slightest fear of the disease being 
communicated by a patient to his attendants. In former times it was universally 
believed that the unfortunate sufferers had both the power and the inclination to 
impart the disease to others by biting them. Every one feared to be bitten, and 
fancied that by merely coming in contact with the body, or treading upon the saliva 
of a diseased person, the malady might be contracted. The nearest relatives fled 
from the patients, and abandoned th^m to their fate, as if they were so many wild 
beasts. Sometimes, however, ^ith tha view of shortening their sufferings, as they 






HYDROPHOBIC. 323 

said, they put them between two feather beds, and smothered them, or they opened 
a vein, and let them bleed to death. It is stated, moreover, in a work recently 
published on the subject, that even in our own day there are districts in Europe (the 
military frontier of Austria) where the dread of hydrophobia is so great that human 
beings who are suffering from it, or who are suspected of being so affected, are 
shot by their neighbours, whilst those who have been bitten by rabid animals not 
unfrequently commit suicide. 

When a person has been bitten by a suspected dog, the animal should on no 
account be killed, for it may turn out that after all it was not really mad. The 
beast should be carefully secured so that it can do no further mischief, and then 
watched. A few days' observation might show that the suspicion as to the nature 
of the disease was unfounded. Rabies is invariably fatal in the dog under ten days, 
so that if the animal survive that time the bitten person may feel assured that he 
is in not the slightest danger, and has no cause for apprehension. By taking this 
simple precaution, not only may the patient's mind be relieved of a most harassing 
fear, which might otherwise have tormented him for months and years, but the dog 
will be afforded an opportunity of clearing his character of a most unjust suspicion 
It should always be remembered that the majority of dogs who bite and snap are 
only vicious and not rabid. When a mad dog bites through the clothes, particularly 
if they consist in part of woollen material, the poison is very often wiped off from 
the teeth, and the system is not in reality inoculated. The large majority of 
those who are bitten by mad dogs escape hydrophobia, in fact, the Board of 
Health's reports show that the annual mortality from this disease seldom exceeds 
four or five, and is often as low as one even. As the greater number of cases occur 
between the thirtieth and fortieth days, when the latter period is safely passed 
every hope may be entertained that no harm will arise from the accident. After 
the expiration of the second month the patient may be considered almost absolutely 
safe. It is the opinion of many doctors that a patient may readily succeed in 
frightening himself to death, and that the terror inspired by the bite of a mad dog 
may prove fatal. 

What should be done when a person is bitten by a mad dog? In Hie case 
of the arm or leg a pocket-handkerchief or piece of rope should be tied tightly 
round the limb above the bite. The sufferer should then immediately suck 
the wound with all his might, or if from its position or his want of presence 
of mind he is unable to do so, some friend or good-natured bystander should 
perform that office for him. No danger is incurred in sucking the part, pro- 
vided there be no wound on the lips or other surface with which the poison 
comes in- contact. As soon as possible the bitten part should be either cauterised 
or cut out with a knife. The late Mr. Youatt, who, in the course of a long 
experience, had treated a very large number of persons who had been bitten by 
dogs undoubtedly rabid, placed the greatest reliance on the application of lunar 
caustic, which, so far as he knew, had in every case prevented the development of 
hydrophobia. ±ie had an undoubted right to speak with authority, for he tells us 
that he had himself been bitten seven times, and that he had operated with the 
caustic successfully on more than four hundred persons, all bitten by dogs respecting 



824 THE TREATMENT OF DISEASES. 

the nature of whose disease there could be no question. It is absolutely essential 
that the caustic should be brought in contact with every particle of the exposed 
surface. When, from the extent or situation of the wound, the nitrate of silver 
stick cannot be effectually employed, fuming nitric acid may be used. Abercromby 
was in these cases an enthusiastic advocate for the use of the knife. He advised 
that a skewer should be cut as nearly as possible into the shape of the dog's tooth, 
and insert it into the cavity which it had made. He then by a bold sweep cut out 
the skewer and the whole of the surrounding tissue in which it was contained, 
taking the greatest care that every portion with which the tooth had come in 
contact was thoroughly removed Many people nowadays would entertain a very 
decided objection to such energetic treatment, even although all pain might be 
avoided by the performance of the operation under chloroform. In the absence of 
a skilled surgeon the application of a red-hot poker or Italian iron is to be preferred. 
If freely applied it is almost certain to confer absolute immunity. The pain of the 
application is probably very much less than is usually supposed Another plan is 
to cover the part with gunpowder and then explode it. 

We must now consider the mode of treatment to be adopted when the disease 
has fully declared itself. Most medical writers on this subject are sufficiently 
explicit, for they affirm their utter unbelief in any method of treatment. " No 
gpecific method of treatment has been shown to have the slightest influence in 
checking or modifying this disease from which, in all probability, no one ever 
recovered" "There is no well-authenticated case on record in which a hydrophobic 
person has recovered." " The physician that cures is Death." Such are the opinions 
of some of our most eminent physicians and writers on medicine. We must admit, 
however, that we are not prepared to receive their verdict as final. If we were 
suffering from hydrophobia we should by no means be prepared to lie down and 
await the bitter end Cases of recovery have been recently recorded, and as long 
as there is life there is hope. 

We believe that sufficient evidence has been adduced in favour of our common 
box (Buxus sempervirens) as a remedy for hydrophobia to justify its employment 
with a certain amount of confidence. It is, moreover, the active ingredient in many 
of the secret remedies which have obtained a reputation for the cure of this disease. 

The Groombridge recipe, which was for several generations in the possession of 
a family living in the neighbourhood of Uxbridge, was some three or four years ago 
purchased at the instigation of a medical man who had had many opportunities of 
witnessing its beneficial effects, and had published an account of several successful 
cases which had occurred under his immediate observation. It was found to consist 
of the terminal branches and leaves of box, of fetid hellebore, primrose roots, 
gascoigne powder (a mixture of crabs' claws, hartshorn shavings, and amber), jalap, 
and carbonate of iron. The primrose roots were not considered essential, and had 
been omitted for some years. 

The Birling remedy, which in popular estimation has obtained a reputation as 
great, or even greater, than the Groombridge, is said to consist of box, staggerwort, 
primrose roots, lears'-foot, powder of white gashen, jalap, and steeL 

Hie mass of evidence in favour of the beneficial effects of these remedies, * 



HYDROPHOBIA, 325 

of undoubted hydrophobia, is so great that it can hardly be attributed to the 
influence of imagination, and we entertain but little doubt that the active ingredient 
in both prescriptions is the box. 

Many of the older writers on medicine and drugs appear to have been acquainted 
with the properties of this plant. Thus old John Parkinson, in his " Theatre of 
Plantes," published in 1640, says : — 

"One medicine that I learned of a friend who had tried it effectual, I will here 
set down unto you to cure the bitting of a mad dogge, is to take the leaves and 
rootes of boxe, and penny-royall, of each a like quantity, shred them small and put 
them into hot broth and let it be so taken three days together, and apply the herbe, 
&c., to the bitten place with sope and hogges* suet melted together." 

In a curious work on the diseases of dogs, published early in the present century 
by Delabere Blaine, a veterinary surgeon, a very interesting account is given of his 
discovery of the composition of a remedy for hydrophobia, and of the results obtained 
by its employment in a large number of cases. It appears that the author had for 
some years known that there lived near Watford a cottager of the name of Webb, 
who dispensed what is commonly called a drink, as a preventive of hydrophobia. 
From the number of testimonials received relative to its efficacy, there were reasons 
to suppose that it really possessed some preventive properties. In the year 1807, 
rabies proved very prevalent, and the public curiosity became much excited on the 
subject. Mr. Blaine had his interest in the question greatly enhanced by " having 
been bitten by a dog unquestionably rabid." He accordingly went to Watford, and, 
as he says, prosecuted his inquiries with such success that from one of the two 
brothers who had dispensed it he gained the original recipe, which he took the 
precaution of having verified on oath before a magistrate. It was found to consist 
largely of box. The method of preparation adopted by Mr. Blaine is as follows : — 
Take of fresh leaves of the tree box, two ounces ; of fresh leaves of rue, two ounces ; 
of sage, half an ounce. Chop these finely, and, after boiling them in a pint of water 
to half a pint, strain and press out the liquor. Beat them in a mortar, or other- 
wise bruise them thoroughly, and boil them again in a pint of milk to half a pint, 
when press out as before. After this mix both liquors, which will then form enough 
for three doses, one of which is to be taken every morning fasting. 

Mr. Blaine, in the course of a long and extensive practice, gave this remedy to 
nearly three hundred living beings, including men, women, and children, horses, 
hogs, sheep, and dogs. In almost every case he was enabled to trace the history of 
the danger to the bite of some rabid animal. Although he was unable to regard 
box as an absolute specific for hydrophobia, the number of cases in which it failed in 
his hands was remarkably small. 

We think that this combination of testimony should induce us to give box a 
trial in cases of hydrophobia, more especially as we have practically no other drug 
on which we can rely. We might either follow Mr. Blaine's directions as to its 
mode of administration, or, as we think preferably, omit the rue and sage, and give 
the box alone. The alkaloid or active principle is known as buxine, and is readily 
obtainable, but we know of no case in which it has been given in hydrophobia, 
although it is very probable that benefit might ensue from its administration. 



326 THE TREATMENT OF DISEASE!. 

A case of hydrophobia has been published in which recovery was attributed to 
hypodermic injections of morphia frequently repeated. 

Of late years the use of the vapour bath has been strongly recommended, not 
only as a preventive of hydrophobia, but as a means of curing the disease when fully 
developed. It is not at all improbable that it may be instrumental in eliminating 
a virus which lurks so long in the system. The bath is recommended to be taken, 
ct la liusse, on several successive days, at a temperature of from 57° to 63°. Benefit 
might possibly be derived from the use of the Turkish bath. 

In addition to the specific treatment, we should try to soothe and comfort the 
unfortunate patient by every means in our power, and should be especially careful 
to prevent all noises, draughts, and other sources of excitement which are so liable 
to excite the painful spasm of the throat. It has been suggested, and apparently 
with good reason, that large fluid injections might with advantage be administered 
by the bowel By checking the agonising thirst, they would in all probability greatly 
lessen the sufferings of the patient. 

HYPOCHONDRIASIS. 

Hypochondriasis may be said to consist essentially of an exaggerated egotism. Its 
principal feature is mental depression occurring without adequate cause, and taking 
the shape of a conviction in the patient's mind that he is the victim of some serious 
bodily disease. It is a complaint that has been recognised from the earliest times, 
and has always been known as hypochondriasis or the hypochondriac disorder, and 
sometimes as the " spleen." It might aptly be described by the term " misery." It 
is not pain ; bodily pain is not misery, for you often see patients cheerful and even 
jocose, though daily racked with pains which might almost bring tears into your eyes 
to witness. Misery is worse than pain ; it is a terrible infliction, as those who have 
experienced it know welL 

In this case there is no perversion of the understanding such as frees the insane 
from the responsibility of moral agency. Indeed, the average intellectual capacity 
in hypochondriacs is not below but rather above the general standard. Without 
any sufficient reason for such conduct, and without any signs of intellectual impair- 
ment, the patient concentrates his attention on some particular organ of the body 
and imagines that it is seriously diseased. He is constantly tormenting himself — 
and others too, for the matter of that — by dwelling upon his miserable condition, 
and suffers from the incessant dr«ad of the existence of some serious malady, with 
perhaps a fear of impending death or insanity. He may fulfil his ordinary duties 
creditably, but, as a rule, is preoccupied with his own condition, to the exclusion of 
all other interests and affections, and is ever writhing under the petty despotism of 
an imaginary eviL Many a hypochondriac might exclaim with Hamlet : — " I have 
of late (but wherefore I know not) lost all my mirth, foregone all custom of exercises; 
and, indeed, it goes so heavily with my disposition, that this goodly frame, the earth, 
seems to me a sterile promontory ; this most excellent canopy, the air, look you — this 
brave o'erhanging firmament, this majestic roof fretted with golden fire — why, it 
appears no other thing to me than a foul and pestilent congregation of vapours." 

Hypochondriacs generally present a healthy appearance, and sleep and perfonr 



KTPOCHOKURIASX*. $2? 



their ordinary functions well. They go " the round of the doctors," if they can 
afford it, and are always changing their medical attendant, being particularly anxious 
to try any new drug that may for the time be fashionable. They take a strange 
delight in talking about their ailments, and are very fond of using scientific terms 
without, however, always quite understanding what they mean by them. A curious 
feature is that although they do their best to nurse their malady, they always appear 
to be most anxious to get rid of it, and have an unlimited faith in medicines, not- 
withstanding repeated failures in treatment. Perhaps the most vivid picture extant 
of a hypochondriac is contained in the autobiography entitled " Grace abounding 
unto the Chief of Sinners," being the history of the feelings of " God's poor servant, 
John Bunyan," as he styles himself. 

The precise symptoms complained of vary much, and they are liable to change 
from time to time. Often enough there is a great but indescribable sensation of 
uneasiness in the chest, or there is a burning pain at the pit of the stomach. A very 
common delusion is that there is consumption or fatal heart disease, and a little 
indigestion and consequent palpitation may serve to keep up this idea. In the case 
of persons whose family is strongly tainted with insanity these delusions may assume 
a far more serious character, and the patient may believe, for instance, that his 
stomach is full of tadpoles, or that a serpent is writhing about in his entrails. The 
judgment may even become affected to such a degree that the patient entertains most 
preposterous ideas, as that he is made of glass, and is in constant danger of being 
broken, or that he. is being magnetised, or that people are conspiring to poison him. 
The wife of a tradesman believed that she had become solid, so that there was no 
room for any food, which, nevertheless, she continued to take. An idle country 
gentleman was convinced that some stones that had been thrown in his face weeks 
before had gone down his stomach, and could be heard rattling about in his inside. 
These can hardly be regarded as simple cases of hypochondriasis, and many of these 
people ultimately become insane. 

Hypochondriasis is pre-eminently a disease of adult and middle life. It is hardly 
ever seen in young people, and rarely makes its first appearance after the age of 
fifty. It is confined almost exclusively to men, and in women is for the most part 
replaced by hysteria. Beyond all other circumstances that favour its occurrence is 
the existence of a strong hereditary taint of insanity. No station in life gives 
immunity from hypochondriasis, but it is most frequently met with in those who, 
having retired from business, find the time hang heavily on their hands for the want 
of some active employment. So also those who from their social position have not 
been brought up to any occupation suffer greatly ; those accustomed to sedentary 
pursuits, who neglect to take sufficient exercise; and those again who over-work 
themselves mentally, or who suffer from prolonged anxiety or strain. Reading men 
at the Universities are often tormented with great depression of spirits ; often the 
conscience is over- sensitive, and the importance of becoming distinguished is exag- 
gerated. Disappointment, loss of wealth, loss of husband, wife, children, friends, 
of health, character, or social position, are often assigned as causes of hypochon- 
driasis, and in many cases the complaint appears to have originated in the moral 
collapse consequent on an over-exhausting labour, or on the sudden revelation to thfi 



THB TREATMENT OP DISEASES. 



mind of an idle man that his time has been wasted, and that he is a mere burden on 
the face of the earth. The intellect of a hypochondriac is usually of a superior 
order, thus Shakespeare makes Hamlet, who may be regarded as a good type of a 
hypochondriac, a courtier, soldier, and scholar, " the observed of all observers." 

A hypochondriac should be encouraged to engage in some active work. Probably 
the best thing that could happen to him would be to fall in love with some one — 
besides himself, that is. The great thing is to have an object in life, something 
to work at, something you can throw your whole energy into, heart and souL Any- 
one who has a tendency to be hypochondriacal should not be allowed to read medical 
books of any kind. If once he gets into the hands of a designing quack, there is 
no end to the mischief that may be done. Those little pamphlets that are thrust into 
your hands in the street should be systematically rejected. The tale they tell is so 
plausible that he must be a strong-minded man who can read them with impunity. 
The best thing, and the safest course, is to have nothing to do with them. Then 
there is another thing ; if a man is hypochondriacal it is of no use trying to laugh 
him out of it, for you will not succeed. What he wants is help and encourage- 
ment, and not " chaff." When the appetite is poor it is important to improve it by 
quinine (Pr. 9), gentian and soda (Pr. 14), infusion of calumba or quassia, or something 
of the kind, taken, of course, before meals. When there is indigestion, with constipa- 
tion and sluggishness of the liver, nux vomica is the best remedy ; from five to ten 
drops of the tincture may be given in half a tumbler of cold water three times a day. 
Flatulence is often complained of, and three drops of cajeput oil taken on a piece 
of sugar occasionally will move the wind better than anything. When there is 
anaemia (see Anaemia) it will have to be removed by iron, which, if preferred, may be 
taken in the form of one of the natural mineral waters. When there is failure of 
strength, cod-liver oil is useful. When it cannot be borne, cream, butter, or some 
other form of fat, will often agree better for a time. Pancreatic emulsion is some- 
times taken with benefit. Sea-bathing proves especially beneficial, and when it 
cannot be obtained it will be found a good plan to put a handful or two of sea-salt 
into the bath in the morning. When constipation is the chief trouble it should be 
remedied by a plentiful supply of vegetables and fresh fruit, rather than by medicines. 
It is very essential to obtain natural, quiet sleep, to procure which the bedroom 
should be fairly large and well-ventilated, and the bed should be free from drapery. 
There must be sufficient, but not too much, clothing. If there be restlessness, it may 
be relieved by a tepid bath the last thing before going to bed, or perhaps by briskly 
rubbing the skin all over with a rough towel. Kest is important, but it is seldom 
necessary to take more than nine hours' sleep out of the twenty-four. The hair 
should be kept short, and the teeth should be well cleaned night and morning. 
Dumb-bells are useful, and the best authorities recommend that their weight should 
be in proportion to that of the individual using them, as pounds to stones. Thus 
a man of 140 pounds should select instruments each weighing five pounds. Their 
use gives flexibility and tone to the muscles, and promotes general activity. Should 
club exercise be preferred, wooden bats are to be selected, about two feet in length, 
and each weighing from three to nine pounds, according to the strength of tb^ 
individual 



SYSTERIA HYSTERICS. 329 



HYSTERIA HYSTERICS. 

A fit of hysterics may occur in a great variety of forms, but the following 
may be regarded as the description of a bad attack. The patient has been 
" put out," or " upset " about something. She begins talking vehemently and 
unreasonably, and becomes greatly agitated. She laughs or cries, or perhaps 
exhibits a combination of both. She is probably more or less aware of her 
condition, and of the notice her conduct is attracting, and she may, perhaps, 
apologise for or lament her weakness. Suddenly she loses all self-restraint, 
and seems entirely to abandon herself to the intensity of her feelings. 
She gives a cry or a scream, and falls down, throwing her arms about in a 
disorderly manner. She makes a great noise, utters incoherent sentences, sobs 
violently and repeatedly, and complains of her throat, her stomach, or breath. 
After a time she seems faint, or exhausted, or "worn out," and then gradually 
"comes to herself" again. These paroxysms vary greatly in diflerent cases, 
not only in their severity, and the symptoms they present, but also in their 
duration. Sometimes it is " all over " in a minute or two, and the patient gets 
"all right" again, but more commonly this condition continues more or less 
for an hour or two, or, perhaps, the whole afternoon. After the paroxysm the 
patient commonly voids a large quantity of pale limpid urine, looking almost 
like water, and this is sometimes discharged during the fit. 

At first sight this may appear somewhat like the description of an epileptic 
fit, but in reality very little difficulty is experienced in distinguishing between 
these two conditions. We have already pointed out the means of making the 
diagnosis (see Epilepsy). It will be seen that in hysteria the onset of the attack 
is less sudden than in a real fit ; the patient gives some kind of warning, and 
if you have had any experience of such matters, you will know pretty well 
what is going to happen. A young lady in hysterics takes good care not to 
fail unless there is some one by to catch her, or at all events to condole with her 
after she has fallen, and she is, moreover, especially careful not to fall in an 
ungraceful attitude, or to damage her clothes in falling. Of course there are 
exceptions to this rule, for some people go into hysterics regardless of expense. 
It will be noticed that an attack seldom comes on at night, or when the patient 
is alone. Then, in hysteria, unconsciousness is seldom complete ; you may 
think the patient is quite insensible, but if you are rash enough to make any 
uncomplimentary remark, you will find that appearances are deceptive. In 
an hysterical fit there is never that frightful distortion of the countenance that 
one meets with in epilepsy. The pupils are quite natural, and are never dilated. 
The eyelids may quiver, or the eyeballs may be turned upwards, but there is 
no squinting, and the eyes never remain wide open with a ghastly stara It 
is obvious that the patient can see, for the eyes are often directed towards some 
one standing near, and then rolled up again under the eyelids. The tongue 
is not bitten, although there may be a great deal of spluttering, and foaming 
at the mouth. The attack is often followed by exhaustion, but never by stupor. 

When the fit is more severe than we have described, it is, probably, not • 



330 THE TREATMENT OF DISEASES. 

case of true hysteria, but a combination of hysteria and epilepsy. These mixed 
cases are not common, but they are occasionally met with. In the majority of 
instances the attack is less severe than we have described. Although these fits 
constitute the most characteristic feature of hysteria, they are by no means essential 
to its existence. Many people are distinctly hysterical, but never have a fit 
of hysterics. We often meet with young women who, from their hysterical 
tendencies, are a source of constant anxiety to their friends, but who, nevertheless, 
nsver have any definite outbreak. 

For the better understanding of that condition which we call hysteria, it will be 
convenient to consider in detail the circumstances that favour its production. 
It occurs almost exclusively in the female sex, but still we meet with it every now 
and then both in men and boys. Thus the case is recorded of a young doctor who 
was distinctly hysterical. He was exceedingly attentive to his own sensations, and 
fancied that he laboured under a number of diseases that had no existence but in 
his own imagination; he showed great uneasiness and infirmity of purpose; was 
what is called " very nervous," and had occasional outbursts of choking tears and 
laughter, exactly resembling those so frequently met with in the other sex In 
women hysteria generally makes its appearance about the age of sixteen, or from 
that to twenty. When once established it may last for years — in fact, for a life-time. 
When it occurs in men, it generally begins later — about the age of forty. In them 
it is usually the result of over-work or excessive worry and anxiety, and that is 
about the age at which these begin to telL There is often considerable deterioration 
of health, an impaired nutrition, and a feeble circulation, with exhausted brain. 
Hysteria occurs in all conditions of life, but it is more frequently met with in the 
unmarried than in the married, although it is by no means confined to the former. 
It was at one time thought that this preponderance of hysteria in single women 
showed that it was in some way connected with the womb, but this idea is now 
pretty well exploded. Its more frequent occurrence in single women is probably 
rather the result of their social surroundings. A woman, if not married, has, as a 
rule, very little to do — at all events, in the middle and upper classes of society. She 
has no housekeeping to attend to, no children to look after, nothing, in fact, to 
occupy her mind and rouse her out of herself, and this condition is pre-eminently 
favourable to the development of hysteria. On the other hand, a wife with a family 
has a good deal to occupy her attention, in fact, she is more likely to be over-worked 
than not ; she has to think of other people besides herself, and an attack of hysteria 
finds no place in the routine of her daily duties. An active employment and hysteria 
seem almost to be antagonistic. Many women who are hysterical exhibit some dis- 
turbance of the menstrual function, but then, on the other band, many women are 
irregular in this respect without exhibiting any tendency to hysteria, so that these 
two conditions obviously do not of necessity stand in the relation of cause and effect 
There is no evidence to show that hysteria is hereditary, and this is no more th 
we should expect considering that it occurs with the greatest frequency in 
unmarried. The determining cause of an outburst of hysterics is usually 
mental or moral disturbance, often enough some trivial circumstance, whick ? 
the individual by surprise, overcomes her power of self-restraint, 



irmiiA — HYSTERICS. S31 

We now pass on to the consideration of other symptoms which are usually 
present in cases of hysteria. There is often a perverted mental condition, and a 
marked inability or indisposition to exert the will. The patient believes that she 
cannot do certain things, and so confident is she in the correctness of her belief that 
practically she cannot do them. Perhaps, for example, she takes it into her head 
that she has lost all power over her legs. She asserts this strongly, and believes it 
so firmly that she fails to make the requisite effort to move them, and the result is 
that she is to all intents and purposes paralysed. But often, under the influence of 
some unexpected idea or emotion, or sensation, the effort is made, and the very thing 
is done which a moment before was believed to be impossible. " A patient may be 
carried into the room, and may fall when left for a moment to herself ; tell her to 
walk, and a wooden doll seems as capable of movement ; but, under the stimulus of a 
wish that what she is saying should not be overheard, she walks to the open door and 
closes it. Certain ideas seem rampant in her mind ; she cries about them, and gesticu- 
lates in the wildest manner ; tell her to be silent, to keep them to herself, or to control 
her feelings, and you find them exaggerated, and she affirms that ' all the world shall 
hear ' what she has to say ; but a gentle tap at the door, that may come from the hand 
of some one from whom she wishes to conceal her state, is sufficient in a moment to 
hush this stormy talk, to compose her face, to dry her eyes, and make her speak and 
smile with placid composure. Sometimes she speaks in a whisper only, and if asked 
to 'exert herself or 'make an effort,' so that some particular friend who is a little 
deaf may hear what she has to say, the only effect is that the whisper becomes quite 
inaudible — that she makes less sound than ever, and often none at all. She moves 
her lips, but not even the ghost of a sound is heard to pass them ; and yet this 
self -same person may, when no attention is directed to the voice, speak loudly enough 
to be heard and understood in the adjoining room. The fact seems to be that the 
will can be called into exercise only by some one dominant idea or emotion, and that 
it is this which determines the varying phases of the mental state." So says one of 
our leading authorities on this subject This curious condition may, perhaps, be 
better realised by the consideration of a case related by another writer on nervous 
diseases. " A young lady," he says, " came under my charge for what was supposed 
to be a disease of the spinal cord. She had taken to her bed suddenly, soon after 
striking her back rather gently against the edge of a table, declaring that she could 
not walk. On examination, I was convinced that there was no disease whatever of 
the spine, other than that of a purely hysterical character, and I so expressed myself 
to her. She nevertheless insisted upon it that her spine was seriously injured, and 
she continued to keep her bed, lamenting her sad fate at being compelled to pass so 
long a time shut out from the enjoyments of life. There was no paralysis, or even 
simulation of it, for she moved her legs about freely enough in bed. But one evening 
her brother, who had long been absent, returned home. She heard the bustle in the 
house attendant upon his arrival, but all were too busy to pay any attention to her 
in her chamber upstairs. Suddenly exclaiming, ' I can stand this no longer,' she 
sprang from her bed, rang for her maid, and, hurrying on her clothes, proceeded 
down-stairs and entered the drawing-room, to the great surprise of all her family." 

A very common belief on the part of the victim of hysteria is that she is " not 



332 THE TREATMENT OP DISEASES. 

understood." She is very apt to think that every one is against her, that she is 
neglected, and that even her best friends are intentionally unkind to her. She 
entertains an exaggerated belief in her own importance. She is always thinking of 
herself, and is apt to forget that she is not an equally agreeable object of content 
plation to others. Often enough she is despondent and depressed, and she shedjg 
tears profusely, but a few minutes after has forgotten her grief and laughs 
immoderately without any adequate cause. Laughing and. crying alternate with 
almost ludicrous rapidity, and sometimes even they may co-exist. Often the 
patient is listless and indifferent to everything of ordinary interest, or she may be 
absorbed in some trivial occupation She may exhibit great restlessness and 
impatience, with extreme irritability of temper on any attempt being made to control 
her in any way. It is not uncommon for these patients to display an emotion 
exactly the reverse of that which would be ordinarily excited. One, for instance, 
draws the chief prize in a lottery, and begins at once to cry and ring her hands. 
Another hearing that burglars have broken into the house and stolen the plate and 
jewellery, sits quietly in her chair, with her hands folded in her lap, and seems rather 
to enjoy it than otherwise. 

Excited sensibility is another very common accompaniment of the hysterical 
condition. One patient cannot bear the light ; another is distracted by the slightest 
sound ; to a third all ordinary odours are intolerable ; whilst to others certain tastes 
are highly objectionable. Here is an example : — " A middle-aged hysterical woman, 
whom I saw in the hospital a few days ago, had been lying for weeks with her hand 
before her eyes ' to keep out the light ' of a dull London sky. Bringing a candle 
before her — the room being so dark from an accidental fog that I could not see the 
pupils — she shuddered, knit her brows, and held both hands between her and its 
feeble light. There was no undue contraction of the pupils, and when her mind was 
distracted to the condition of her front teeth — the light being still close to her eyes — 
the brows were relaxed, the hands removed, and there was no expression whatever 
of uneasiness." The same author, in describing another case, says : — " A lady to 
whom I was speaking lately, in a tone by no means loud, exclaimed in a voice much 
noisier than mine, and putting her hands to her ears at the time, ' Not so loud, not 
so loud ! ' but a moment afterwards she stirred the fire so vehemently, and made so 
much noise in the process, that it was positively annoying to myself, and this 
without appearing to give herself the least uncomfortable sensation." 

Illusions and hallucinations are by no means uncommon in hysteria, and may be 
connected with one or more of the senses. In the majority of cases the patient at 
once recognises the fact that they are illusions, and nothing but illusions. She 
sees certain things, but she is aware that they are purely ideal and that they have no 
actual existence. She does not " believe in them," and they exert no influence over 
her actions. Moreover, they are rarely permanent, and soon take their departure. 

Hysterical people often complain of pain, which is chiefly muscular in origin. It 
is often experienced in the chest or back, and especially between the shoulders and 
over the loins. A very common hysterical pain is that occupying some one point in 
the head ; the patient speaks of it as a sensation like that which might be caused by 
driving a nail into the part It is often situated just abo^e one eyebrow, aod ii 



HYSTERIA — HYSTERICS. 333 



sometimes comes on every day at the same hour, like brow-ague. Occasionally the 
pain is experienced in the breast, and a fear may be entertained that a cancer is 
breeding. Pain in the joints is a common manifestation of hysteria, and may be 
mistaken for some serious disease. It has been stated on good authority that among 
the higher classes of society at least four-fifths of the female patients who are 
commonly supposed to labour under diseases of the joints labour under hysteria and 
nothing else. This may be an exaggeration, but at all events it serves to show the 
frequency with which pain occurs as a symptom of hysteria. " Such pain, wherever 
it may be situated, usually requires strong adjectives for its description, and the 
account given of it is sometimes tediously minute. I have heard one hysterical lady 
enumerate and detail nine different kinds of pain in her chest ! Of these, some 
were bearable, some 'intolerable,' others 'agonising,' four or five of them usually 
appeared together, and were present at the moment of description, and yet the face 
was calm, and simply conveyed the expression of interest in the description." 

One of the commonest seats of hysterical pain is in the abdomen, just below the 
ribs, and it occurs with greater frequency on the left side than the right. Sometimes 
the pain is lower down, either in the groin or a little above it, and then, too, the 
left side is more frequently affected. The pain is an acute — nay, a very acute — pain, 
and the patient cannot tolerate the slightest pressure on the part, and can barely 
suffer the weight of the bed-clothes. It is not only the deeper parts, but even the 
skin and muscles, that exhibit this tenderness. Many a patient has been leeched 
and blistered under the impression that she had peritonitis, when in reality the 
symptoms were purely hysterical in nature. 

In some cases of hysteria there is complete loss of sensibility over the whole of 
one half of the body. On that side you may prick them, run needles into them, as 
much aS'you like without their feeling it, and what is more, no bleeding follows the 
injury. This fact was first discovered in the case of a patient in one of the Paris 
hospitals. On leeches being applied, their bites yielded very little blood on one side, 
whilst on the other it followed as usuaL This loss of sensation is a symptom which 
requires to be sought for, and, in fact, many patients are quite surprised when its 
existence is revealed to them. A curious circumstance is that the lost sensibility 
may, in many cases, almost immediately be restored by the application to the skin 
of plates of metal, such, for instance, as gold coins. This fact was known and pub- 
lished years and years ago, but it has recently been rediscovered and received by the 
medical world with considerable eclat. 

Many of the ordinary processes of life with which the majority of us go on 
unfelt or unheeded are keenly appreciated by the hysterical patient. She feels the 
movements of the heart, the pulsation of the vessels caused by the circulation of the 
blood, and even the passage of the food from the stomach into the bowels. Many 
of these people complain of a feeling like a lump in the throat ; sometimes it seems 
as though it would choke them, and an effort may even be made to get rid of it by 
swallowing a little water or a morsel of bread. We need hardly say that the sensa- 
tion is perfectly imaginary, and that there is no lump or anything of the kind thera 
Hysteria is a complaint that may at times simulate almost every disease under the 
Sometimes even vomiting of blood may be hysterical in origin. In proof of 



534 THE TREATMENT OP DISEASES. 

this, we cannot do better than quote the following case, which rests on the evidence 
of a physician of the highest eminence in his profession : — " A romantic girl," he 
says, " was for some months under my care in the hospital with this complaint. She 
vomited such quantities of dark blood (which did not coagulate, however), as I 
should not have thought possible if I had not seen them. Day after day there were 
potfuls of this stuff; yet she did not lose flesh, and she menstruated regularly ; and, 
what was very curious, the vomiting was always suspended during the menstrual 
period, and recurred again so soon as the natural discharge ceased. I said she was 
romantic, but I should rather have said that she had that peculiar mental constitu- 
tion which belongs to hysterical females. She used to write me long letters of thanks 
for my attention, though I was heartily tired of her ; and these were couched in all 
the fine language of 'hn Minerva press. At last I sent her away, just as bad as 
when she came into Uie hospital Five or six years afterwards she called at my 
house with a present of some game, and told me she had got married to a hair- 
dresser, and was quite recovered." 

We occasionally observe in hysterical patients, especially at the catamenial period, 
a complete suppression of urine, lasting from twenty -four to thirty-six hours. There 
may, perhaps, be some uneasiness experienced, and the pulse may be quickened, but 
after a short time a few spoonfuls of urine are expelled, and the normal state is 
restored. In other instances, during the lapse of several successive days, weeks, or 
even months, the quantity of urine secreted in the twenty-four hours may be quite 
insignificant or almost nil. Occasionally there is complete suppression for days 
together. When matters take this turn there is superadded, as it were of necessity, 
another phenomenon, which may be regarded as the complement of the first, and that 
is vomiting, the ejected matter presenting the appearance and exhaling the odour of 
urine. This may go on for weeks or months without any visible disturbance of the 
general health. Of course, this condition may be feigned, and girls have been 
known to drink their urine in order to conceal the fact of their having been able and 
obliged to void it, but in many cases the patients have been so strictly watched that 
there was no possibility of deception, and no reasonable doubt can be entertained of 
the truth of the phenomena we have described. 

It must be admitted that many of these facts are very difficult to explain, but 
they are none the less real for that. Many doctors refuse to have anything to do 
with them, declaring that they fall within the province of Dr. Lynn or Mr. 
Maskelyne, or Robert Houdin, rather than within that of the physician. That is 
absurd, and those who are acquainted with the care and accuracy with which obser- 
vations are now carried on in the wards of our hospitals, know that deception is well- 
nigh impossible. Hospital nurses, nowadays, are intelligent, well-educated young 
women, with sharp eyes and quick ears, and they are as incapable as the physicians 
of countenancing any imposture. More than that, in some cases in which doubts 
have been expressed as to the reality of the phenomena, the patients have for a time 
been placed in a straight waistcoat, so that they were powerless to help themselves 
in any way. 

In a case of hysterical suppression of urine, which was in one of the Paris 
hospitals in 1871, the patient also suffered from contraction of all her limbs. The 



RT8TEHIA — ETgTEBIO. 53ft 

contraction was as perfect as it is possible to conceive — in fact, it was absolute — 
persisting night and day, during sleeping and waking, even resisting the influence of 
sleep induced by chloroform. As her physician says, " Better conditions could not 
be desired to render surveillance easy, I took care, moreover, to place near her two 
devoted patients, bed-ridden like herself, who were ready to reveal all if they should 
discover any trickery. I had there the best possible police, that of women over 
women, for you are aware that if women enter into any plot among themselves they 
very seldom succeed. This statement will, I believe, be sufficient to convince you 
that simulation was impossible." 

There is a group of symptoms, known to doctors as " spinal irritation," which if 
not identical with hysteria, is, at all events, closely allied to it. Its nature may be 
gathered from the following condensed description of a case : — 

The patient, an unmarried lady, aged twenty-three, first came under obser- 
vation complaining of pains in the head and face, loss of appetite, nausea, 
flatulence, palpitation, breathlessness, " sinking feelings," weakness, and low spirits. 
The pain, which was the chief suffering complained of, was sharp and neuralgic in 
character, and varying in its seat, being sometimes in one part of the head or face, 
sometimes in another, and generally on the left side only. In the head it was 
confined to a spot which might be covered with the tip of the finger. Headache, in 
one form or another, was brought on, or exaggerated, by any effort, physical or 
mental ; it was usually relieved by lying down and keeping perfectly still ; it was 
scarcely ever absent except when faceache had its turn ; and sometimes it was so 
continuous and oppressive as to necessitate remaining in bed for days together. 
Nausea and sickness were its frequent accompaniment, and vomiting and great 
prostration were its common termination. In the upper part of the spine there were 
considerable tenderness and a disagreeable feeling of weight, and pressure there 
brought on or increased the headache, and induced a feeling of nausea and oppression. 
The feet were always cold ; *• chills and flushes " were of frequent occurrence, and so 
were yawning, sighing, and stretching of the arms. Sleep was often made hideous 
by nightmare ; fits of lowness of spirits and crying, attended by a sense of choking, 
as from a ball or knot in the throat, and followed by plentiful gushes of pale, limpid 
urine, were brought on by the most trivial causes, and the manner and appearance 
were altogether those of an eminently nervous or hysterical person. 

These symptoms, it appeared, had their starting-point about twelve years before, 
in the shock and grief caused by witnessing the death of a brother, her last remain- 
ing near relative, in an epileptic fit Before that the patient had enjoyed fairly good 
health. Her family history, however, was bad, for in addition to the brother who 
died in the fit, it appeared that she had lost her father from consumption, and that 
her mother was then under confinement in a lunatic asylum. 

Under the use of a more liberal diet, with ammonia and calumba, and with 
occasional blisters to the nape of the neck, health was re-established in little more 
than a month. 

A year or so later this young lady again returned to her medical attendant, 
looking very worn and thin, with all her old symptoms in force, and with 
cough and difficulty of breathing in addition. The cough was very violent ; barking, 



$36 THX TREATMENT OF DISEAS1 



unattended with expectoration, and often carried on until it ended in retching and 
vomiting. The difficulty of breathing was chiefly at night ; usually it was slight, 
but now and then quite asthmatic in character ; almost invariably it was accom- 
panied by a sharp pain in the left side, or by severe aching in the left shoulder and 
down the left arm. An examination of the chest failed to detect anything wrong 
with the heart or lungs, but pressure along the spine revealed tenderness in the 
neck and back, and at the same time brought on cough, deep inspirations, pain 
and throbbing at the pit of the stomach, and a feeling of great faintness and 
breathlessness. On this occasion a very fair state of health was soon re-established 
by the plan of treatment which proved successful in the first instance. 

Two years later, this lady, then married again, applied to her doctor. For three 
weeks she had been in bed with her knees bent, and the thighs drawn up tightly 
against her abdomen. This contraction was unremitting during the waking state, 
and only partially relaxed during sleep ; it was unattended by pain, and could for 
the time be overcome by slow and steady extension. The headache and faceache 
had quite gone, and so had the pain at the pit of the stomach, and in the left 
shoulder and arm ; the cough, and difficulty of breathing, and palpitation, were of 
rare occurrence, the appetite and digestion, and the action of the bowels, were 
tolerably natural, and the patient now complained chiefly of colicky pains in the 
lower part of the abdomen, pains often very severe and sickening about the loins and 
hips, with constant calls to pass water, attended with considerable pain on so doing. 
The spine was now tender, not in the upper part, but quite low down towards the 
loins ; and pressure over this region brought on colicky pains in the lower part of 
the abdomen, with an almost irresistible impulse to pass water then and thera 
Pressure in the upper part of the spine gave rise, not to the marked symptoms 
produced in this way in the two previous illnesses, but simply to a disagreeable 
thrill all over the body. There was no numbness or tingling in the legs or else- 
where, but tickling the soles of the feet gave rise to painful spasmodic shocks in the 
legs, to a disagreeable thrill passing up the body as high as the throat, and to the 
involuntary escape of a small quantity of urine. The condition of the general 
health was fairly good, in fact much better than during the two previous illnesses. 

It appeared that somewhat more than twelve months before, after having been 
quite well for the year previously, the patient married, and in due course became 
pregnant In the early months of pregnancy she had much headache, depression, 
weakness, and sickness ; but after a while these symptoms passed off, and every- 
thing went on smoothly and satisfactorily until two months after confinement, when 
her baby died suddenly. The fretting about her baby brought back the old head- 
aches, the headaches produced great sleeplessness and notability of the stomach, and 
then came on a state of uncontrollable fidgetiness which kept her incessantly 
moving about until her legs, one leg especially, failed altogether, and obliged her to 
take to her bed, when on the very next morning the leg had become contracted. 
The treatment on this occasion consisted chiefly in a liberal allowance of food and 
wine, in repeated blisterings over the spine, and in the administration of bromide 
of potassium ; the result was the cessation of the contractions in about three weeks, 
and the complete re-establishment of health in about two months and a hall 



HYSTERIA— HYSTERICS. 337 



Tenderness over the spine is always a prominent symptom in these cases of 
so-called spinal irritation. Often enough, however, it is not complained of untij 
specially inquired after, and now and then its existence is not even suspected by the 
patient until she is made to wince on the application of pressure. Nervous pains, 
neuralgias of different kinds, often shifting suddenly from one place to another, are 
a very common, perhaps the most common, symptom of this affliction. They are 
often brought on by lifting any weight, by twisting or straining the back, or by any 
effort, mental or physical ; and as often they are relieved, to some extent at least, by 
lying down. Nausea, retching, and vomiting are also common symptoms, as are 
spasmodic cough and difficulty of breathing. Palpitation is sometimes met with, 
often in connection with a feeling of pulsation at the pit of the stomach, throbbings 
in the temples, heats and flushes, and a tendency to faint. The contraction of the 
limbs, which formed so conspicuous a symptom in the case we have quoted, is by no 
means of uncommon occurrence in this form of hysteria. The lower extremities 
are the parts most frequently affected, but occasionally the arms are also involved. 
This contraction, which is generally painless, may continue for weeks or months, 
even during sleep, or there may be occasional intermissions of short and uncertain 
duration. The onset of the attack is usually very sudden, and the departure is often 
equally abrupt. In a case occurring in one of the Paris hospitals, there was con- 
traction of the leg of at least four years' standing. On account of the misconduct of 
this patient, her physician gave her a stern admonition, and threatened to turn her 
out. On the next day the contraction had entirely disappeared. In another instance 
the patient was charged with theft, and the contraction, which had lasted for two 
years, vanished suddenly from the moral shock caused by this accusation. As a rule, 
there is no real paralysis of the limbs, and the functions of the bladder and bowel are 
not interfered with. One of the most remarkable characteristics of this peculiar 
complaint is the suddenness with which all the symptoms may disappear and be 
replaced by others. The victims of this disorder are, with few exceptions, of a dis- 
tinctly hysterical or nervous temperament. They are very prone to pass under or 
after any strong emotion or excitement large quantities of pale limpid urine. They 
usually suffer from sudden and distressing flatulent distension of the stomach and 
bowels, v'th loud rumblings and explosions, accompanied by the feeling of a ball 
rolling about, firsfin the left flank, and then mounting or tending to mount into the 
throat, where it gives rise to a sense of choking and to repeated acts of swallowing. 
At times they suffer from bursts of crying, sobbing, or laughing, and they may sigh 
and yawn, and stretch the arms, and have fits of convulsive agitation and struggling. 
Other symptoms from which they frequently suffer are breathlessness, nervous 
cough, palpitation, throbbing in the temples or at the pit of the stomach, flushes and 
chills, fainting, hiccup, nausea and vomiting, aversion to food or unnatural craving 
for it, heartburn, languor and debility, fidgetiness, tremulousness, singing in the ears, 
and many others of a similar nature. 

Whatever the symptoms complained of may be, we suspect that the affection 

is hysterical if the patient is a young unmarried woman, if her menstrual 

functions are performed irregularly, and especially if, at some former period, 

she has suffered from fits of hysteria. Our suspicion is confirmed if we find 

23 



338 THE TREATMENT OF DISEASES. 

that these symptoms have existed for a considerable time, without any corre- 
sponding deterioration of the general health or strength. When the complaint 
simulated is some form of inflammation, the thermometer renders good service 
in enabling us to distinguish between the true and false disease. In real 
inflammation there is always elevation of temperature, whilst in its counterfeit 
presentment there is no fever. Hysterical affections have all a strong family 
likeness, and this often enables us to decide upon the nature of a doubtful case. 
Moreover, there is a peculiar expression about hysterical women, impossible almost 
to define, yet readily recognised when once it has been observed. They crave 
for sympathy, and always endeavour to make out that they are worse than 
they really are. 

Hysteria, when once established, is a very difficult complaint to cure. The 
most hopeful cases are those which have been recently established. In young 
people much may be done to avert a tendency to hysteria by judicious mental 
and moral training, but when the disease has taken a firm hold of its victim, 
it often requires a long course of treatment to restore the nervous system to 
its former degree of stability. It is important to keep the bowels in order by 
carefully-regulated diet, or, if necessary, by the cautious administration of aperients. 
The cold sponge-bath, exercise in the open air, either on foot or horseback, 
and the avoidance of hot, close rooms, are important elements in treatment. 
Hysterical girls are often in the habit of sitting up late at night novel-reading, 
and of lying in bed in the morning ; this should be put a stop to without a moment's 
hesitation. Systematic study should take the place of light literature, a change 
which works wonders in improving the general mental and moral condition. 
There is no one drug that can be trusted to cure hysteria, and each case must 
be treated on its own merits. The first thing is to endeavour to improve the 
condition of the general health. When there is anaemia we give iron (Prs. 1 — 7), 
and when there is want of nervous energy we rely on quinine (Pr. 9), or nux 
vomica or phosphorus (Pr. 53 or 54). If there be indigestion or flatulence, we resort 
to one or other of the remedies mentioned when speaking of those complaints. 
Decided benefit is often derived from a course of bromide of potassium (Pr. 31), 
and sometimes large doses succeed when smaller have failed. Valerianate of 
zinc is a valuable remedy in hysteria. The chief indications for its employment are 
hysterical spasms coming on, chiefly in the evening, a lump in the throat, a profuse 
discharge of clear watery urine, great sensitiveness and tendency to shed tears, 
and neuralgia, especially if situated in the neighbourhood of the groin. The dose 
is five grains three times a day, and it may be given either dissolved in water or in 
pills. Musk and assafcetida are often used in hysteria, but they seldom do much 
good, at all events permanently. 

Now, as regards the " spinal irritation " cases. The application of leeches or a 
blister to the affected portion of the spine will often do a great deal of good. Cases 
that have existed for months are sometimes cured in a single day by a good large 
blister. As regards medicine, benefit is often derived from the use of the ordinary 
tonics, such as quinine, steel, cod-liver oil, and the different preparations of phos- 
phorus. It is, no doubt, advisable to avoid standing or walking to the extent of 



HYSTERIA HYSTERICS. 339 



producing fatigue, but there is no necessity, except as a very temporary measure, to 
insist upon the recumbent position being retained for any length of time. A " spinal 
apparatus " is seldom or never required. As regards diet, the great thing is to see 
that plenty of nutritious food is taken, in conjunction with wine or some other 
alcoholic drink. In many cases there is a great prejudice on the part of the patient 
against the use of stimulants, but this must be overcome, for the progress of cure is 
greatly facilitated when the diet is made to include a fair share of some alcoholic 
liquid. 

During a fit of hysteria there is very little to be done. The patient is in no 
danger, and will come round all in good time if let alone. Her dress should be 
loosened, she should be prevented from hurting herself by striking the floor or 
furniture, and she should have plenty of fresh air. Smelling salts should be held 
tinder the nostrils; and, if she can swallow, a good dose of bromide of potassium should 
be given. Should the insensibility, or apparent insensibility, continue, cold water 
may be poured on the face. An old writer, speaking of cold water, recommends 
that its application should be " sudden and lavish," but the great objection to it is 
that it spoils the carpet A very good substitute is to dip the end of a towel in cold 
water, and then flap the face and hands with it pretty vigorously. An attack may 
often be arrested by closing the mouth and nose with the hand, so that the patient 
cannot breathe. She soon begins to struggle, and at last succeeds in getting loose, 
and taking a deep breath, and this often stops the fit Sometimes the fit may be 
stopped by keeping up firm pressure with the hand over the painful spot in the groin 
for three or four minutes or mora A calm manner, the absence of all appearance 
of alarm, and of either scolding or distressing sympathy, will in many cases bring 
the paroxysm to a speedy conclusion. 

There can be no doubt that often recovery is retarded by injudicious manifesta- 
tions of sympathy on the part of friends and relatives. Their assiduous tenderness 
serves only to keep up the craving for attention and interest which is so constant 
and striking a feature of the malady. In illustration of this fact, a physician tells 
the story of a lady who had terrified her friends and excited the greatest commotion by 
threatening to put an end to her existence by jumping out of the window. " "When 
I saw her," he says, " she was strapped down to a bed, and was being supplicated by 
half a dozen people in the room not to kill herself, to which she was energetically 
replying that she would. I loosened the straps, opened the window, and told her to 
jump out She walked to the window, looked out for a moment, and then, applying 
no very polite epithet to me, went back to bed, and I heard no more of her suicidal 
desires." In every case of hysteria it is of the utmost importance that, while the 
value of self-control is inculcated, healthy mental occupation and recreation i should 
be afforded. Travel is of inestimable advantage, and, above all, association with 
men and women whose intellects control their emotions, and who are endowed with 
sound common sense, and that tact and knowledge of human nature which for the 
purposes of every-day life are of greater value than many other qualities often more 
highly estimated. 



340 THE TREATMENT OF DISEASES. 



INDIGESTION, OR DYSPEPSIA. 

Indigestion is the prevailing and fashionable malady of civilised life. The 
doctor is more frequently consulted about disorders of digestion, and those connected 
with eating and drinking, than about any others. 

Rightly to understand that condition which we call dyspepsia, it is necessary 
to have some acquaintance, however rudimentary, with the physiology of digestion. 
In the natural process of digestion the food is first masticated and mixed with 
saliva, and then swallowed. In the stomach it is moved about by a kind of 
revolving or churning action, and is acted on by the gastric juice, which reduces 
it to a semi-fluid consistence, and converts it into a uniform pulp known as 
"chyme." It then passes into the intestines, where it is mixed with bile, and 
with the pancreatic juice, which is secreted by the pancreas, or sweetbread, 
and closely resembles saliva. The nutritive portion of the food is now taken up 
by the veins and other vessels, and is by them carried into the blood, whilst the 
excrementitious part, which is useless for the purposes of nutrition, is conveyed 
out of the body. The gastric juice is a secretion poured out by and peculiar 
to the stomach. It is an acid fluid, and to its acid, combined with a substance 
known as "pepsine," it owes its solvent or digestive properties. The readiness 
with which the gastric juice acts on different articles of food is in a great 
measure determined by their tenderness and state of division. By minute 
division of the food, the extent of surface with which the digestive fluid can 
come in contact is increased, and its action proportionately accelerated. A weak, 
dyspeptic stomach acts slowly, or not at all, on solid xumps or tough masses 
of food. A knowledge of this fact affords an explanation of one of the commonest 
causes of dyspepsia, and at the same time suggests the appropriate mode of 
treatment. Persons who are subject to dyspepsia should never eat in a hurry, 
as busy men and those of studious and solitary habits often do. They should 
be cautioned not to "bolt" their food, which should be well ground in the 
mill of Nature's own providing. It has been supposed, and the supposition 
appears feasible, that the increased longevity of modern generations is in 
some degree attributable to the capability of chewing their food which the 
skill of the dentist prolongs to persons advanced in life. Tender and moist 
substances offer less resistance to the action of the gastric juice than do tough, 
hard, and dry ones, for they are thoroughly penetrated by it, and are thus attacked 
not only on the surface, but at every part at once. The readiness with which a 
substance is acted on by the gastric juice is, however, no indication of its nutritive 
value, for a substance may be nutritious, and yet, on account of its toughness 
and other qualities, hard to digest, and many soft, easily-digestible bodies contain 
comparatively little nutriment. It is obvious, however, that a substance which 
the stomach cannot digest is incapable of nourishing the body, and there is there- 
fore, so far, a necessary connection between the digestibility of a substance and 
its power of nourishing. 

These are not mere matters of speculation, but of actual observation. Some 
7«ars ago an American physician, Dr. Beaumont, was afforded the singular privilege 



INDIGESTION, OR DYSPEPSIA. 



of looking whenever he liked into the interior of a healthy man's stomach, and 
watching the process of digestion. This privilege was obtained by what must be 
regarded, from a medical point of view, as a happy accident. It appears that a 
young Canadian, Alexis St. Martin, had a portion of the skin, muscles, and ribs of 
the left side of his body blown away in a gun-shot wound, which laid open the 
stomach also. He recovered from the frightful injury, but with an open wound in 
the side which led directly into the stomach. The opportunity was taken, with the 
patient's consent, of instituting a number of experiments on the process of digestion. 
Different articles of food were eaten by St. Martin, and the action of the gastric 
juice upon them in the stomach was carefully watched. It is difficult to over- 
estimate the value of the information so obtained. In fact, it is to these observations 
that we owe much of our knowledge respecting the relative digestibility of different 
articles of food. It was found that beef was more readily digested than mutton, 
and mutton more readily than either pork or veaL Among the substances most 
quickly digested were rice and tripe, both of which disappeared in an hour. Fowls 
are far from possessing the digestibility usually attributed to them, but turkey is of 
all kinds of flesh, except venison, the most readily disposed of. 

There are certain substances upon which the gastric juice exerts no action, and 
it should be remembered that whatever goes through the stomach untouched, passes 
undissolved through the whole of the alimentary canal, and appears in the motions 
unchanged. The frequency with which such substances as dried currants and 
apple-pips are passed unaltered is familiar enough to all. Indigestible substances, 
instead of being at once excreted, are occasionally retained in the stomach, causing 
pain, indigestion, and irritation for days and days together. 

There are many circumstances, besides the nature of the food, which exert an 
influence on the process of digestion. First and foremost among these is the 
quantity of food taken ; for the efficient performance of digestion the stomach should 
be fairly filled, but not distended. Dr. Beaumont's experiments showed that a 
certain bulk was necessary for the performance of healthy digestion. This fact has 
long been known by practical experience to uncivilised nations. Thus the Earns- 
chatdales are in the habit of mixing earth or saw-dust with the train oil on which 
alone they are frequently reduced to live, and the Yeddahs, or wild hunters of 
Ceylon, on the same principle mingle the pounded fibre of soft and decayed wood 
with the honey on which they feed when meat is not procurable. The time which 
has elapsed since the last meal was taken should, for the effectual performance of 
digestion, be sufficient to ensure the stomach being quite clear of food. The amount 
of exercise taken previous and subsequent to the meal is not without its influence, 
gentle exercise being favourable, and over-exertion injurious, to digestion. Then there 
is the state of mind, tranquillity of temper being apparently essential to quick and 
easy digestion. In addition may be mentioned the state of bodily health, and the 
state of the weather. 

This naturally brings us to the consideration of the causes of dyspepsia. These 
will probably have been in a measure anticipated from what we have said con- 
cerning the normal process of digestion. There is no more frequent cause of 
dyspepsia than an excessive consumption of food. Over-eating, whether it coi 



341 TH1 TREATMENT OF DISEASES. 

in a single surfeit, or in that habitual indulgence, to excess of which so many of vm 
are guilty, is especially injurious. Drinking too much fluid of any kind at a meal 
is mischievous, by over-diluting the gastric juice and impairing its solvent power. 
Imperfect mastication of food, either from carelessness or hurry, or owing to the 
pain of bad teeth, is another cause. Indigestion may arise from an improper 
arrangement of the meals ; some people, for example, take only one meal in the 
twenty-four hours, whilst others huddle all their food into the stomach at four or 
five periods within seven or eight hours, and then leave it idle for sixteen or 
seventeen hours. The error most frequently committed is that of not allowing a 
sufficient time to elapse between the meals to permit of the stomach doing its work 
and getting a proper rest. The stomach is a long-suffering organ, but still you 
must not impose on its good-nature ; it must have time to perform one task before 
it can set about another. It is just as bad to allow too long an interval to elapse 
between the meals as too short a one, and many cases of severe and obstinate 
dyspepsia have been induced by the habit of going without anything to eat from an 
early breakfast to a late dinner. A very marked effect of long-fasting is familiar 
to all under the title of having " overstayed the appetite," and it has been found 
that the secretion of gastric juice is greatly diminished by long abstinence from 
food. 

Much has been urged respecting the injudicious admixture of foods as a cause of 
dyspepsia. Of the frequently injurious influence of a mixture of many different 
kinds of even wholesome articles of diet there can be no doubt. It is impossible, 
however, to make any very positive assertion on this point, for within certain limits 
variety is undoubtedly conducive to health, and the too strict limitation to one or 
two kinds of food is frequently quite as detrimental as excessive heterogeneous 
indulgence. Eating indigestible or unwholesome food is, as every one knows, one 
of the commonest causes of dyspepsia. In addition to substances which may be 
regarded as generally more or less injurious there are many which become injurious 
only from the circumstances or condition under which they are taken. For 
example, there are many people who can eat pastry in the middle of the day, but 
who don't dare touch it for supper or at a late dinner. 

Want of bodily exercise, excessive labour, inordinate intellectual exertion, 
mental anxiety, and general debility, are all prominent factors in the production 
df dyspepsia. The nervous irritability of many literary and scientific men has its 
c/rigin in dyspepsia. Sedentary pursuits, with over-mental labour, will soon disturb 
the digestive functions, for, as has been very justly said, one digests with the legs 
almost as much as with the stomach. There can be no doubt that in many cases 
dyspepsia may be traced to excessive indulgence in tea or coffee, or alcoholic liquors, 
to the inordinate use of condiments, to immoderate smoking, or even to the practice 
of taking large quantities of snuff. 

We must now consider the symptoms of dyspepsia. They vary very much both 
in nature and severity, one individual suffering severely when his dinner " disagrees n 
with him, whilst another experiences merely a slight depression. In chronic cases, 
however, there will usually be loss of appetite, pain, or a feeling of weight and 
fulness in the chest or stomach, flatulence or wind, nausea or vomiting, costiveness 



INDIGESTION, OR DYSPEPSIA. 343 



alternating with diarrhoea, acidity, a furred tongue, and offensive breath. In 
addition there may be dull headache, giddiness, and disinclination for exertion. All 
these symptoms need not, of course, be present in every case, but some of them are 
sure to be. 

The appetite in dyspeptics is very variable. In some it remains but little 
affected, there being simply a distaste for certain articles of food, whilst in others 
there is an absolute repugnance to all forms and varieties of food. It occasionally 
happens that the appetite is absolutely increased, whilst in many instances a persis- 
tent sense of uneasiness or emptiness, with constant craving for food, is experienced. 
More rarely the appetite becomes depraved, the patient not merely craving for 
aliments of an unwholesome character, but swallowing earth, coals, chalk, and other 
substances which are not only void of nutritive properties, but are disgusting and 
even absolutely injurious. Thirst is usually absent, at least, to any abnormal degree. 
Sometimes there is positively a dislike for fluids, which not unfrequently, especially 
when taken at meals, aggravate the dyspeptic symptoms. 

A sensation of pain or uneasiness in the chest or stomach is a very frequent 
symptom of dyspepsia. In some cases it comes on mainly when the stomach is 
empty, and disappears under the influence of a meal ; in others it comes on only after 
food. Sometimes it is more or less persistent, being present when the stomach is 
empty, and increasing in severity after eating. Sometimes it is experienced 
immediately after a meal, but it may be delayed for two, three, or even four hours. 

Respecting flatulence, or wind, we shall have more to say presently. It is 
usually a prominent symptom of dyspepsia, and eructation may be for a time almost 
continuous. 

The nausea and sickness of dyspepsia are often extremely distressing. Vomiting 
may ensue when the stomach is empty, but more frequently it occurs soon after a 
meal ; occasionally it is delayed for an hour or more. The vomited matter may 
consist of food, almost unaltered > or of a clear watery fluid, having many of the 
characters of saliva. Between these two extremes there are all kinds of gradations. 
The quantity also varies very much, there being in some cases only a few tea-spoon- 
fuls, whilst in others the whole contents of the stomach are forcibly ejected. 

Pyrosis, or water-brash, is of frequent occurrence in connection with dyspepsia. 
It is characterised by " heartburn," or a burning sensation in the stomach, followed 
by the vomiting, or rather eructation, of a thin watery liquid resembling saliva, some- 
times sourish, but usually insipid and tasteless. The quantity of fluid rejected at 
one time may vary from a mouthful to a pint or more. 

The tongue in dyspepsia varies considerably in character, but it seldom or never 
presents an entirely healthy appearance. When it is habitually clean and moist, 
neither too florid nor yet too pale, and of natural size, you may be pretty sure that 
digestion is efficiently performed. When, on the contrary, the tongue is furred, with 
excessive redness of the tip and sides, or when the whole organ is swollen, flabby, 
and indented at the edges, there is some interference with the functions of the 
stomach. 

Costiveness is a very frequent concomitant of gastric affections, and this sluggish 
state of the bowels often aggravates, if it does not produce, dyspepsia. The evacua* 



344 THE TREATMENT OF DISEASES. 

tions may be dry and solid and hard, and are usually very offensive, and whiter in 
colour than natural. When there is much irritation, diarrhoea may supervene, and 
when the motions are liquid they are often frothy, from fermentation having taken 
place. 

Palpitation of the heart, irregularity of the pulse, and even fits of asthma may 
arise from a disordered stomach. Even when the patient does not suffer from dis- 
tinct asthmatic attacks, there is often a sensation of shortness of breath. The feeling 
is of a load or oppression in the upper part of the chest, especially across the breast- 
bone, impelling the patient to sigh or draw a deep breath in order to relieve the 
sensation, which, however, speedily returns. It is not at all uncommon for sufferers 
from indigestion to torment themselves with the belief that they have disease of the 
heart. Dyspeptic patients are particularly liable to suffer from different forms of 
skin disease, such as nettle-rash and acne, the latter appearing as red spots about the 
nose and cheeks. The severer forms of indigestion, especially when there is much 
sickness, are often attended with considerable debility and emaciation. In fact, the 
loss of flesh will sometimes rival that met with in cancer or consumption. 

We must not conclude our account of the symptoms of dyspepsia without referring 
— however briefly — to the mental condition which it engenders. We all know, 
many of us from personal experience, that indigestion interferes with intellectual 
work, and impedes the expression of thought. The habitual dyspeptic often exhibits 
great lethargy, which may become so great as to cause him to be incapable of even 
the slightest mental exertion. After meals he usually experiences an invincible 
desire to sleep, and exhibits an insurmountable repugnance to move. He often dis- 
plays a marked degree of nervous irritability. He is low-spirited, and his low spirits 
may vary from slight dejection and ill-humour to the most extreme melancholy. He 
is frequently morose, and so irritable that he eannot bear to be thwarted in the 
slightest degree, either by word or deed. He misconceives every act of friendship, 
is suspicious of those who desire to serve him, and exaggerates slight ailments into 
substantial grievances. In fact, the confirmed dyspeptic makes anything but a pretty 
picture. The mental condition so often associated with dyspepsia did not escape the 
acute observation of Sydney Smith. Referring in his characteristically humorous 
way to the horrors of indigestion, he says : — 

" The longer I live the more I am convinced that the apothecary is of more 
importance than Seneca, and that half the unhappiness in the world proceeds from 
little stoppages, from a duct choked up, from food pressing in the wrong place, 
from a vexed duodenum, or an agitated pylorus. The deception as practised upon 
human creatures is curious and entertaining. My friend sups late ; he eats some 
strong soup, then a lobster, then some tart, and he dilutes these esculent varieties 
with wine. The next day I call upon him. He is going to sell his house in London, 
and to retire into the country. He is alarmed for his eldest daughter's health. His 
expenses are hourly increasing, and nothing but a timely retreat can save him from 
ruin. All this is lobster ; and when over-excited nature has had time to manage 
this testaceous incumbrance, the daughter recovers, the finances are in good order, 
and every rural idea effectually excluded from the mind. In the same manner ©Id 
friendships are destroyed by toasted cheese, and hard salted meat has led to suicida 



INDIGESTION, OR DYSPEPSIA. 345 

Unpleasant feelings of the body produce correspondent sensations in the mind, 
and a great sense of wretchedness is sketched out by a morsel of indigestible and 
misguided food." 

Now, as to the treatment of dyspepsia. If you really want to get rid of your 
indigestion, and we suppose you do, it is not such a very difficult matter. In the 
first place you will have to regulate your diet, for without this all your efforts will 
be futile. The great secret is to take the most easily assimilable food, and at the 
same time to avoid overloading your stomach. Your food should be varied, but 
selected for its digestibility. Three moderate meals a day are usually sufficient 
unless you are a very hard worker, but sometimes four are necessary. Meat should 
be eaten at least twice a day. Beef and mutton, and game with the exception of 
hares and rabbits, are excellent ; but pork and veal are very indigestible, and should 
be avoided. If you like chicken, or sweetbread, or tripe, take them by all means. 
You must avoid all meats that have been hardened by culinary art or by condiments, 
and all cured meats such as ham, tongue, sausages, and so forth. Eggs, if they agree 
with you, are to be recommended. Fish is not so good, but may be eaten in modera- 
tion. Oysters often agree well, but differences in this respect are observed in different 
individuals, and some people cannot take them. 

Vegetables should be by no means excluded from your diet, but a certain amount 
of caution is requisite in their use. If they cause much flatulence, their place may 
be supplied by rice or macaroni, or by some kind of fruit, such as grapes or straw- 
berries, or, better still, stewed prunes. Your potatoes should always be well boiled, 
unless you like them fried or mashed, and they should not be new. Other kinds of 
vegetables should also be fresh and carefully cooked. Turnips, parsnips, carrots, 
and Jerusalem artichokes may, perhaps, not agree with you ; but you may take 
spinach, vegetable marrow, beet-root, and young peas and French beans with per- 
idot safety. All raw vegetables, such as salads, cucumbers, and pickles, must bo 
eschewed. 

Bread should not be eaten new. If you cannot get on with the ordinary house- 
hold bread, try the aerated bread. It is very nice for a change, although few people 
like it for a permanency. If this does not do for you, you will have to fall back on 
biscuits or toast. Fresh butter you may eat in moderation. 

Pastry is to be eschewed, but light farinaceous puddings — rice, sago, and arrow- 
root — are digestible enough. Fried dishes are forbidden, and in the same category 
must be placed shell-fish, nuts, pickles, and cheese. Sugar may be used in modera- 
tion, but jams, marmalade, and other condiments are seldom admissible, except 
perhaps in the case of elderly people and those habituated to their use. " Things 
sweet to taste prove in digestion sour ; " moreover, they possess very little power of 
increasing the flow of gastric juice, and are apt to set up irritation. 

What ought you to drink ? May you take wine or beer, or brandy and water ? 
You would be much better without anything at all, especially if you have been in 
the habit of taking a good deal. Not good to give it up all at once 1 Not at all, 
there is not the slightest danger. Do you not know that the health of even the most 
inveterate spirit-drinker improves instead of suffers upon the sudden and total 
abstinence from spirits 1 But you are not an inveterate spirit-drinker ? Quite so; 



346 THK TREATMENT OF DISEASES. 

but the principle is the same. Well, if you really cannot do without something in 
the way of stimulants, we suppose you must have it. Abernethy used to say that 
nobody could be persuaded to pay due attention to his digestive organs till death or 
the dread of death was staring him in the face, and he was about right. At all 
events, we shall have to keep you strictly within the bounds of moderation, and 
you must not take anything except at meals. What may you have ? Well, if you 
really must have it, it does not matter so very much how you take it — sherry, or 
claret, or hock, or champagne, just as you like. The best way is to ring the changes 
on them, if they all agree with you equally well. You must strictly limit the 
quantity : a pint bottle of champagne, three fair-sized glasses of sherry, or a pint of 
good claret is quite enough for the day. Raw spirits are strictly forbidden — no, not 
even your petit verre. May you have beer 1 You may try it if you like, but malt 
liquors are very apt to produce wind, so do not grumble if you have to suffer for it 
afterwards. Simple aerated waters, soda or seltzer, often prove very grateful to an 
irritable stomach. If you take coffee after your dinner, do not taste it for at least 
half an hour after you have finished your meal. 

The following plan of diet is recommended in, say, the case of a gentleman 
about forty, engaged in business for six or eight hours daily, and troubled with an 
irritable, revengeful stomach, and no great amount of vital power : — ■ 

7.0 a.m. — A cup of tea or a tumblerful of equal parts of milk and soda water, or of milk and lime 
water, or of milk with just a dash of rum or brandy. 

7.30 a.m. — To get up. Cold or tepid sponge-bath, containing sea-salt; brisk rub with rough 
towel. Dumb-bells or Indian clubs. Dress leisurely. If fine, five or ten minutes' walk in 
open air. 

8.30 a.m. — Breakfast. One cup of tea or coffee with plenty of milk, or cocoa made with nibs. 
Sole, or whiting, or the lean of a not over-cooked mutton chop, or one or two new-laid eggs 
lightly boiled. Stale bread, or toast with a little fresh butter. Watercresses occasionally if 
they do not cause flatulence. 

1.0 p.m. — Luncheon. Oysters, if they agree, or slice of roast mutton. Biscuit, or stale bread. 
One glass of dry sherry. If there be Httle or no appetite, a raw egg beaten up in a glass of 
sherry, and taken with a biscuit, may be substituted. 

6.0 p.m. — Dinner. Cod, sole, whiting, smelts, turbot, or brill. Mutton, venison, chicken, grouse* 
partridge, pheasant, tripe, sweetbread, boiled leg of lamb, or roast beef. Stale bread. Cauli- 
flower, asparagus, vegetable marrow, French beans, floury potato, or sea kale. Half a wine- 
glassful of cognac in a bottle of soda water, or two glassfuls of dry sherry or claret. A 
few grapes, an orange, a baked apple, or strawberries if desired. 

0.0 p.m. — A small glass of cold brandy and water and a biscuit, or cup of weak tea with slice of 
bread and butter, or a small cup of gruel or arrowroot. 

11.0 p.m. — Bed. To sleep on a mattress without much covering. The room to be properly 
ventilated, and a small fire kept burning if the weather is cold. 

Such a dietary as this would probably prove too liberal for a person of sedentary 
habits. We, of course, were presuming that a fair amount of exercise had 
been taken, and that something attempted, something done, has earned a night's 
repose. 

This is merely a broad outline of what a dyspeptic should take and what 
he should avoid, but to this, as to all rules, there are many exceptions. Milk 
agrees capitally with most people, but with some it indices Yomiting; diarrhoea, 



nn>IGESTION, OR DYSPEPSIA. 347 

and absolute indigestion, and must then be avoided. No one with a grain of 
sense would take what he knows will upset him, and any one who has been 
suffering for some time with dyspepsia has a wonderfully correct knowledge 
of the aliments which best agree with him. 

It is important not only to refrain from substances which are indigestible, 
but also to avoid mixing together in the stomach different substances of various 
degrees of solubility. Hence there are two reasons why it is salutary to dine 
off one dish. In the first place you avoid the injurious admixture just adverted 
to ; and as to the second, you escape that desire to eat too large a quantity, which 
is provoked by new and various flavours. 

We have already referred to the importance of allowing the stomach time 
to perform one task before another is imposed upon it. Abernethy always 
exhorted his patients to allow five or six hours to elapse between one meal and 
the next, and there can be no doubt that his advice was as much founded in 
reason as justified in practice. There are very, very many people who allow 
a much shorter interval than this between each of the three principal meals of 
the day, and the effects of such a system are every bit as injurious as those of 
over-eating. Many delicate people think it is necessary to eat often to keep up 
their strength, but fail to recognise the fact that when meals are taken frequently 
they should be small. The injurious effects of eating between the meals cannot 
be over-estimated. When meat is eaten in tolerable quantities two or three 
times a day, the addition of milk, eggs, wine, beef-tea, bread and cheese, biscuits, 
<kc, destroys the beneficial effects of alL It should be remembered also that the 
amount of food required varies with the expenditure of the system, and that a 
person leading a sedentary, inactive life requires far less food than one who is 
performing considerable bodily or mental labour. 

Attention to general hygienic conditions will do much in the treatment of 
dyspepsia, although it will seldom effect a cure unless the diet be also regulated. 
The sufferer from dyspepsia should take plenty of exercise, especially in the 
open air. Walking and riding often exert a considerable influence in increasing 
the digestive powers of the stomach, and in the case of those who of necessity 
lead sedentary lives in large cities, the use of the gymnasium often proves of 
the greatest service. Exhaustion, however, is most carefully to be avoided, 
and after active exercise time should be allowed for the body to cool before 
food is taken. The effects of cold or tepid bathing, and the daily use of the 
hair glove or flesh-brush, are often very beneficial. Mental distress, mental 
solicitude, mental toil, and over-much study, are all prolific sources of dyspepsia, 
and those harassed by care or anxiety, as well as those engaged in absorbing 
intellectual pursuits, should take their meals in cheerful society. A light heart 
is a great digester. You will do well to encourage an indolent sense of content- 
ment for some little time after eating, so as not to divert from the stomach the 
nervous force which is so essential for the due and proper performance of its 
functions. A change of scene often does a great deal of good, and a run down to 
Brighton-Beach, or Long-Branch, or Newport, if only for a few days, may be 
tried with advantage. Six weeks among the Adirondack Mountains, or upon the 



348 THE TREATMENT OF DISEASES. 

rivers of France or Germany, will often do more towards restoring a dyspeptic to 
health than a twelvemonth's regimen and physicking at home. 

There is one apparently trivial, but in reality extremely important, point 
to which we wish especially to call attention. See that your teeth are in good 
working order, and if they are not, go to a dentist and get them supplemented 
or replaced by new ones. If mastication is imperfectly performed, all treatment 
directed to the stomach will be in vain. In a letter which recently appeared 
in the Lancet, a source of dyspepsia was pointed out, which we believe has been 
very generally overlooked. The writer says : — 

" When I was travelling on the Continent last September I lost two of my front 
teeth, and afterwards another ; besides this, one of my back teeth was so tender that 
I could not masticate with that side of my mouth. This tooth, on my return to 
London, my dentist, whom I have employed for twenty years, told me would be of 
no further use to me, and it was extracted. 

" I now determined to go to any expense, that for the remainder of my days my 
mouth and teeth might be in proper order (the upper jaw only being affected). For 
a month I gave the gums time to harden, then a cast of the upper part of the mouth 
was taken, and four days before Christmas, everything being in readiness, the new 
arrangement was placed in situ, a perfect fit, quite comfortable. I felt proud of my 
appearance, and could bite the hardest substance with every tooth in my head ; but 
to effect this there was a gold plate covering the whole of the roof of the mouth. I 
remonstrated against this, and was told that it was of no consequence, that the 
tongue was the organ of taste, and that it would not interfere with the process of 
digestion. Now what happened ? I masticated perfectly, the saliva mixed with the 
food, and then went down my throat as though it had passed through a tin funnel. 
For a few days I felt no evil consequences ; but in about a week or ten days I began 
to get out of order — griping, &e. First the gastric juice went wrong ; then there 
was one day too great a supply of bile, another day too little, and at last none at all 
— in fact, congestion of the liver. Knowing that nothing will attack this except 
blue-pill, although I never take medicine, I went home one Sunday evening at 
seven with a pure blue-pill, and slept soundly for sixteen hours, and after this a mild 
aperient. The action of the liver and the bile was restored ; but still I had no 
appetite. I tried to tempt it with a good dinner, but turned away from everything, 
and I have gone four days and a half without food or drink, except perhaps water. 

" Having thirty years ago attended lectures* in Edinburgh on Physiology, in- 
cluding the subject of digestion and dietetics, it now suddenly occurred to me that 
in covering up what my dentist called the roof of my mouth he had, in fact, covered 
up my palate, and I went to him one day at eleven, and then and there insisted that 
a large piece should be cut out of the plate, leaving what remained in the form of a 
W'seshoe, with quite as firm a bearing as before, and freedom of contact between 
tJie tongue and the palate. Two hours afterwards I enjoyed my lunch, as I have 
every meal since ; and although after such disorganisation time and attention are 
necessary, yet every meal I now take is adding to the tone of the stomach and 
system." 

The medicinal treatment of dyspepsia is by no means an easy problem. When 



HTDIGESTIOK, OB DYSPEPSIA. 949 



the tongue is red and has a raw appearance, and the general symptoms are those in- 
dicative of a certain 'amount of irritation of the stomach, bismuth, either alone or in 
combination with hydrocyanic acid, is the appropriate remedy. The ordinary dose of 
carbonate of bismuth is fifteen grains, but a larger dose, say up to thirty grains, 
may often be taken with advantage. It should be administered suspended in a 
little water. "We have already given a formula for a mixture containing bismuth 
(Pr. 18), and three minims of dilute hydrocyanic acid may be added to each 
dose. Bismuth should always be taken about half an hour before meals ; it does 
little or no good if taken on a full stomach. A dose should be taken every four 
hours. It is especially indicated when nausea and vomiting are prominent 
symptoms. Should bismuth not succeed, arsenic (Pr. 40) may be tried. A tea- 
spoonful of the mixture may be taken four times a day, shortly before meals. 
It is a valuable remedy, especially when there is an irritable condition of the 
stomach or intestines. 

When the tongue is large and flabby, and the symptoms generally indicate want 
of tone in the stomach, bitters are employed. Those most commonly used are the 
infusions of gentian, quassia, calumba, cascarilla, chiretta, and chamomile, and perhaps 
absinthe and hop. Quinine is not much used in stomach affections, unless loss of 
appetite is the prominent symptom. Respecting the relative merits of the different 
infusions, it may be stated that calumba appears to present certain sedative pro- 
perties, and may often be administered when the others would be too irritating ; and 
that gentian, in addition to its bitter properties, has also the advantage of being a 
slight laxative. The dose of the different infusions is from two to four table- spoon- 
fuls, and of the corresponding tinctures from one to two tea- spoonfuls. They should 
be taken about half an hour before meals, the infusions alone, and the tinctures in a 
wineglassful of water. The infusions very rapidly decompose, especially in hot 
weather ; but the tinctures, being prepared with spirit, will keep for almost any time. 
If the infusions are used they should be freshly prepared ; there can be no greater 
mistake than using medicines that are not of the best possible quality. 

Alkalies, as we have already seen, have a marked power of increasing the secre- 
tion of the gastric juice. With this view, bicarbonate of soda is usually given in 
fifteen-grain doses about half an hour before meals. It is best administered in com- 
bination with one of the bitter infusions. We have already given a formula for a 
gentian and soda mixture (Pr. 14), but cascarilla or calumba, or any other bitter 
may be substituted for the gentian. Acids given about half an hour after a meal are 
often a great aid to digestion. Weak hydrochloric acid is usually employed for this 
purpose, it having been ascertained that the natural acidity of the gastric juice is due 
to this substance. The acids, like the alkalies, are usually given with some bitter 
infusion. The acid and gentian mixture (Pr. 15) is a good formula, but the gentian 
may, if thought desirable, be replaced by one of the other infusions. Acids, if given 
before meals, lessen the secretion of gastric juice, and should consequently always be 
given after food unless acidity is the prominent symptom. 

Pepsin enjoys a high reputation in the treatment of many forms of dyspepsia. 
It is the active principle of the gastric juice both in man and many of the lower 
animals. The pharmacopceial preparation is obtained from the stomach of the pig, 



350 THE TREATMENT OF DISEASES. 

For the benefit of those who may have to prepare it for themselves, we may briefly 
explain the process, particularly as it presents no difficulty. « The stomach of a 
recently killed pig is cut open and laid on a board, with the inner surface upwards. 
Any adhering portions of food, dirt, or other impurity are removed, and the exposed 
surface is slightly washed with cold water. The cleansed mucous membrane is then 
scraped with a blunt knife, and the viscid pulp so obtained is spread on a piece of 
glass or glazed earthenware, and quickly dried in the sun or before a fire. In this 
way a light yellowish-brown powder is obtained, the dose of which is five grains. 
It should be given after the two chief meals of the day, either alone or at the same 
time as the acid mixture. It is a very valuable remedy when the functions of the 
stomach are imperfectly performed, and is especially indicated where pain or other 
disturbance follows the use of animal food. Many chemists keep pepsin wine and 
pepsin lozenges, both of which are convenient and agreeable forms of taking the 
medicine. The preparation sold as rennet wine is prepared as follows : — Take the 
stomach of a calf as fresh as it can be obtained from the butcher. Slit it up from 
one end to the other, and then gently wipe the inside with a clean, dry napkin, 
taking care to remove as little of the clean mucus as possible. Then cut the stomach 
into small pieces, the smaller the better, and put it all into a common wine bottle. 
Fill up the bottle with good sound sherry, and let it remain corked for a fortnight, 
when it will be fit for use. It is to be taken immediately after meals — a tea-spoonful 
in a wine-glassful of water, to which if necessary from ten to fifteen drops of dilute 
hydrochloric acid may be added. 

When uneasiness rather than pain occurs after a meal, with a sensation of weight 
at the pit of the stomach, and indisposition for mental or bodily exertion, it may be 
inferred that the work of digestion is slow and difficult, from too scanty secretion of 
gastric juice. In these cases it is desirable to employ those drugs which are known 
to promote the secretions of the stomach, and for this purpose we may administer 
before meals either the gentian and soda mixture, or a little ipecacuanha wine. The 
ipecacuanha is especially indicated when the dyspepsia is associated with^ constipa- 
tion, and is characterised by depression of spirits, flatulence, coldness of the extremi- 
ties, and the food lying on the stomach " like a weight." The wine should be given 
in a dose of from five to ten drops half an hour before meals. In this form of 
dyspepsia, the use of salt, mustard, or cayenne pepper as condiments is not 
objectionable. 

In one form of dyspepsia the pain does not begin till from two to four hours after 
a meal, but continues for several hours. It is frequently accompanied by pain and 
tenderness on the right side, and is supposed to be due to an excess of acid in the 
stomach. At all events, it is speedily removed by a small dose of any alkali, such 
as fifteen or twenty drops of sal volatile in a little water, or a dose of the gentian 
and soda (Pr. 14) or bismuth (Pr. 18) mixtures. In a closely-allied form, in which 
pain is experienced when the stomach is empty, and is relieved by taking food, the 
same mode of treatment may be adopted. 

There if another form of dyspepsia in which the movements of the stomach and 
intestinea are over-energetically performed. The food is no sooner swallowed than 
the stomach, instead of digesting it, passes it on into the intestines, where, owing to 



INDIGESTION, OR DYSPEPSIA. 851 

its crude condition, it acts as an irritant, and sets up diarrhoea. Patients suffering 
from this disorder have a constant feeling of emptiness in the stomach ; this is 
relieved by food, but no sooner is the meal finished than it returns, and they feel 
hungry again. There is in this disorder always an evacuation of half-digested 
food immediately after a meal, and sometimes even before it is finished. This 
complaint is very common in children from six to twelve years of age. It can 
nearly always be cured by giving from two to five drops of laudanum in a little 
water a few minutes before each meal. This small quantity of opium received into 
the stomach before digestion has commenced is sufficient to quiet and regulate its 
ismscular movements, upon the inordinate extent of which the symptoms are 
dependent. If a larger dose be given, it not only arrests the muscular movements, 
but also the secretion of the gastric juice, and so increases instead of calming the 
disturbed state of the digestive organs. Trousseau attached so much importance to 
the small dose that he always commenced with a single drop of laudanum, 
augmenting it if necessary. Should the laudanum fail, a tea-spoonful of the 
arsenic mixture (Pr. 40) may be taken immediately preceding each meal. 
Belladonna, too, is undoubtedly useful in this form of dyspepsia, although 
its beneficial effect is less marked than that of opium. As in the case 
of opium, it is essential that it should be given in small doses — three drops of 
the tincture of belladonna just before the commencement of each meal. Many 
people, especially those advanced in life, suffer from a sensation of sinking or 
craving at the pit of the stomach. This may depend on want of tone in the 
stomach or on the general condition of health. If the intestines are not in an 
irritable condition, cod-liver oil may be given with advantage — say a tea-spoonful three 
times a day. 

In the so-called irritative dyspepsia, where the tongue is furred and covered 
with scattered red points, a tea-spoonful of the arsenic mixture (Pr. 40) taken 
shortly before food acts like a charm. This mode of treatment often cures pain 
after food, vomiting, and other dyspeptic symptoms. It is a valuable remedy. 

Dyspepsia is often complicated with constipation, and little benefit would be 
obtained from treatment until this is removed. In remedying constipation in these 
cases much care is required to avoid irritation, and only the gentlest and least 
irritating laxatives are admissible. When possible even these should be dispensed 
with, and the action of the bowels, when not occurring spontaneously, should be 
daily solicited by an enema of cold water. Friction over the stomach, the wet 
compress worn at night, protected by a piece of mackintosh, or the use of the cold 
douche to the abdomen, will often prove useful adjuncts. When medicines are 
given, rhubarb and aloes are to be preferred to others. The dinner pills (Pr. 65) 
not only act on the bowels, but considerably increase the digestive powers. 
Recourse should be had as little as possible to purgative remedies, for it may 
afterwards become difiicult to dispense with their assistance, and their habitual use. 
tends further to exhaust the muscular and nervous power of the stomach and 
intestines. 

Nux vomica is a drug which is frequently used in the treatment of dyspepsia, 
caused by taking indigestible food. It is indicated when the symptom* we pain, 



$53 THE TREATMENT OF DISEASES. 

tenderness, and fulness of the stomach after meals, heartburn, sour acid rising, 
flatulence, frequent vomiting of food and bile, a sour or bitter taste in the mouth, 
and morning headache accompanied by a feeling of disinclination for exertion. It 
is also useful in the case of people of a sallow, yellowish complexion, who, in addition 
to the above symptoms, suffer from irregular action of the bowels with ineffectual 
urging. This, it will be seen, is just the dyspepsia of men of business and intel- 
lectual workers, who perform their tasks with hurry and worry, and give neither 
brain nor stomach fair play. Nux vomica is said to be especially indicated in 
persons of a dark bilious complexion, who in addition to employing their brains too 
much, take but little out-door exercise, eat largely, and drink freely of alcoholic 
liquors. The nux vomica mixture (Pr. 44) may be advantageously employed. 

Pulsatilla (Pr. 43) is the remedy for indigestion arising from fatty food or pastry, 
end accompanied by heartburn and frequent loose evacuations. It is indicated in 
the case of females suffering from deranged periods, particularly when the tongue is 
coated with a white rough fur, and when there is nausea with little vomiting and 
absence of much pain. 

The Turkish bath is the best remedy for people who, after dining out, suffer th© 
next day from malaise and slight indigestion. In the case of gouty subjects, it is 
advantageous to combine colchicum with any anti-dyspeptic remedy. 

So much then for the medicinal treatment of dyspepsia. We have an almost 
unlimited faith in the curative action of medicines, but on the principle of audi 
alteram partem, we give the advice of a physician, evidently no believer in drugs, 
to a long-suffering dyspeptic. It is as follows : — " 1. Take a good stock of the 
usual medicines for stomach disorders, and go down to New York. 2. Go on 
boara the first Cunarder or White Star steamer for Liverpool, with return ticket. 
3. Throw all the medicines overboard. 4. Live like other people as soon as you 
have got your sea-legs, and smoke when you can." He adds that in an ordinary 
case he would almost guarantee a cure, and that " No. 3 is to be especially attended 
to." 

Many of the more prominent symptoms of dyspepsia, such as vomiting, pyrosis, 
and flatulence, are of such importance that their treatment necessitates a separate 
and detailed account. 

INFLUENZA. 

Influenza is an epidemic disorder attended with great depression, chilliness, 
running from the eyes and nose, headache, cough, restlessness, and fever. It was 
called influenza by the Italians, because it was attributed to the " influence" of the 
stars. In France it is known as the " grippe." It has received various other names, 
for it has been known and noticed from the remotest antiquity. Thus we learn that 
in 827 a.d., an attack of cough spread like a plague over the whole of Europe, and 
some forty or fifty years later, the army of Charlemagne, returning from Italy, 
suffered most severely from the same complaint. During the present century somf 
ten or a dozen epidemics have been recorded, the most noteworthy being those of 
1803, 1831, 1833, 1837, and 1847. It was formerly supposed that an outbreak 
occurred regularly once in a hundred years, but during the seventeenth century there 



IOTLCEffZA. 353 

were twelve distinct epidemics, from which we may conclude that the intervals are 
in reality much shorter. 

Occasionally the disease is limited to a comparatively small area, but more 
frequently it invades a large portion of the earth's surface. In some instances so 
great has been its prevalence that almost all parts of the world have been attacked. 
Its onset is in many cases remarkably sudden; thus in the year 1837 it seized upon 
all parts of the metropolis within the space of a very few days. It has been 
observed to occur also at the same time on land and on board different vessels which 
have had no communication either with the shore or with each other. Often enough 
it breaks out simultaneously in many different places, but sometimes its progress 
from country to country is comparatively slow. Thus it has spread over the whole 
of Europe in six weeks, but it may take six months to do so. In any particular 
country its progress may also be slow ; thus between the invasion of New York 
and Western citisa, weeks, or even mouths, may elapse. 

A curious circumstance in the history of these epidemics is that they appear to 
travel or migrate from place to place, and this they do in spite of adverse winds 
and variations in temperature. In spreading over a large tract of country, influenza 
has been observed to follow a regular course, usually from north or north-east to 
the south and west It has been known to pass from Chinese Tartary to Russia, 
Germany, Holland, England, Scotland, France, and then to Italy and the Mediter- 
ranean, or to America, in rapid succession. In its course it appears to pass over 
seas, and has, as we have said, been known to attack ships in mid-ocean. 

When it enters a large town it usually remains there from six weeks to 
two months, but sometimes its stay is more protracted, as at Paris in 1831, 
where it was prevalent more or less for nine or ten months. Ultimately, how- 
ever, it always disappears, and in the intervals of the attacks isolated or sporadic 
cases never occur. Where it comes from originally no one can telL Some 
people think it always exists at some one spot and spreads from there, whilst 
others maintain that under favourable conditions, whatever those might be, it may 
originate anywhere. Usually, each nation attributes to its neighbour from whom it 
derived the disease the unenviable honour of having originated it. Thus, the Italians 
have called it the German disease ; the Germans, the Russian pest ; the Russians, 
the Chinese catarrh, and so on ; these names affording, as will be seen, some indica- 
tion of its usual tract. 

In passing through a country it does not attack all parts of it ; most commonly 
it spares the villages and small towns, but sometimes even large towns escape. It 
is generally met with in cities before appearing in the towns and villages around 
In large cities an outbreak is usually made up of a number of localised attacks 
certain streets or districts being more frequently affected than others. The numbe* 
of people seized during an epidemic is usually very great In London, in 1847, r 
has been calculated that at least 250,000 persons suffered, in Paris between one 
fourth and one-half of the population, and in Geneva about a third. 

Influenza prevails on every soil and geological formation, and there is no 
evidence to show that it is in any way connected with volcanic disturbances, as was 
at one time assorted. It is not, as far as we know in any way influenced by 
23 



354 THE TREATMENT OF DISEASES. 

electrical or magnetic conditions of the atmosphere. A favourite theory years ago 
was that it was caused by an excessive accumulation of electricity in the animal 
economy. It occurs at all times of the year, and not especially at any particular 
season. It is not dependent on cold or sudden variation in temperature, and it is 
a mistake to suppose that such is the case. It is uninfluenced, too, by moisture, for 
it is met with in the dry air of Upper Egypt, in the moist air of sea-coasts, and even 
on the sea itself. 

It has been suggested that influenza might depend on the presence in the 
atmosphere of an excessive quantity of ozone. Pure or atmospheric oxygen when 
exposed to the action of electrical sparks is transformed into an odoriferous matter 
called ozone, which is supposed to be merely a modified form of oxygen. Most 
persons who have stood near an electrical battery at the time of its discharge must 
have noticed a peculiar smell, and it is said the same odour pervades the air during 
the prevalence of thunderstorms. It is asserted that the inhalation of strongly 
ozonised air produces a painful affection of the chest — a sort of asthma, accompanied 
with violent cough, and from this it has been argued that ozone must be the cause 
of influenza. The conclusion is certainly not justified by the premises, and the fact 
that the disorder may prevail in a city or town, while a village a mile or two off 
remains untouched, tells heavily against this theory. 

In some cases a thick and acrid fog has shortly preceded or has immediately 
ushered in the influenza. We are told that the grippe of the spring of 1733 
appeared in France immediately after offensive fogs, " more dense than the darkness 
of Egypt." So also in 1775 it is recorded that the disease was ushered in by 
" thick noisome fogs." In the same year it visited the shire of Galloway, in 
Scotland, where " a continual dark fog and particularly smoky smell prevailed in the 
atmosphere for five weeks, the sun being seldom seen." It is recorded, too, that in 
1782 "the sun was for many weeks obscured by a dry fog, and appeared red, as 
through a common mist." In 1837 "a dark fog brooded over the metropolis " during 
the prevalence of the distemper. It has been observed, too, that during the 
prevalence of these epidemic catarrhs various species of brutes and of birds have been 
extensively affected with sickness, while on some occasions prodigious swarms of 
insects have made their appearance. These statements are worth recording, but too 
much importance must not be attached to them, for they may be mere coincidences. 

The main spread of influenza is not influenced by the wind, it does not move with 
the same velocity, and it often moves against it Yet it is probable that in some 
cases the direction of the wind may have some share in its propagation. Thus we 
are told that on April the 3rd, 1833, the Stag frigate was in the English Channel, 
and arrived at two o'clock off Berry Head, on the Devonshire coast, all on board 
being at that time well. Half an hour afterwards, the breeze being easterly, and 
blowing off the land, forty men were down with the influenza ; by six o'clock the 
number was increased to sixty, and by two o'clock the next day to 160. On that 
evening a regiment on duty at Portsmouth had a clean bill of health, but on the 
following morning so many of the soldiers were affected by the influenza, that the 
garrison duty could not be performed. 

It is no easy matter to decide whether influenza is infections or not. The 



INFLUEN1A. 956 



rapidity of its spread would seem to negative the idea of there being any connection 
between human intercourse and the propagation of the disease. We are told that 
at St. Petersburg, in 1782, 40,000 people were attacked with influenza in a single 
night, and this clearly could not have been by contagion. Moreover, the epidemics 
do not seem to follow the great lines of commerce. On the other hand, when it has 
entered a town in which investigations can be carried on, it has frequently 
proved that the first cases have been introduced, and that the townspeople 
the invalids have been the first to suffer. So also when it breaks out in a novae, II 
often attacks one person after another. In some instances isolation or seclusion of 
a community, as in prisons, has given immunity ; or, at all events, the inmates have 
not been attacked. All contagious diseases have a remarkable property, and that is, 
that after the entrance of the poison into the system, there is a period of incubation 
or latency during which it lies dormant and produces no symptoms, or, at all events, 
none of which we are cognisant. This incubative period is supposed not to exist 
in the case of influenza, which strikes down persons in perfect health almost like a 
stroke of lightning. In some cases, however, a period of incubation may possibly 
have existed, but even then it is undoubtedly very short. Whether influenza affords 
immunity from future attacks is another point on which there is some discrepancy 
of opinion. Although persons seldom suffer twice during the same outbreak, it is 
probable that they are not protected against a subsequent epidemic. 

Influenza occurs both in men and in women, and with about equal frequency. 
It attacks people of all ages ; but young children, it is said, are less affected by it 
than old. Domestic animals — dogs, cats, &c. — often suffer in the same way. In 
1827 there was an epidemic of influenza amongst horses, which spread over almost 
the whole of Europe. At that time influenza prevailed among men in North 
America, Mexico, and Siberia, but not in Europe. Persons in ov«r-crowded 
dwellings usually suffer more than those who are more favourably situated as 
regards sanitary conditions. In several instances large schools and barracks have 
been first attacked, the disease raging there for some days before breaking out in 
the town around. People living in low, damp, ill- ventilated places are more likely 
to suffer than others. 

The symptoms of influenza are somewhat as follows : — The patient feels chilly, 
or perhaps shivers ; presently headache occurs, with a sense of tightness across the 
forehead ; the eyes become tender and watery ; and sneezing and a copious acrid 
discharge from the nose ensue, followed or accompanied by heat and uneasiness 
about the throat, hoarseness, a troublesome cough, a sense of constriction in the 
chest, and oppression of breathing. In fact, the symptoms are those of a very bad 
cold, to which are added a sudden early and extraordinary subdual of the strength, 
and most commonly great depression of spirits. The debility which comes on at the 
very onset of the complaint is one of its most striking phenomena, occurring as it 
does almost instantly, and being apparently so much greater than would have been 
anticipated from the symptoms it ushers in. Indeed, this rapid and remarkable 
prostration is more essentially a part of the disorder than the catarrhal affection, 
which is sometimes, though rarely, absent or imperceptible. Not unfrequently there 
are disturbances of the digestive organs ; the tongue is white and creamy, appetite 



356 THE TREATMENT OF DISEASES. 

and taste are completely lost ; nausea and vomiting are not uncommon, and there 
may be diarrhoea. The skin, at first hot and dry, soon becomes moist, and sometimes 
exhales a peculiar musty odour. In some epidemics, profuse perspiration has been 
a prominent symptom. The patient complains also of pains in the limbs and back, 
and of much soreness and tenderness in various parts of the body. In a simple, 
uncomplicated case, the disease runs its course in three or four days, and the patient 
is convalescent before the end of the week. Cough and much debility are apt to 
last longer than the other symptoms, and till the patient gets rid of these the 
complaint is easily renewed. The most frequent complications are bronchitis, 
inflammation of the lungs, and rheumatism. Respecting the course of the tempera- 
ture, we know little or nothing : it is a subject for observation in future epidemics. 
In some cases delirium is a prominent symptom, and is to be regarded as an un- 
favourable sign The cough is usually very severe, and has been known to produce 
rupture, and to give rise to abortion in pregnant women. The cough, at first dry, 
is soon attended with thick, stringy expectoration, often tinged with blood. 

Influenza cannot be regarded as a very serious disease, although the mortality 
varies greatly in different epidemics. In 1837 the death-rate was in London two 
per cent., and this was universally acknowledged to be an unusually severe outbreak. 
Although the relative number of deaths to those attacked was so small, the absolute 
mortality was enormous ; and it was calculated that in that year more people died 
of influenza than died of the cholera which had raged a few years previously. In 
fact, funerals were for a time so numerous, that the resources of the undertakers 
were stretched to their utmost. One firm alone had seventy-five bodies waiting for 
interment, and mourning coaches and black horses could not be procured in sufficient 
numbers to meet the demand. It will be seen that the danger of influenza to the 
community is great, whilst to the individual attacked it is comparatively small. 
Death claims a certain number, but has, so to speak, a very large choice of victims. 
In cholera it sometimes happens that half the patients die, but then the number 
attacked is comparatively smalL 

True influenza is met with solely as an epidemic attacking large numbers of 
people, and spreading rapidly over the whole of the globe. If we bear this in mind 
there will be no danger of our confounding it with those local catarrhal affections 
that occur in all temperate climates almost annually. One thing is certain with 
respect to influenza, and that is that it does not arise from exposure to cold, or, as we 
say, from " catching cold." This has been observed in many epidemics. 

The very young and the very old bear influenza badly, especially the latter. A. 
writer during the prevalence of the epidemic of 1837 says : " The daily newspaper 
obituaries have been unusually long, and the ages of the persons whose deaths they 
announce are in almost all cases great." Frequent delirium, convulsions, and 
fainting are bad symptoms ; whilst as favourable signs may be mentioned copious 
warm sweats, free expectoration, spontaneous diarrhoea, and a copious red deposit 
from the urine. People with pre-existing lung disease often bear influenza very badly. 
Curiously enough, it seldom attacks those labouring under acute diseases until the 
period of convalescence arrives, when their immunity apparently ceases, and they 
become just as liable to its invasion as others. Thus it has often happened that ft 



INFLUENZA. 357 

patient labouring under typhus or typhoid has escaped as long as the fever con- 
tinued, but on the very day convalescence commenced the symptoms of influenza 
appeared. This is a very unfortunate circumstance, for just as a poor fellow has 
struggled through an illness of three or four weeks' duration, he is attacked with a 
new and dangerous malady, which again places him in a situation of imminent 
danger. 

We know of no means by which influenza can be prevented. Unfavourable 
hygienic conditions, and especially over-crowding, heighten its prevalence and 
severity, but persons in the most favourable circumstances may be attacked. It 
has been thought that those in well-warmed and yet ventilated houses escape best, 
but this is very doubtf uL In one of the last epidemics it was said that persons who 
took the best care of themselves, who always went warmly clothed and were never 
exposed to the inclemency of the weather, contracted the disease just as readily as 
the half-clad labourer who had to undergo daily exposure to the vicissitudes of our 
changeful climate. 

We now come to the treatment of the disease when it has actually declared 
itself. It is of great importance to have the room cool and properly ventilated. 
In a common cold the patient is best in bed and in a warm room ; but in influenza, 
if the patient is not too ill, it is better to get him out of bed after the third day, and 
place him on a sofa. Draughts and chills must be avoided on account of the risk of 
inflammation of the lungs. As there is usually complete loss of appetite, it is a 
difficult matter to get him to take much nourishment. Solid food may have to be 
abstained from in bad cases for two or three days. Should beef-tea be given, it 
should not be very hot, as it is apt to increase the headache and languor. Plenty 
of milk should be given, alone or mixed with soda water, as may be most palatable 
to the patient. Cold drinks, orange and lemon juice, cream of tartar water, rasp- 
berry vinegar, weak citrate of potash, citric acid and water flavoured with sugar, 
barley-water with lemon-juice, infusion of mallows, and so on, should be given ad 
libitum, and when there is much fever they should be iced. ■ Weak cold white wine 
whey often proves grateful In the way of stimulants, claret or hock, with seltzer 
water, is useful ; but in the case of old people suffering greatly from debility, it is 
usually necessary to give port wine or brandy. As soon as the fever begins to sub- 
side, the patient should be encouraged to take solid food, although at first there may 
be little or no appetite. The air of the sick-room should be kept moist by means of 
the steam of a kettle placed on the hob, or by putting boiling water into flat, shallow 
vessels. The inhalation of hot steam several times a day from a suitable inhaler 
may prove useful, and the addition of ten or twenty drops of chloroform to the 
water may subdue the violence of the cough. 

Bleeding in influenza always proves injurious, and the high mortality in some 
epidemics is believed to have been due to the adoption of this mode of treatment. 
Active purgation is to be avoided, but in many cases it is a good plan to begin 
treatment by the administration of a three-grain calomel pill at bed-time (Pr. 61), 
followed by a draught in the morning (Pr. 25). The calomel generally brings away 
oop>ous dark-coloured motions, after which the patient is much better in spirits, and 
tW fever abates. In the case of mildren a dose of grey powder may be substituted 



358 THE TREATMENT OF DISEASES. 

for the calomel, or what is even better, an injection of warm water containing a little 
castor oil may be administered In simple cases very little medicine is needed, 
but nitrate of potash (saltpetre) is often given. It should be largely diluted 
with water, and flavoured with sugar and lemon-juice, so as. to be taken as a 
drink. From one to two drachms of nitre may be administered in the course 
of the twenty-four hours. When cough is a prominent symptom, linseed-meal 
poultices should be applied to the chest, back and front, and should be changed 
every three or four hours, night and day, and oftener if necessary. An occasional 
mustard poultice, or the application of a mustard-leaf for a few minutes over 
different parts of the chest, so as just to redden the skin, may do good. Benefit 
might be derived from painting the chest or back with iodine liniment, taking 
care not to apply too much. Blisters, as a rule, do no good, and only add 
to the patient's sufferings. Immediately the acute symptoms are subsiding, 
quinine (Pr. 9) should be given. In some instances aconite (Pr. 38) and gelseminum 
(Pr. 41) have been tried, and when administered quite at the commencement 
of the disease, they may be expected to do good. Cases are recorded where 
arsenic (Pr. 40) was given throughout with marked benefit. During convalescence 
iron and quinine (Pr. 11) should be administered, and a very nutritious diet, with 
beer and wine, must be employed. Milk in large quantities is useful, milk and 
seltzer water being a favourite remedy in Germany. In all cases of influenza the 
attendance of a meaical man is necessary, and the sooner he is summoned the better. 



ITCHING AT THE ANUS. 

This is a far more prevalent complaint than is usually supposed. The fact is, 
the sufferer, from motives of delicacy, seldom mentions its existence, even to his 
most intimate friend, and often refrains from seeking medical advice from the same 
reason. This is to be regretted, for there never need be the slightest hesitation in 
consulting a doctor about any bodily ailment. It may seem a disagreeable matter 
to have to mention it to anybody, but it must be done, and you will soon find the 
doctor thinks nothing of it, and takes it quite as a matter of course. 

This painful itching about the back passage is a most distressing malady, and 
many people's lives are rendered almost unendurable by it. The irritation is, in the 
majority of eases, worse at night, especially when the patient gets warm in bed. 
The greater part of the night is rendered sleepless and inexpressibly wretched. 
Towards morning, irritable and worn out, the unfortunate sufferer falls off into a 
fitful slumber, from which he often awakens by involuntarily scratching himself. 
This, of course, makes the part more or less raw, and materially increases the dis- 
comfort during the day-time. The more the patient scratches, the worse he gets, 
although it is very difficult to help seeking the temporary relief it affords. Many 
people say they would infinitely prefer decided pain to the dreadful and constant 
itching they have to endure. Nervous, excitable people are often greatly troubled 
in the day as well as at night, the itching setting in badly after exercise, or on 
leaving the cold air and coming into a warm room. These unfortunates are 
practically excluded from society. 



ITCHING AS THE Asm S59 



In many cases, on examining the part, there is nothing to be seen, but sometimes 
the skin is thick and rough from the scratching, and sometimes a little eruption may 
be observed in the neighbourhood. 

The disorder is met with both in men and women, but it is not of frequent 
occurrence in young people. In some cases it seems to be a kind of neuralgia, but 
it is often caused by the irritation of piles, by worms, by confined bowels, and in 
women by arrest of the periods. It sometimes occurs during the later months of 
pregnancy. It is frequently induced, or at all events kept up, by habits of too free 
eating and drinking, although it is occasionally met with in persons who are strictly 
abstemious. It is sometimes induced, too, by particular articles of food ; one man 
gets an attack after eating lobster or crab, another from indulging in salmon, whilst 
a third suffers only after drinking champagne or ale. Excessive smoking may act 
as an exciting cause in those who have a tendency to it 

It must be remembered that itching of the anus is a very intractable complaint, 
and if you want to be cured you will have to practise a certain amount of self- 
restraint and self -denial. You will have to follow strictly, patiently, and persistently, 
the rules laid down for your guidance, for if you do not you most assuredly will get 
no better. You are a stout, full-blooded, well-to-do, middle-aged gentleman, rather 
fond of the good things of this life than otherwise. Well, we shall have to cut 
down your diet. You must give up all rich and highly-seasoned dishes, you must 
eat but little meat, and live chiefly on fish, poultry, vegetables, and fresh ripe fruit. 
It is no good saying you will not, for if you want to get better you must. You 
must knock off your beer and your port and your spirits, and confine your attention 
to light sherry and claret. You may take Yichy or soda or seltzer water as much 
as you lika You will have to give up coffee and take tea or cocoa for breakfast. 
You should take a good long walk every day, and try and get yourself into a slight 
perspiration. If you are not accustomed to much walking you had better begin with 
half a mile and gradually increase it, in the course of a week or ten days, to three 
or four miles, only be careful not to over-do it. You should take a cold sponge-bath 
every morning, and a warm or Turkish bath once a week. At bed-time well wash 
the parts with warm water and yellow soap. 

Now as to medicine, get this mixture made up, and take two table-spoonfuls of it 
two or three times a day : — Sulphate of magnesia, an ounce ; carbonate of mag- 
nesia, forty grains ; colchicum wine, forty minims ; syrup of senna, an ounce ; com- 
pound tincture of cardamoms, half an ounce ; infusion of cherata to make it up to 
eight ounces. Then take one of these pills every other night : — Plummer's pill, 
two grains ; compound rhubarb pill, three grains. Mix, to make a pilh 

After the washing at night, apply calomel ointment freely. This is an officinal 
preparation, and you can get it from any chemist You will have to persist in this 
treatment for some time, and if you do you will probably be amply rewarded. 

When itching of the anus occurs in young men or women, a different mode of con- 
stitutional treatment will have to be adopted. When there is much debility, cod-liver 
oil may be given internally, in addition to the use of the local applications. When 
there is anaemia, the different preparations of iron will have to be used as recommended 
when speaking of that complaint In excitable nervous people, in whom an attack 



360 THE TREATMENT OP DISEASES. 

is Induced by mental anxiety, over- work, or worry, bromide of potassium is the appro- 
priate remedy (Pr. 31). Ten or fifteen grains of chloral may be added to the nightly 
dose, and this will usually ensure a good night's rest. In alternation with the 
chloral, advantage often results from taking from one to two drachms of conium 
juice three times a day. This is the full dose, and must not be exceeded. In addi- 
tion to this, phosphorus (Pr. 53 or 54) or cod-liver oil taken after meals may do 
good by restoring the shattered nerve-form Not unfrequently in young people 
this malady is a kind of neuralgia, and then anti-neuralgic remedies will have to be 
resorted to. A course of quinine (Pr. 11 or 9) or arsenic (Pr. 40) or phosphorus 
(Pr. 53, 54, or 55) may be expected to prove useful. You should never forget to 
look out for worms, and if they are present you will have to get rid of them by 
appropriate remedies. (See Worms.) When the itching seems to be due to piles, 
they will have to be treated. (See Piles.) You must always remember that the 
itching is not a purely local complaint, but a part of a general constitutional malady. 
At the same time, you will not neglect local applications, but will resort to both 
internal and external treatment. 

There are many applications which may be used besides the calomel ointment, 
and when one fails you will have to try another. Only do not be in too great a 
hurry to change ; give one a fair trial before you go on to the next. The following 
is a very good formula : — Carbonate of soda, two drachms ; hydrochlorate of mor- 
phia, sixteen grains ; dilute hydrocyanic acid, half an ounce ; glycerine, two ounces ; 
water to make it up to eight ounces. Make a lotion. Dab the part frequently. 
You must remember that this is a Poison, so that it should be distinctly labelled as 
such, and should not be left about. 

A chloroform pomade sometimes acts admirably. It is made as follows : — 
chloroform, two drachms ; glycerine, half an ounce ; lard, an ounce and a halt This 
to be used frequently. If you do not like the smell of it, tell the chemist to scent it 
w?th roses or elder-flowers. 

These are all very good applications, but we have by no means exhausted our 
list. A very useful lotion is one consisting of one part of carbolic acid to a 
hundred parts of water. Sometimes the skin becomes so red and irritable from 
the constant scratching that even a weak lotion such as this causes considerable 
burning and smarting. It is by no means a bad plan to make a small plug of lint, 
or out of an old handkerchief, soak it in this lotion, and push it up the passage, 
leaving a part outside to act as a pad. When there is any suspicion that the 
itching might possibly depend on some parasite such as the itch or lice, sulphur 
ointment should be freely applied. In obstinate old-standing cases it is a good plan 
to commence treatment by rubbing the parts thoroughly with a solution of nitrate 
of silver of the strength of two drachms to the ounce. It usually softens the skin 
and allays the itching. Tilden's Bromo-Chloralum is very useful for the same 
purpose, and should be applied two or three times a week. A case is said to have 
been treated most satisfactorily after all remedies had failed by a lotion composed 
of one part of liquor carbonis detergens to three of water applied freely. Some 
very obstinate cases had been cured by washing the affected part at bed-time with 
a saturated solution of borax in water. 



JAUNDICE. 361 

However bav the itching may be you should avoid taking laudanum or opium in 
any form. You may possibly get a night's rest, but you pay for it in the long-run, 
and are almost sure to be worse the next day. When the irritation is so very 
great that the patient is almost worn out by want of sleep, a mechanical mode of 
treatment may be resorted to. Get a plug of bone made shaped like the nipple of 
an infant's feeding bottle, and furnished with a circular shield to prevent it from 
slipping into the bowel ; the nipple should be about an inch and a half in length, 
and as thick as the end of the forefinger. This is introduced into the back passage 
at bed -time, and retained all night It is most efficient in preventing the nocturnal 
itching, and a good night's rest is almost sure to result from its use. It is 
recommended, however, that it should be worn only every other night. The idea 
of this plug was first suggested by noticing the fact that many patients can obtain 
relief and sleep, when the itching is very bad, only by introducing the end of the 
forefinger into the bowel and making pressure. 

Itching occurring about the front passage in women is usually successfully 
treated by one of the applications we have mentioned above. The calomel ointment 
is especially useful, but in obstinate cases it may be necessary to resort to the 
employment of leeches or blisters to the inner side of the thighs. A strong solution 
of alum applied several times a day often succeeds when other things have failed. 
It must not be forgotten that this complaint may depend on irritation of the womb, 
and the treatment may have to be directed to this organ. 



JAUNDICE. 

Jaundice occurs as a symptom in the course of many diseases of the liver. It 
may depend upon various, and very different morbid conditions, the nature of which 
in any given case is often involved in obscurity. 

The word jaundice is derived from the French, jaune, yellow. Its technical 
appellation is icterus, the Greek name for a bird with a yellow plumage, the Galbula, 
or golden thrush, the sight whereof by a jaundiced person was said to be death to 
the bird, but recovery to the patient. The Latins called it morbus arquatus, from its 
exhibiting some of the bright hues of the rainbow, and aurigo, from its resembling 
gold. Even now-a-days we speak of a person being as yellow as a guinea. 

There is never any difficulty in recognising the presence of jaundice, at all events, 
when well marked. You have only to look at your patient in daylight to see 
what is the matter with him. By candle or gaslight the yellowness of the skin is 
readily overlooked, and often cannot be detected at alL The symptoms constituting 
jaundice may be said to be yellowness of the skin and of the eyes, whitish or 
drab-coloured motions, and urine having the colour of saffron, and communicating a 
bright yellow tinge to white linen. There are other symptoms to which we shall 
have occasion to refer presently. The characteristic yellow complexion of jaundice 
is owing to the presence of bile in the blood. The deep tint of the urine is evidently 
derived from the same source. The paleness of the motions is ascribed to the absence 
of the bile which always exists in natural and healthy excrement. 

If there is any doubt as to whether the patient is really jaundiced, or only 



362 THE TREATMENT OF DISEASES. 

yellowish from sallowness, you have only to look at the whites of the eyes and the 
urine, both of which betray the yellow tint of jaundice very early and conclusively. 
The greenish-yellow colour of countenance observed in that form of anemia called 
chlorosis (see Anaemia) might, on a superficial examination, be mistaken for jaundice. 
The slightest attention would serve to rectify the error, for in that complaint the 
whites of the eyes are even whiter than natural, and the urine is normal in appear- 
ance. In cancer, and other wasting diseases, the skin often assumes a greenish- 
yellow, or lemon-coloured, waxen appearance ; but here again the whites of the eyes 
have the proper colour. A dusky yellowish tint of the surface is not unfrequently 
seen in persons who have suffered much from ague ; and sometimes also in those 
whose systems have been poisoned with lead ; but this need never be confounded 
with jaundice. Jaundice has been successfully feigned by soldiers and sailors 
desirous of obtaining their discharge. The yellow colour of the skin has often been 
simulated by painting it with infusions of saffron, turmeric, rhubarb, broom-tops, or 
soot ; whilst the colour of the urine has been heightened by taking rhubarb or santo- 
nine. The point that puzzles these gentlemen is that they cannot make their eyes 
yellow — they remain persistently white. Moreover, they cannot stand being washed ; 
a little soap and water, or better still, a weak solution of chloride of lime in water, 
at once cures their jaundice and reveals the imposition. 

The colour of the skin in jaundice varies in different people. The young, and those 
who are pale and fair, present a bright lemon colour. In those who are florid, or 
whose cheeks and skin are flushed with fever, the tint will more resemble that of a 
Seville orange. If the patient be naturally swarthy, or if his visage be livid or 
dusky through imperfect action of the heart and lungs, the super-addition of jaundice 
will give him a greenish, or olive hue. In old age the colour is usually less livid. 
Sometimes, in very bad cases of jaundice, the face becomes quite dark in colour, con- 
stituting green or black jaundice. Even in the same person the intensity of the 
colour may vary from day to day, according to the diet, the amount of bile secreted 
by the liver, and the activity of the bowels and kidneys. The colour of jaundice 
often remains in the skin for some time after the cause has been removed, and it is 
important to know this with reference to treatment. It is useless in such a case to 
continue the administration of medicines which act on the liver, but the departure of 
the colour may be expedited by warm baths, and drugs acting on the bowels and skin. 

Often enough in jaundice the perspiration is coloured by the bile, so that it 
stains linen yellow. Sometimes the saliva and tears have been found to be similarly 
affected. Sometimes the milk is tinged, whilst at others it is not. In one case, a 
woman with deep jaundice suckled her baby for six weeks without imparting to it a 
yellow colour, or affecting its health in any way. 

Derangement of digestion is nearly always associated with jaundice. It generally 
takes the form of flatulence, or wind, and constipation. In jaundice the bowels are 
nearly always most obstinately confined. Naturally the bile acts as a kind of 
stimulus to the intestines, and when it is not secreted in the proper way, there is 
nothing to make them act. People in jaundice often suffer greatly from the hard- 
ness of the motions. They strain and strain, and yet are unable to pass anything 
This difficulty may be the starting point of piles. 



Itching of the skin, without the occurrence of any eruption, is sometimes a very 
obstinate and annoying symptom in jaundice. It may be so intolerable as to drive 
the sufferer almost crazy. 

It is an old notion that to the jaundiced eye all things appear yellow. By many 
this is regarded as a mere poetical fiction, but certainly it is sometimes, though very 
rarely, a fact. Curiously enough, in one case everything appeared yellow when 
looked at with one eye, but not with the other. 

Jaundice usually induces a condition of general debility and exhaustion, asso- 
ciated with mental depression and irritability of temper. The temperature of the 
body, provided there be no concurrent cause of fever, is usually slightly below the 
normal standard. The pulse is often reduced to 50, 40, or even 20 beats in the 
minute. This slowness of the pulse is particularly noticeable when the patient is 
lying down ; when he stands up the circulation is quickened. 

Jaundice, as we have seen, may depend on a great number of different causes. 
One of the commonest is obstruction of the bile-duct — the duct leading from the 
liver to the intestine — by a gall-stone. Sometimes the bile itself gets so thick that 
it blocks up this duct. The bile may even become quite hard, and may ultimately 
be passed in the shape of a black, gritty powder — very like powdered cinders or coal- 
dust. Sometimes, curiously enough, a round-worm crawls from the bowel into the 
duct, and causes the mischief. It would seem at first sight that such cases must be 
very exceptional, but they are not so in reality. Worms appear to have a passion 
for wriggling into any little hole they may find about, and the mouth of the duct 
affords them a good opportunity of displaying this proclivity. Sometimes the lining 
membrane of the duct gets inflamed and swollen, and, by obstructing it, gives rise to 
jaundice. In certain cases the complaint may arise from organic disease, such as 
cancer of the liver or one of the adjacent organs. Fits of anger, of fear, or of alarm 
have been followed by jaundice, and it has also been produced by great bodily suf- 
fering, by a severe surgical operation, or perhaps by the dread which attended it. 
An instance is recorded in which an unmarried woman, on its being accidentally 
disclosed that she had had a child, became in a very short time quite yellow. We 
remember the case of a medical student who had an attack of intense jaundice which 
could be traced to nothing else than the excitement and worry of an examination at 
which he was a candidate. It is said that cases coming on thus suddenly are more 
serious than when the jaundice arises from a more ordinary cause, and that they 
sometimes prove fatal. 

It has been noticed that jaundice occurs most frequently in hot weather, and it 
is probable that a high atmospheric temperature, long continued, exerts some influ- 
ence in producing certain forms of this disorder. Jaundice occasionally comes on 
during pregnancy, and disappears after childbirth. The pressure of the womb may 
thrust other organs — a loaded intestine, for instance — against the liver, and so im- 
pede the passage of the bile. The little exercise that pregnant women take, and the 
costiveness that frequently attends their condition, is probably not without its 
influence. 

Children, a few days after birth, frequently become jaundiced. It is seldom 
attended with any disturbance of the health, and usually passes off in a few days, 



864 THE TREATMENT OP DISEASES. 

It has been supposed that this is in reality not true jaundice. The surface of an 
infant at birth is often enough of a deep red colour, presenting a condition which 
falls little short of a mild but universal bruise. By degrees the redness fades, as 
bruises fade, through shades of yellow into the genuine flesh colour. It need never 
occasion any alarm or anxiety. 

How long does jaundice last 1 ? It is impossible to answer the question very 
definitely, as the time is so variable. It may last but only a day or two, or a month 
or more. In the majority of cases it is all over in a fortnight.* 

There is rarely any danger in jaundice. The result is nearly always favourable, 
except when it depends on some structural disease of the liver, or supervenes 
suddenly on some great mental or bodily shock. In both cases there are grounds 
for alarm. Intense yellowness of the skin and eyes is often more hopeful than a 
fainter tinge of yellow. The prognosis is not good in old people, when the constitu- 
tion is impaired, and there is no obvious cause for the disease, and particularly when 
the colour of the skin is greenish or approaching to black. 

We will now consider the treatment of jaundice. Theoretically, all treatment 
should be directed to the cause of the jaundice, but as practically we are often unable 
to find out what that is, we must be content to prescribe for the most prominent 
symptoms. As a rule we manage to get our patient well- without much trouble. 

In the first place, the diet must be restricted, There is probably complete loss 
of appetite, and possibly persistent vomiting. It would obviously be impolitic to 
load the stomach with food, which would be rejected, or would set up irritation. 
One of the best articles of diet in these cases is milk, and when there is much sick- 
ness or nausea, nothing else should be taken. Some people like it alone, but as a 
rule it is better to mix it with soda water. Half fill a soda water tumbler with 
milk, in which a few pieces of ice are floating, and then fill up with the soda water. 
Of course a considerable quantity of milk will have to be taken in the course of the 
day, and it should be taken at regular intervals, say every two or three hours, so as 
to constitute meals. Many people want brandy in the milk, but they are better with- 
out it. Lemonade cannot be substituted for the soda water, as it curdles the milk. 
When there is no sickness there is no objection to a few biscuits with the milk. 
Two or three sponge cakes with a tumbler or two of milk and soda water form by 
no means a bad meal, as we can testify. In some cases a rice or sago pudding may 
be allowed, but if there is any vomiting it is better to do without it. When even 
the milk and soda water is not retained, milk and lime water may be tried, one part 
of lime water to four of milk. If these are rejected, it must be given in very small 
quantities, commencing with a table-spoonful at a time, and gradually increasing the 
dose. As a rule in jaundice vomiting is not very troublesome, and if the diet is 
confined to the milk and soda water no difficulty will usually be experienced. 

As jaundice nearly always depends on some form of liver disorder it is advisable 
to apply friction over the region of that organ. The hand should be used for the 
purpose, and not a towel or bath-glove, or anything of that kind. It is as well to 
employ some simple liniment to rub in, such as opodeldoc, although it is the rubbing 
that does the good. You will find it impossible to do it yourself, for the part 
should be steadily rubbed, with short intervals of rest for a quarter of an hour, night 



JAUNDICE. 365 



and morning. In the case of a man living in rooms it La often difficult to get any- 
one to do it, although of course when a man is married it is easy enough. There is 
one thing, a shampooer from the nearest Turkish bath will generally come in for 
half an hour when his work is done for a shilling or two. If the skin becomes 
tender, or if for any other reason the rubbing cannot be continued, hot fomentations 
may be substituted. A piece of flannel rung out of hot water, folded in the middle 
and covered with a rather larger piece of oil-silk or thin mackintosh will- answer 
admirably. It should be renewed as often as it gets cold. 

People with jaundice are generally very low-spirited, and often drowsy, and 
quite unfit for any mental work. In most cases there is no occasion for them to 
remain in bed. They should get up late, dress leisurely, and then go in the sitting- 
room and spend the day lying on the sofa covered with a rug, or sitting in an arm- 
chair by the fira The great thing is to have a novel or two by your side, and drop 
off to sleep when you are tired. It is of no use trying to see people on business, at 
least unless it is very urgent ; for with all that bile circulating in the system your 
brain is not clear enough for serious work. A man with jaundice generally feels so 
frightfully despondent that he is apt to think he never can get over it, and yet it 
nearly always comes all right in a week or two. The great thing is not to catch 
cold, and not to return to solid food until you are quite sure you are out of the 
bush. 

Constipation is a very great troubla For days and days you have no call from 
nature, and when you do it is agony. You spend an hour or more over that simple 
operation, and the motion is so hard and unyielding that it is passed with the 
greatest pain. Sometimes relief will be afforded by pressing with the hand on the 
lower part of the back. It is a good plan to take one of the sugar and grey 
powders (Pr. 71) every four hours. If after two or three days you obtain no relief 
from them, try chloride of ammonium — twenty grains every four hours. If you 
watch your urine day by day, and also the motions when they are passed, you will 
be able to tell how you are getting on, and whether the medicine is doing you good. 
If the urine gets lighter in colour, or if the motions get darker, you are getting 
better. When it is all over you will probably find it necessary to go away for a 
change of air, for jaundice is a thing that pulls one down, and takes away all desire 
for work. It may seem hard to have to go away after losing so much time in 
the sick-room, but there is no help for it, and it is really economy of time, for if 
you do not get thoroughly rid of it you are very likely to have a relapse. When 
once it is quite gone, and you feel well and strong again, there is no reason why it 
should ever come back. 

If the grey powders fail to act on the bowels, and very often they do fail, take 
either Friedrichshall or Pullna water.. Try half a tumblerful every morning, with 
an equal quantity of warm water. It is much better to take it tepid than cold. 

Should the above mode of treatment fail, we should advise a trial of purified 
bile from either the ox or the pig. As it is not desirable that it should come in 
contact with the stomach it should be taken in capsules. These capsules are obtain- 
able from almost any chemist. They usually contain five grains each of prepared or 
concentrated bile, which, roughly speaking, is equal to about a hundred grains of 



306 THE TREATMENT OF DISEASES. 

liquid bile fresh from the gall-bladder. Two or three may be taken as a dose, about 
two hours after meals, when the stomach digestion is near completed, and the food 
is passing into the intestines. The capsules imbibe moisture in the stomach, and in 
their soft, swollen condition they probably get broken as they pass into the intestines, 
so that the bile is landed just where it is wanted. , 

Flatulence is sometimes very troublesome in jaundice. Cajeput oil, in three- 
drop doses, on a piece of sugar, will generally bring up the wind, but, on the whole, 
it is better to take something that will prevent its formation Ten or twenty grains 
of wood charcoal, or a charcoal biscuit or two, will often answer this purpose 
admirably. Creasote— two drops in a pill every four hours — sometimes does well. 
A dose of from ten to twenty drops of a saturated solution of carbolic acid, in 
water, taken with a few drops of chloric ether, in three or four table-spoonfuls of 
peppermint- water, often quickly relieves this symptom. 

The itchiness, which is often a source of great discomfort, will sometimes be 
alleviated by warm baths, the use of the flesh-brush, and the internal administra- 
tion of twenty grains of bicarbonate of potash, in water, three times a day. Some- 
times relief is obtained from acetic acid baths — half a pint of acid to three gallons of 
water. A lotion of chloroform (one part), and glycerine (five parts), often succeeds 
admirably. Olive oil, the calomel ointment of the Pharmacopoeia, or lotions made 
by dissolving four grains of cyanide of mercury, or a drachm of cyanide of potassium, 
in a pint of water, are also useful. Whatever you do, do not get these lotions mixed 
up with your medicine, or take them by mistake. 

For black jaundice, or malignant jaundice, as it is often called, phosphorus is the 
remedy. It is indicated when the skin and the whites of the eyes are of a brownish- 
yellow colour, when there is much prostration, with little bruise-like spots on the 
body, and when there is scanty, high-coloured urine. The phosphorus may be 
given in the form of capsules (Pr. 54), each containing ■£§ of a grain, one every 
four hours ; or from five to eight drops of the saturated solution of phosphorus in 
ether (Pr. 53), may be given at similar intervals, in a little milk. The phosphorous 
capsules are, on the whole, to be preferred. 

When jaundice appears to have been suddenly engendered by moral causes, the 
rationale of its production is obscure, and the treatment is correspondingly uncertain. 
The jaundice of new-born infants calls for no treatment, as it causes no incon- 
venience, and usually passes off in a week or two. For the jaundice of pregnant 
women, delivery is the natural end, although it may sometimes be removed by the 
careful employment of aperients. 

Should you send for a doctor in jaundice ? It is as well to do so, although, truth 
to tell, you would probably get along just as well by yourself in an ordinary simple 
case. You are sure to feel very despondent, and it is just as well to have some one 
to see after you, and make sure that there is really nothing amiss. In the so-called 
green jaundice, and in jaundice coming on from mental causes, you should certainly 
have a doctor. If your jaundice lasts over a fortnight, you had better call in some- 
body, unless you are getting better. 



jronrrs — diseases op the joints. S67 



JOINTS — DI8EA8X8 OF THE JOINTS. 

The majority of the diseases of the joints, from their complexity and difficulty 
of recognition, require the attendance of a surgeon for their successful treatment. 
There are, however, a few of the simpler forms that may be fairly considered to fall 
within the province of domestic medicine. Some information on this subject, with 
directions for treatment, will be found in the articles on Gout and Rheumatism. 

Acute inflammation of a joint — the knee, for example — is usually the result of a 
blow or strain, or it may follow some mechanical injury. The most prominent 
symptoms are severe aching pain in the joint, aggravated by the slightest motion, 
great swelling quickly following the onset of the pain, redness of the surface, tender- 
ness, and fever, which is often really alarming. The presence of swelling may be 
detected in doubtful cases by comparing the joint with its fellow on the sound side. 
The best thing is to send for a surgeon, and pending his arrival to keep quiet and 
take tincture of aconite, a drop in water every ten minutes for the first hour and sub- 
sequently hourly. In the absence of medical attendance the joint should be kept at 
rest by means of a splint such as is used for a broken thigh. It should be padded, 
and arranged so that it may be fastened to the limb at some distance above and below 
the painful spot, the bandages not being carried over the joint itself. Pain may 
often be eased by the application of linseed-meal poultices sprinkled with laudanum. 
When there is a tendency to gout, or when there are grinding, excruciating pains, as 
if the joint were being torn asunder, the colchicum mixture (Pr. 33) should be given. 
We can only repeat that in cases of acute inflammation the personal attendance of a 
doctor is very desirable. 

Chronic inflammation of a joint is characterised by swelling, as in the acute form, 
but there is little or no fever. The pain is usually of a dull aching character, is 
increased at night, and is often attended by sudden startings of the limbs, with a 
sense of weakness and relaxation in the part In these chronic cases the application 
on either side of the joint of a blister about the size of half-a-crown often proves 
useful. These blisters should be heated as quickly as possible, and may be repeated 
after a short interval if necessary. Painting the joint with tincture of iodine often 
does good These applications should not be continued if they cause any aggrava- 
tion of the pain. Even in these chronic cases it is as well to get the joint looked to 
by a doctor. 

In many chronic affections of the joints the cold douche is an excellent remedy. 
It may be employed to remove the stiffness remaining after slight injuries or resulting 
from rheumatism or gout. In the earlier applications it is a good plan to play the 
water in the neighbourhood of the joint, rather than on the affected part itself. In 
some instances it is desirable to use tepid water, and in every case the part should 
be rubbed immediately after the application till they are warm and dry. When 
stiffness and pain occur in several joints nothing succeeds better than the Turkish 
bath, and they often succumb to this after resisting all other modes of treatment. 
Galvanism, too, often does good in these cases. Inunction with cod-liver oil or olive 
oil for five or ten minutes, night and morning, often effects great improvement, and 
fit may succeed when other measures have failed Constitutional treatment must not 



$6£ THE TBEATMENT 07 DISEASES. 

be neglected, and in many cases we have to trust to the influence of good diet and 
sea air, with cod-liver oil, steel wine, iron, quinine, <fcc. Some affections of the joints 
are dependent on a syphilitic taint, and then a course of iodide of potassium (Pr. 32) 
will do more good than anything. 

In cases of stifihess arising from exertion, the part should be well rubbed with 
tincture of arnica, a drop or two, or a tea-spoonful of the mixture (Pr. 42) 
being taken internally in water every half or alternate hour. Rhus toxicoden- 
dron sometimes proves useful ; it does most good when the pains are accompanied 
by only a slight amount of swelling, and when they are intensified by warmth and 
motion. Three drops of the tincture may be taken in water every three hours. 
The internal administration of tincture of bryony (Pr. 49) is often attended with 
marked benefit ; it is specially indicated when the pains are worse on movement. 
Pulsatilla (Pr. 43) proves useful for pains in the joints occurring in women with 
menstrual derangement. 

LOSS OF APPETITE, 

Loss of appetite is known medically as " anorexia." It is of common occurrence 
at the onset of many fevers, but usually it is a far more chronic complaint. Nothing 
is commoner in New York than to hear people say that they "have gone off their feed," 
they " have no appetite," they " do not care for anything," or that they " hate the 
sight of food. "@ It is often enough associated with a condition of debility and general 
inaptitude for work. It is by no means uncommon in those who are worried and 
anxious, and find it difficult to make both ends meet. People who devote too much 
attention to the brandy-bottle generally find meals rather a trouble than otherwise ; 
breakfast, especially, is a difficulty. These individuals are generally very dainty 
and fanciful, and when at home grumble at everything that is set before them. 
They are very fond of abusing the cook for what is in reality the morbid condition 
of their own digestive organs. Tobacco-smokers, or, at all events, those who smoke 
in any quantity, are seldom great performers with the knife and fork. Tobacco and 
opium and alcohol seem all to have the power of deadening the appetite. People 
who take little or no out-door exercise generally complain that they do not eat well, 
and no wonder. If a man wants a good appetite, he must earn it somehow or other. 
Some one may give him his dinner, but if he is to enjoy it he will have to bring his 
own sauce in the shape of an appetite. 

Irregularity of meals is another common cause of loss of appetite. The stomach 
appreciates regularity, and likes to have its want attended to at the proper tima 
It is curious how in a well-regulated body the desire for food is experienced day by 
day at exactly the same hour. We all know how dreadfully bad-tempered many 
people get if their dinner is only five minutes late. It is all very well to say that 
they are stupid, and should not be put out about trifles, but it must be remembered 
that it is no trifle to them, and that even a slight delay may give rise to a consider- 
able amount of bodily discomfort The stomach has been accustomed to receive 
supplies at certain regular intervals, and, if it fails to receive them, it objects most 
emphatically. Nothing is more likely to spoil the appetite than eating or drinking 
between meals, You hear a man complaining that he cannot eat his dinner, and jom 



I0S8 OP AVPETITB. 369 



find on inquiry that about an hour before he had three or four dozen oysters, and 
some bread-and-butter, and a pint of stout, "just to pull him together." It may be 
thought that this is an exaggeration, but it is not We have seen it, and we wish 
we had not, for nothing can be more contemptible than a man who makes a deity of 
his stomach. We should eat to live, and not live to eat. For people who dine in 
the middle of the day, lunch is a great mistake. 

The hour at which we enjoy the pleasures of the table exerts a far greater 
influence than is ordinarily supposed upon the process of digestion. The ancients, 
who understood thoroughly the science of gastronomy, were in the habit of 
consecrating the end of the day to the reparation of the corporeal forces, and the 
joyous effusions inspired by the repast. It seems, indeed, as if, at that hour of 
silence and peace, there is spread over the whole nature a happy calm, which 
ought not to disturb in any way the important mystery of the daily resurrection, 
which we are about to entrust to its benignant influence. 

Now a word or two about some of what may be called the curiosities of appetite. 
Sometimes a mother brings her boy to the doctor, and says she thinks he must have 
worms, "he is always eating — he is never satisfied." If the boy is strong and 
well nourished, let him eat by all means, and do not be stupid enough to give him 
anything to spoil his appetite. We do not suppose he has any worms, and even if he 
has it does not matter very much. They will not do any harm, and it is only fair that 
they should have a feast once in the way. At all events, if they do give any trouble, 
there is never much difficulty in getting rid of them, and we will speak of the 
different modes adopted for their' expulsion by and by. In diabetes mellitus, or 
sugary diabetes, there is often, as we have already seen, a most inordinate appetite. 
It is no joke in the 3ase of a poor man. Sometimes they seem as if they would eat 
almost any quantity, and we certainly should not like to contract for them. Hysterical 
young ladies often exhibit the most depraved appetites ; they will eat almost any- 
thing, from slate-pencil to egg-shells. Few people like cinders as an article of diet, 
but they really seem to enjoy them. Pregnant women occasionally exhibit these 
vagaries of appetite, and either have, or pretend to have, inordinate longings for 
particular kinds of food. It is to be feared that these fancies are often fostered by 
encouragement ; at all events, they are less frequently heard of among the poor, who 
have not the means of gratifying them, than in the higher ranks of society. 

What is to be done for loss of appetite % In the first place, it is essential to avoid, 
as far as possible, any of the circumstances we have mentioned as causes of this com- 
plaint. Be regular in your habits ; get up early ; do not stay out late at night ; take 
plenty of outdoor exercise; have your bowels well open every morning; do not 
drink much tea; be quite sure that you are not smoking too much, and are not 
taking more than you ought to in the way of stimulant. It is a great thing if you 
can dine in cheerful, pleasant society — the example of eating seems to be almost 
contagious. It is astonishing what a great deal bad cookery has to answer for in 
the way of exciting a distaste for food. Many a man living in rooms or chambers 
gets to hate the sight of his dinner, simply because he is so heartily tired of those 
everlasting chops and steaks. The best thing he can do is to get into a good club, 
and have his dinner there in a civilised fashion. In New York there are nowaday? 
24 



370 THE TREATMENT OP DISEASES. 

so many different restaurants — English, French, German, and Italian — that if a 
man cannot manage to get a little variety now and then, it must be his own fault. 
In some places. you can even have your dinner served up to the accompaniment of 
vocal and instrumental music, which, we suppose, is to be regarded as a stimulant 
to the mucous membrane of the stomach. 

The practice of taking bitters before meals with the view of increasing 
the appetite is a common one. It is undoubtedly a bad habit, but in certain 
functional derangements of the stomach an occasional gin-and-bitters or sherry- 
and-bitters may have its advantages. "We may mention, en passant, that the 
custom of taking what has been called an " epigastric spurrer," is by no means 
confined to our own country. In France the oysters and chablis or sauterne 
with which a dinner Men monte is preceded, may be regarded as an institution. 
In Denmark and Sweden dinner is invariably prefaced by a mouthful of caviare, 
or salt fish, or a dram of raw spirits. In Russia dram-drinking and condiment- 
eating preparatory to the prandial meal, are customs very widely disseminated ; 
in the United States we go further, and pickled oysters and small cubes of salted 
cod are frequently to be seen in the bars of our palatial hotels, although 
these latter are probably to be regarded less as incentives to eating than as 
provocatives to drinking. 

Probably the drug most frequently employed with the view of stimulating 
the jaded appetite is quinine. Two table-spoonfuls of the tonic quinine mixture 
(Pr. 9) should be taken about half an hour before meals, or two table-spoonfuls 
of quinine wine will do equally welL The infusion of quassia may also be used 
for this purpose, and its efficacy is greatly enhanced by the addition of three 
or four drops of tincture of nux vomica. Nux vomica is one of the pleasantest 
bitters we know, and will often succeed admirably, even when given in plain water. 
Other tinctures and infusions employed for a similar purpose are those of calumba, 
gentian, chirette, and cusparia. These infusions should be given in two table- 
spoonful doses, while the dose of tinctures is a tea-spoonful in water. The tincture 
of nux vomica it will be remembered is a much more powerful drug, and the 
dose of this should not exceed eight drops. The different preparations of hop 
are useful, but are, we think, best taken in the form of bitter beer. Absinthe, 
or wormwood, is largely employed on the Continent. With many people, especially 
those who are predisposed to constipation, two or three table-spoonfuls of compound 
decoction of aloes, or " Baume de Vie," will succeed better than anything. We 
have given a formula for a "dinner-pill" (Pr. 65), which in many cases acts 
admirably. For elderly people, pepsin taken in five-grain doses half an hour 
before meals is U3efuL We need hardly say that for patients who are anaemic, 
or suffering from what is Hsually called "poorness of blood," iron is the remedy 
(Pr. 1 or 2). 

LOSS OF TOIOB (APHONIA) — HOARSENESS. 

By the term "aphonia" we mean loss of voice. It may vary in degree from 
slight impairment to complete dumbness, and it may be temporary or permanent. 
It may be due to mere functional disorder or to some structural change in the 



LOSS OF VOICE (APHONIA) — HOARSENESS. 371 

muscles and other tissues of the larynx. The functional variety is the more common, 
and is that to which we shall especially devote our attention. It is as a rule 
associated with and probably dependent on that peculiar condition which we recog- 
nise by the term hysteria. It occurs chiefly in women, and more especially in 
women in whom there is some disturbance or derangement of the functions of the 
womb. Sometimes the periods are deficient in quantity, but more frequently they 
are excessive. In some cases there is marked ansemia or even chlorosis. The 
patient sometimes completely loses her voice without any very apparent cause, and 
at others she speaks quite in a whisper, possibly for days together. In a fashionable 
school, where the studies were principally devoted to the so-called accomplishments, 
three out of the eight pupils suffered from occasional attacks of aphonia. In two of 
the cases the disease was hysterical, but in the third the affection was simply feigned, 
the young lady being capricious and wayward, though in good health. Galvanism, 
moral influence, and a course of iron cured all three patients. Such cases unfortu- 
nately are common enough, and are met with not only among the upper classes of 
society, but not unfrequently in the out-patient rooms of our hospitals. 

In men aphonia has been known to result from a sudden shock to the nervous 
system. The case is recorded of a soldier who, in a charge of his regiment, received 
a severe bullet wound. He instantly and completely lost his voice, and for nearly 
two years was unable to articulate a word. He suddenly recovered his speech while 
in a state of excitement during an altercation in a public-house. In some cases 
aphonia is due to the pressure of a tumour on the nerves which govern the muscles 
of the larynx. It is then usually accompanied by marked shortness of breath. 

There can be no difficulty in recognising the condition of which we have spoken 
under the term aphonia. It can never be confounded, even by the least observant, 
with that failure of articulate language which is the consequence of disease of the 
cerebral hemisphere — the seat of the mind 

The treatment of complete aphonia must, of course, vary with the cause. When 
it is dependent simply on some morbid condition of the larynx, the treatment 
recommended for relaxed sore throat and clergyman's sore throat may be resorted to 
with advantage. Benefit may be anticipated from the use of the astringent spray 
preparations. Every means must, of course, be taken to improve the condition of 
the general health. The direct application of galvanism to the interior of the larynx 
is sometimes followed by the most astonishing results. We on one occasion 
witnessed the instantaneous restoration of the voice by this means in a young 
woman who, we were assured, had not spoken a word for nearly a year. 

In obstinate cases, phytolacca both given internally and used in the form of 
spray is deserving of a patient trial. The dose of the tincture is three drops every 
three hours, and the spray solution is made by mixing twenty-five drops w it h a 
quarter of a pint of water. Should this fail the internal administration of phos- 
phorus may be tried (Pr. 53 or 54). 

When there is only partial aphonia, and the patient is suffering from mere 
hoarseness, far less difficulty will be experienced in effecting a cure. In very many 
cases hoarseness is simply due to a cold, and the best treatment for it is the Turkish 
bath. When in the hot chamber the voice generally becomes quite clear and natural, 



372 THE TREATMENT OP DISEASES. 

though the hoarseness may afterwards return in a slight degree. Improvement of 
the voice in the hot chamber may be taken as an indication that the bath has done 
good, even though after the bath the hoarseness returns to a great extent In 
chronic cases several baths may be necessary to effect a cure. 

An inhalation of sulphurous acid often proves beneficial A few drops of the 
Pharmacopoeia solution are added to a jug of boiling water, and the steam is gently 
inhaled. If carefully used, it excites hardly any irritation or annoyance. The 
application of the sulphurous acid may be conducted as follows : — Put a few hot 
cinders into a kitchen shovel, and sprinkle them from time to time with flowers of 
sulphur, till the room is not inconveniently filled with the smoke. The fumes of the 
acid are likely to act injuriously on steel or on gilt. The treatment is best conducted 
in an empty room. 

A solution of alum, ten grains to the ounce, often proves of use when employed 
in the form of spray. 

It has been found that a piece of borax, the size of a pea, allowed to dissolve in 
the mouth, restores the voice sometimes like magic, in cases of sudden hoarseness 
brought on by cold, and frequently, for an hour or so, renders the voice quite clear 
and silvery. Borax is useful in the hoarseness common among clergymen and 
singers. 

Phytolacca is not a remedy to be lost sight of. 

LUNGS — DISEASES OP THE LUNGS. 

The diseases of the lungs most frequently met with are consumption, bronchitis, 
pleurisy, pneumonia, and asthma. Strictly speaking, asthma should not be regarded as a 
chest complaint, but as an affection of the nervous system, it being obviously more closely 
allied to such paroxysmal complaints as epilepsy, megrim, and angina pectoris than 
to bronchitis, pleurisy, and consumption. The great bulk of the patients who apply 
for relief at our chest hospitals are suffering either from consumption or chronic 
bronchitis. The form of chronic bronchitis, known as winter cough, is especially 
prevalent among the city poor who are much exposed to hardship and privation, 
and the same patients come under observation year after year, always obtaining 
relief, but never a cure. Only the other day an old woman informed us that fot 
twenty-nine consecutive winters she had been an out-patient at the same hospital for 
her cough and breathing. 

The symptoms of which patients with lung mischief most frequently complain are 
cough, accompanied by expectoration, shortness of breath, spitting of blood, night 
sweats, and loss of flesh. Sharp cutting pains in the side are of common occurrence 
in pleurisy and inflammation of the lungs, whilst dull aching pains under the collar- 
bones are not uncommon in consumption. The mere appearance of a patient will, 
in many instances, enable us to form some idea of the nature of his complaint. For 
instance, a tall, thin young man enters the room, and as he walks up to the table 
and we notice his want of muscular development and general feebleness, we have 
no difficulty in deciding that in all probability he is the subject of consumption. 
Following him comes a great big burly fellow, evidently a navvy, and as we mark his 



LUNGS — DISEASES OF THE LUNGS. 878 

shortness of breath, and listen to his paroxysmal cough, we conclude that he is 
probably suffering from chronic bronchitis. These are not infallible signs, but to the 
practised eye they are replete with meaning. 

A patient's occupation or mode of life undoubtedly exert a marked influence in 
detennining the nature of the lung disease from which he will suffer. The clerk 
spending his days in a dark, dull, ill-ventilated office, working in a constrained 
attitude with his chest-walls fixed, falls a victim to consumption, whilst the bargee 
or street hawker, exposed day after day to the inclemency of our climate, constantly 
getting wet through, without the opportunity of changing his soaking garments, 
contracts chronic bronchitis. Although the primary complaint made by both these 
patients may be the same, it will be found on entering more fully into detail that 
their cases are essentially different. Both, for instance, complain of cough. The 
consumptive tells us that he has a nasty dry hacking cough that keeps him awake at 
night, and this came on so gradually that he can hardly say when it began, but he 
is positive he has had it for only a few months. The patient with winter cough tells 
a very different story ; he has had his cough every winter for years ; it is an old 
business with him — he has been to every doctor and hospital in New York, and says 
he does not expect to be cured, and all he wants is something to ease the cough and 
stop the shortness of breath which makes him " wheeze like a broken-winded horse." 

In the early stage of consumption there is often little or no expectoration, but 
the winter cough man on the contrary is always spitting up " a lot of phlegm," 
"thick, yellow, nasty-looking stuff," " all black from the fog." The consumptive not 
unfrequently spits blood, although this is not to be regarded as a constant symptom. 
We have known cases in which the disease has run its course from first to last 
without the appearance of a single drop of blood. In chronic bronchitis there is 
never any real spitting of blood, although after a violent bout of coughing, such as 
the patient often gets the first thing in the morning, there are not unfrequently 
streaks of blood in the expectoration. This often alarms people very much, but 
quite unnecessarily, for it is no indication of the existence of consumption, and 
simply shows that the paroxysm of cough has been more violent or more prolonged 
than usual. Many doctors make it a rule never to regard anything as spitting of 
blood unless it amounts to a tea-spoonful at a time. There is often a little oozing 
of blood from the gums, or perhaps from some trifling abrasion of the throat, and 
to a superficial observer, or to a hypochondriac, this might readily be magnified 
into an attack of blood-spitting. Hence the necessity, when any one tells 
you that he has been spitting blood, of ascertaining the precise quantity that has 
been expectorated. Then, as to shortness of breath. This is usually a far more 
prominent symptom in chronic bronchitis than in consumption The consumptive 
complains of weakness and debility, but is not conscious of any shortness of breath, 
at all events in the early stages. In winter cough, on the other hand, shortness of 
breath is always a prominent symptom, and is often so marked that the patient 
cannot walk across the room without puffing and blowing, whilst getting up-stairs is 
almost a morning's work. Loss of flesh occurs more frequently in consumption than 
in other lung affections. In chronic bronchitis, it is true, there is usually some loss 
of flesh in the winter, but the patient quickly regains it when the summer comes 



374 THE TREATMENT OF DISEASES. 

again; and there is no progressive loss as there is in consumption. Mare variation 
in weight is never of much consequence, a gain to-day and a loss to-morrow, but 
progressive loss of weight going on steadily for weeks or months is a bad sign, 
unless it can be accounted for by some change in habit or mode of living. In the 
lung diseases which run an acute course, such as pleurisy and pneumonia, there is a 
loss of weight corresponding to the amount of fever, just as there is in scarlatina, 
measles, or small-pox, but this is rapidly regained on the establishment of 
convalescence, and is no evidence of the existence of consumption. Night sweating, 
one of the most distressing and exhausting symptoms of consumption, is seldom met 
with in other chronic lung affections. We have often asked the winter cough 
patients if they suffer from perspiration at night, but the reply is nearly always in 
the negative ; they tell us that, on the contrary, the skin " will not act," and they 
never can get in a perspiration, though they wish they could, for they think it would 
do them good. 

We have already had occasion to refer incidentally to the influence of occupation 
in the development of chest diseases, but we have no hesitation in returning to the 
subject, seeing that a knowledge of certain facts connected with it may have 
considerable weight in the ■ selection of an occupation for a boy coming of a 
consumptive stock. It is a curious fact that although a man may be fully aware 
that his trade is an unhealthy one, and that the work has gradually undermined his 
constitution, he generally ends by bringing his children up to it. Open-air occupa- 
tions are of all the most suitable for those threatened with lung diseasa First and 
foremost stands agriculture, which is recommendable for the exposure to pure air 
which it implies, for the abundant exercise it involves, and for the simple hours, 
habits, diet, and amusements which of necessity accompany it. There is no temp- 
tation to indulge in excesses of any kind ; there are not the enticing surroundings 
of city dissipation, and the excitement of professional business ; political or 
fashionable life is not at hand to urge the feeble to join in a race in which the 
strong are the winners, and the weak drop behind strained and shaken by the 
conflict. Whether, therefore, this country life implies being a landed proprietor, 
living on and exercising the duties of his estate ; a farmer subsisting by the daily 
superintendence of his work ; a labourer doing the drudgery of toil, and earning his 
daily bread literally by the sweat 01 nis Drow ; or a cattle-raiser on a ranch in the 
West, it is preferable to the largest independence in a cicy. As a recent writer 
on consumption says : " Let those who have money and to whom there exists no 
necessity for increasing their means, visit the interesting and beautiful parts of 
their own country. Let them go abroad and see what is new in institutions, 
wonderful in natural phenomena, grand in nature, and worthy of study in art. A 
long and healthy sea-voyage may convey them in renewed vigour to the calm and 
even climates of Tasmania or New Zealand, or the more bracing air of South 
Australia. Here let them live on horseback and enjoy all that is new and exciting 
in these younger nations of the earth. The extremes of climate are not forbidden 
them, and a winter in Canada, or a summer in Colorado, may lend them new vigour. 
In the pure and invigorating air of the upper regions of Mexico, Oregon, or 
Peru, in the exciting atmosptere of the Cape, are to be found, it is said, fresh 



LUFG8 — DISEASES OP THE LUNGS. 875 

pleasures to the senses, and stimulants to the nervous and muscular powers, such as 
must be experienced to be described. But man can bear and even profit by all 
extremes. The relaxing influence of Grecian or Roman plains, or of Egypt, the fresh, 
dry, and calm desert air, the- life passed in tents, are spoken of by travellers as giving 
new vigour, from the healthy tone which is imparted to the nervous and muscular 
powers. "We have all met with men who have done much of this — cultivated men, and 
not mere idlers — wanderers of necessity and of liking, who have fought off the inherited 
taint, and who have lived to old age, hardy and vigorous, and " temperate in all things." 
And this, which need not be an altogether selfish existence, but may include many 
to help and much that is useful to do, is one of the high and pure enjoyments which, 
in certain cases, money is permitted to purchase." This may appear almost Utopian, 
but it must be remembered that consumption is the heritage of the rich as well as of 
the poor, and to many such a mode of life would be quite possible. Every man 
can bring his children up to an out-door occupation of some kind, provided only that 
he can make up his mind to sacrifice something ; and he should remember that he 
can make no greater sacrifice than that of health. In any particular case it is no 
easy matter to select the climate which possesses the greatest advantages and the 
fewest drawbacks. There is no model climate, and no country can boast of being 
perfect. In making the selection attention must be paid to the sick man's general 
condition, and to the amount of constitutional strength. Then as regards the 
locality attention must be paid to its aspect, its drainage, its elevation above the sea 
level ; to the temperature and its equability ; to the dryness or moisture of the soil 
and atmosphere, a degree of heat being often well borne when the air is dry, which 
is quite unbearable when it is moist, and to the nature of the prevailing winds. The 
amount of rain which descends in a season is not of such moment as the way in 
which it usually falls, a region liable to sharp heavy showers being much more 
favourable for the individual than one where it drizzles — like a Scotch mist — for 
days together. A clay soil should be avoided ; get on gravel if possible. Luxuriant 
vegetation is not always a recommendation, for often enough it means high 
temperature combined with moisture, conditions not favourable for the consumptive. 
Districts where marshy lands abound, or where occasional inundations occur, are 
notoriously unhealthy, for the evaporation of the water lowers the temperature, 
whilst the decaying vegetable matter may set up ague. 

The best time ror leaving the North is between tr.s end of September and 
the middle of October, and a patient suffering from chest disease should not 
return till the beginning of May. He must remember that in going abroad 
he is merely placing himself under the conditions most favourable for recovery, 
and that he is not justified in abandoning other remedial measures. He must 
not lose sight of the fact that he is still an invalid, and must be careful not 
to run to excess in the matter of sight-seeing. For a sick man to visit picture 
galleries, museums, damp old ruins, and cold churches, is often to frustrate the 
only object he should have in view, the restoration of his health. In even 
apparently hopeless cases, a visit to another part of the sufferer's country, or 
to some foreign station, will now and then ward off complications, give mental 
exhilaration, promote appetite and digestion, and insure tranquil nights. 



376 *HE TREATMENT OF DISEASES. 

It is a curious fact that butchers are almost exempt from consumption. 
If we remember that their shops are airy and open, that they are abundantly 
fed on animal food, and that from early morning they are rapidly driving about 
in the open air, taking much exercise and living • well, we shall be able to 
understand the influences which prevent the access of chest affections. These 
conditions of open-air exercise and high feeding are in fact antagonistic to 
consumption. It must not be supposed that we are urging all threatened 
consumptives to become butchers, but their mode of life might be imitated 
with advantage. 

Dust is one of the commonest causes of lung mischief. In many cases it 
is not the only exciting cause, but often it is the chief and most deadly of several 
deleterious influences to which workmen are exposed. The mortality amongst 
those employed in many dusty occupations is simply enormous. We are told few 
men who enter certain rooms in cotton factories ever live to attain to the age of 
thirty-eight. Out of twenty-seven men in a certain flax factory, twenty-three 
had some form of chest disease. The noxious influence of varnishes, turpentine, 
and drying oils in developing consumption is well known. Chest affections are 
by no means unfrequent among artisans who use solder, such for instance as 
tinmen, coppersmiths, and goldsmiths. Wood-turners, and those whose work neces- 
sitates the use of sand-paper, are usually great sufferers. Many plans have been 
devised for preventing the entrance of dust into the air-passages, and some are very 
simple and worthy of adoption. The practice of wearing a respirator, or a veil 
over the mouth and nostrils, with the growth of the beard and moustache, may be 
cited as examples. The objection usually made to the respirator is the expense, 
but one made of cork can be obtained from the chemist's for a quarter. The 
midday meal should never be taken in the work-shop, and the hands should be 
washed before going out to dinner. These may seem little matters, but only 
those who have workmen for patients know how constantly they are neglected. In 
dusty occupations the pores of the skin get blocked up by the dirt, and it then 
ceases to perform its functions. Normally it acts as a direct purifier of the 
blood, being associated with the kidneys and lungs in this oflice. 

Among the conditions favouring the development of chest disease, there are none 
more certain than depressing passions, especially when profound or of continual 
occurrence, and this perhaps is one of the causes of the greater prevalence of these 
complaints in large towns, where bad habits and bad conduct are more common, 
and are so frequently the cause of those bitter regrets which neither time nor 
consolation can assuage. Some years ago there existed in Paris a nunnery of a 
new foundation, which had not been able to obtain from the ecclesiastical authorities 
anything but a temporary tolerance, on account of the severity of its rules. The 
alimentary regimen of the inmates, although extremely severe, was still not beyond 
the bounds of nature ; but the spirit of the rules of the nunnery, directing the mind 
to the most terrible rather than to the consoling truths of religion, as well as com- 
pelling the inmates to resign themselves in everything to the will of the abbess, 
produced effects as sad as unexpected. These effects were the same in alL At the 
end of two months' sojourn in this house, the menses became suppressed, and in a 



WJKGft DISEASES OF THE LU9G8. 377 

month or two afterwards symptoms of threatening consumption appeared. As the 
nuns had not taken the usual vows, some of them were advised to leave the house, 
and all who did so recovered But during the ten years that followed the opening 
of this establishment, the numbers were renewed twice or thrice, with the exception 
of the superior, the gatekeeper, the sisters who had the care of the garden, of the 
kitchen, and of the infirmary, and of such as had more frequent intercourse with 
the city, and consequently greater distraction. The rest died of consumption. 

It is a point worth noting that the subjects of consumption have in a large 
number of cases had peculiarities of likes and dislikes for different articles of food, 
even from very early life, and whilst seemingly in perfect health. Among these 
peculiarities, the dislike for fat is at once the most prominent and the most im- 
portant. Thus, it may be predicted of a family in which one child distinguishes 
itself from its brothers and sisters by constant refusal to eat fat, that such a child 
is more likely to fall into a decline in after life than any of the others. In people 
who are actually consumptive, this dislike for fat is in many cases very marked. 
The fat of fresh meat is generally the first to disagree, then salted meats, such as 
bacon, and lastly butter. In exceptional cases, this distaste extends to sugar, and 
even to alcohoL 

There is a prevalent opinion among all classes of society that in young women 
marriage tends to ward off or even cure consumption, but there is in reality nothing 
to favour this view. On the contrary, the existence of any symptom of consump- 
tion should be regarded as a distinct bar to marriage. To those exhibiting any such 
tendency, suckling must be considered prejudicial to a degree. It may be laid down 
as a rule that mothers already in consumption, or threatened with that affection, 
should on no account nursa The infant must be provided with a wet nurse, should 
the mother be delicate, and care should be taken to select for this ofiice a woman 
free from all suspicion of lung mischief, either hereditary or acquired. Suckling is 
to the weak and delicate a certain source of ill-health, and is a ready mode of 
developing chest disease, while the child is sure to be imperfectly nourished. 
Moreover, it draws with the supply from its mother's breast an additional 
element of danger to that which results from its parentage. Children of 
consumptive parents should be brought up on milk, diluted, if necessary, with 
water, alone, the admixture of other matters before the teeth are cut being 
fraught with danger. A plentiful supply of fresh air is highly necessary, or 
the infant will be peculiarly liable to attacks of bronchitis. The risk is in 
staying in the house, and not in going out of it. Daily bathing is a valuable habit. 
At first the bath is to be tepid, but very soon it may be taken almost cold. The 
best method is simple and rapid immersion, which is to be preferred to the slower 
process of sponging, the object being to obtain a quick reaction. As the child gets 
older, open air exercise is to be sedulously cultivated. It must be remembered that 
there is no possibility of safety without it. No plea for education, no false theories 
about catching cold, are to be allowed to stand in the way of it. Sedentary occupa- 
tions and close rooms sow the seeds of death where there is a predisposition to lung 
affections. 

The subject of the proper ventilation of the sleeping-room is one of primary 



378 THE TREATMENT OP DISEASES. 

importance to the weak and debilitated, for by many eminent authorities it is con- 
sidered that the presence of an unduly large proportion of carbonic acid in the air is 
one of the chief causes of consumption. It is known that if one per cent, of carbonic 
acid exist in a room the air is unfit for a healthy person, and it must obviously be 
much more so for any one with a tendency to chest disease. A single room should 
never perform the two offices of bed-room and sitting-room. The temperature should 
be kept pretty uniformly at from fifty -five to fifty -six degrees. In some hospitals 
for consumption it is much higher, but we cannot help regarding this as a mistake, 
for the wards get stuffy and the patient weak and languid. There is too great a 
tendency to regard consumption as a hothouse plant An abundant supply of light 
and fresh air would be much more to the purpose. In winter there should be a fire 
in the bedroom — lighted some hours before bed-time ; and it is a good plan to have 
a Louvre ventilator, two feet square, in the door, with access of fresh air from an 
open window on the adjoining staircase. This should be open day and night, but it 
may be partly closed in severe cold weather in winter. This method of always 
obtaining fresh air by an open window has many advantages, one of the chief being 
that the air so entering is obtained from the upper strata, and not from a level with 
the street. Moreover, a fire in an open fireplace is one of the best of ventilators. In 
summer when no fire is necessary, the bedroom window should be left open for a 
couple of inches at the top. Even children run no risk of catching cold provided 
only that they have plenty of bedclothes. The importance of early accustoming 
those with weak chests to sleep in fresh air cannot be over-estimated. 

In cases where there is a tendency to consumption but yet no actual disease of 
the lungs, any exercise which will develop the chest muscles will prove highly bene- 
ficial. Walking, which implies a certain activity of the arms, undoubtedly does 
good, but still it hardly brings the right muscles into play. When we speak of 
walking we of course mean sharp walking, for those funeral processions in which 
girls at school are forced to take part are in no sense of the word exercise. A carefully 
selected system of gymnastics is more likely to do good, and one of the best things a 
young man can do is to go to a gymnasium for an hour or two daily and get himself 
put through a regular course of training. He cannot well do it for himself, but 
should have some one to guide and instruct him. If the gymnasium is out of doors 
so much the better ; at all events, it should be thoroughly ventilated. Should the 
season of the year or the weather not permit of out-door amusements, dumb-bells at 
home or some well-contrived apparatus for arm and back should be daily used in the 
house, and with open windows. Boxing is capital exercise for boys. Rowing, 
running, and riding, if not carried to excess, will do much to expand the chest. Even 
in advanced consumption horse exercise may be taken with advantaga For 
families who are fortunate enough to live near a river or lake, there is nothing for 
the girls better than rowing a light boat or sculling. It expands the chest, 
throws back the shoulders, and straightens the back. Many a sculpturesque 
figure will acknowledge her debt to her boat for her beauty. A few weeks' 
instruction in swimming will take away all sense of danger from the 
amusement. Under a judicious system of training an undeveloped man, even 
though he may be feeble, narrow-chested, and sickly, may become active, full-chested, 



LUNGS — DISEASES OF THE LUNGS. 3?9 



and healthy. We find many examples of this metamorphosis among the boys in our 
training-ships for seamen. The over-fed, short-winded pugilist, rower, or cricketer, 
may in a few weeks be changed by training alone to the firm-fleshed, clear-skin Tied, 
long-winded winner of the fight, the foot-race, or the rowing-match. It is quite 
within our power to direct the physical training of young persons so that the 
apparently sickly and short-winded may in time be developed into the wiry, active 
young man, long in the wind, sound in body, and lithe of limb ; but this result can 
be attained only by judicious feeding, careful exercise, throughout the whole course 
of the development of the body, and by the gradual nursing of the breathing 
powers. For feeble people the first attempt at exercise may be made at home by 
reading aloud, singing, and the practice of sustaining a note preceded by a deep 
inspiration, and of course followed by one. Taking a good deep breath so as to 
thoroughly expand the chest is highly beneficial to those who are weak on the lungs, 
or who come of a consumptive stock. It is not by any means to be considered a 
substitute for out-door exercise, although it is a valuable adjunct. Playing wind 
instruments often does more harm than good, for it tends to induce congestion of 
the lungs, and not unfrequently gives rise to a blood-spitting. Smoking, except 
in the strictest moderation, is likely to prove injurious. 

The great advantage of out-door exercise is that it increases the appetite, and it 
is far better that the assimilating processes should be quickened in this way than by 
the use of tonics or other artificial provocatives. A great point in the treatment of 
the weak-chested is to get them to take plenty of nutritive material in an easily 
assimilated form. Bread with milk, eggs, and fresh meat twice a day, with a due 
admixture of vegetables, will constitute the ordinary diet. In many cases large 
quantities of milk may be given with decided advantage. Most people can take 
two or three pints without trouble, but in exceptional cases twice or three times 
that quantity may be consumed within the twenty-four hours with benefit Should 
it seem cold and heavy on the chest it may be taken tepid. Some people, although 
they cannot assimilate milk alone, digest it without the slightest trouble if diluted 
with an equal quantity of soda water or lime water. There is no objection to the 
addition of a tea-spoonful or even a table-spoonful of rum or brandy to the tumbler- 
ful of milk, as an occasional relish, but we must be careful not to run to excess in 
the matter of stimulants, especially with young people. The habitual use of stimu- 
lants should be avoided by those with a tendency to weekness of the chest. For the 
general improvement of nutrition their effects are too evanescent, and the resulting 
reaction too debilitating. 

Mental over-work is a frequent cause of deterioration of the health, and this 
condition is by no means confined to those in advanced or middle life. It is by no 
means uncommon in schoolboys. It is even said to occur in babies whose precocious 
intellects have been unduly stimulated by an injudicious parent or ignorant nurse. 
"When a boy is over-worked, one of the earliest symptoms is sick-headache, nervous- 
ness, and a disinclination or unwillingness to take part in the games of his school- 
fellows. He not only finds a difficulty in concentrating his attention, but learns his 
lessons unwillingly ; the attempts to do so being not only very irksome, but in- 
variably bringing on the headache. A vacant stare is often seen upon his face, and 



380 



THE TREATMENT OP DISEASES. 



the bright look of boyish glee has given way to one of worry and anxiety. 
Melancholy often accompanies his failures as he and his friends become cognisant of 
the change that has taken place. The boy is generally better at night after food, 
and at early morning after sleep, but is especially stolid at intermediate times. 
These cases, if not looked to, often end in a general break-down with the develop- 
ment of some chest affection. 

The education of threatened consumptives should be physical rather than mental 
Accomplishments are all very well in their way, but they are not much without 
health. A fair amount of study is undoubtedly advisable, but the weakly youth 
should be encouraged to pass his time out-doors in the fresh air, rather than in the 
school-room or study. An hour's gallop will do him more good than a page of 
Euclid. Boys coming of consumptive parents should not, as a rule, be permitted to 
go in for competitive examinations. There is a growing opinion amongst medical 
men that the competitive system is, in a large number of cases, productive of the 
most serious injury to the bodily health. We know that for the real struggle of 
life vigorous health is of even more importance than intellect. How many have 
attained eminence simply because, in addition to a certain amount of industry, they 
are blessed with " the constitution of a horse ? " and how many feeble ones have been 
swept away to make room for the present occupants of our first positions at the Bar, 
in political life, in administrative appointments, and in medicine ? 

People with weak chests often anxiously inquire whether their weight is what 
it should be at their age. This is, undoubtedly, a point worth investigating, and we 
append a table showing the average height and weight of the human body between 
the ages of eighteen and thirty. 



Table Showing the Gbowth op the Human Body from 18 to 30 Yeabs or Age as 

INDICATED BY HEIGHT AND WEIGHT. 



Age. 


Height. 


Weight. 


Age. 


Height 


Weight. 


Tears. 


Ft. Ins. 


St. ft. 


Years. 


It. Ins. 


St. ft. 


18 


5 4 


8 10 


25 


5 6 


10 b 


19 


5 4 


9 4 


26 


6 6 


10 1 


20 


5 5 


9 5 


27 


5 6 


10 4 


21 


5 5 


9 5 


28 


5 6 


10 2 


22 


5 6 


9 12 


29 


5 7 


10 5 


23 


5 6 


10 2 


30 


6 6 


10 1 


24 


6 6 


10 2 









Growth expressed by stature and height is most marked between the ages of 
fourteen and sixteen. Its rate is as much as three inches in height during that 
time, and about ten inches from the age of eleven to eighteen. From eighteen to 
twenty-five it is usually about two inches. 

Persons of spare habit and a temperate mode of life are able to sustain fatigue, 
and to make prolonged exertions which the more robust and fleshy often find it im- 
possible to undergo. Moreover, thin people bear loss of weight, even of rapid occur- 
rence, with comparative impunity, whilst on the other hand the corpulent and flabbj 



LUNGS — DISEASES OF THE LUNGS. 381 

are thrown into immediate peril by disease involving reduction, such, for example, 
as acute inflammations, and severe mechanical injuries, necessitating a restricted 
diet for their treatment. Thin people often make a mistake in trying to get fat. 

"We have no intention of entering into the treatment of lung diseases, for full 
directions will be found under the individual complaints (see Consumption, Bron- 
chitis, Pleurisy, &c). We may, however, mention that cod-liver oil may nearly 
always be used with advantage in chronic cases. We rarely fail to induce a patient 
to take it in some form or other. Some people like it best in milk ; others cover 
the taste by eating a piece of red herring, or anchovy, or sardine before or after 
the dose. A very good plan Is to add to every two tea-spoonfuls of the oil from 
ten to twenty drops of ether. The pure ether of the "U.S. Dispensatory" must be 
used, so that the oil may not be rendered muddy, as it would be if the ether contained 
spirit or water. This combination is indicated whenever there is an inability to take 
the oil in the usual way. It makes an emulsion, and fat or oil when emulsified is more 
easily digested than in any other form. A stomach once intolerant of fat will good- 
naturedly accept full doses of cod-liver oil if combined with ether. Many doctors 
maintain that the administration of tincture of pulsatilla, in small doses, will enable 
their patients to digest fat in any form. It is very desirable that the oil should be 
the best of its sort, that is, as free from smell, taste, and colour as possible, showing 
its careful and recent preparation. It is not a bad plan, where there is likely to be 
a large consumption of cod-liver oil, to have a barrel over from Newfoundland. We 
have known this done in several cases. Many large firms do it for the benefit of 
their employes. In cases where there is an insurmountable objection to the oil, some 
substitute may be found. It is a capital plan to take a pint of milk, warm from the 
cow, several times a day. It is so prescribed in order that the cream may not be 
removed by skimming, but the entire milk obtained. Milks rich in fatty matter, 
such as asses' milk and milk drawn from the cows at a short interval after the greater 
part of their milk has been withdrawn, and known as the " droppings " or " after- 
cup," are found to be beneficial. The same may be said of cream, Devonshire cream, 
and butter. There are many ways in which butter can be taken without upsetting 
the stomach. Haricot beans or lentils will soak up an enormous amount of butter, as 
every cook knows, and they form a very convenient mode of administering fat. Baked 
potatoes may be used, too, for the same purposa Success has in many cases attended 
the use of caviar, fat bacon, and the marrow of bones. Oysters are especially 
nutritious. The following somewhat old-fashioned remedy may be found useful as 
an article of diet and adjunct to other treatment : — " Take of linseed, half an ounce; 
fine bran, one ounce ; water, one quart. Boil these for two hours and strain ; then 
add beef, mutton, or any other meat that may be fancied, to the amount of one 
pound, and boil to a soup with vegetables, to which celery-seed or other flavouring 
may be added. The whole quantity ought to be reduced by one-third." The 
following is not to be despised : — Take six eggs, which must be quite new-laid, wipe 
them with a damp cloth and put them in a large basin. Now squeeze over them the 
juice of seven lemons. Soon little bubbles of gas appear in the fluid indicating that 
the acid is acting on the shells. Continue the maceration till the shells are quite 
dissolved — this may take two or three days — then beat up the eggs with a pint of 



THE TREATMENT OP DISEASES. 



the oldest Jamaica rum, strain through muslin, and add a quarter of a pound of 
sugar-candy. A table-spoonful to be taken two or three times a day. Port wine 
jelly sometimes proves useful, and is an excellent remedy for any little hacking 
cough. It is made as follows : — Put into a jar a pint of port wine, two ounces 
of gum arabic, two ounces of powdered white sugar-candy, a quarter of a nutmeg 
grated fine, and a small piece of cinnamon. Let this stand closely covered all 
night. The next day put the jar into boiling water and let it simmer till all 
is dissolved, then strain it ; let it stand till cold, cut it and take a small piece 
occasionally. Sometimes it is a little tough, not to say leathery, but this 
may be obviated by using rather less gum and isinglass. In some instances 
good results have been obtained from neat's-foot oil — the oil that is obtained 
from the foot of the young heifer. Pancreatic emulsion undoubtedly succeeds 
admirably in some cases, as we can testify : a tea-spoonful being taken twice 
a day an hour after a full meal, in a tumbler of milk, to which a table-spoonfui 
of brandy or rum may be added. The only objection to it is that it is costly. Lard 
may be made into an emulsion, and we are not at all sure that it would not succeed 
equally well. These remedies may be given either in consumption or chronic 
bronchitis ; in fact, in any long-standing chest complaint. The benefit derived from 
cod-liver oil in consumption is generally recognised, but the fact that it does almost 
as much good in winter cough is not so generally known. It is an error to suppose 
that cod-liver oil is good only for young people, for it answers admirably for 
those advanced in years. We have given it to octogenarians and nonogena- 
rians with marked benefit. Infants can seldom take cod-liver oil. It usually 
disagrees before the ninth month, and often until the child has attained the age of 
one year. In these young children it is an excellent plan to rub the body all over 
with pure olive oil night and morning before the fire ; it will be found that absorp- 
tion takes place more readily when the child has just been taken out of its bath and 
then wiped dry. Rubbing the skin hard is an excellent tonic, and is useful for the 
relief of many of the local conditions of discomfort, pain, and distress, for which the 

patient most frequently 
applies to the physician. 

In many chest affections, 
especially bronchitis and 
inflammation of the lungs, it is desirable to keep the air 
of the room moist. An ordinary kettle placed on the 
fire may accomplish this purpose, but often the draught 
up the chimney carries all the vapour with it. A piece 
of tin tubing fixed on to the spout, so as to project 
beyond the fireplace, will obviate this difficulty. Some 
Fig. 7.-bhoxc"^is kettle. P e0 P le use a " Pouchitis kettle," in which a long spout 
is fixed into t'ue lid. Its shape will be seen in the 
accompanying figure. It might be knocked together by any tinman for a few 
shillings, or the lid and spout might be fitted to any kettle in ordinary use. Siegle's 
steam spray apparatus (Fig. 2) is useful for moistening the air of the room, and 
has this advantage, that it may be placed near the bedside. 




U7NGS — INFLAMMATION OF THE LUNGS, 383 



LUNGS — INFLAMMATION OF THE LUNGB. 

Inflammation of the lungs is known technically as pneumonia. In this disease 
the substance of the lung itself is in a state of inflammation ; in bronchitis it is the 
air passages that are inflamed; whilst in pleurisy the inflammation attacks the 
pleura or membrane covering the lung. In acute pneumonia the fever runs as high, 
and the whole course of the disease is as abrupt as in many of the eruptive fevers. 
As a rule pneumonia attacks only one lung, the lower part or base being primarily 
involved. Occasionally there is inflammation of both lungs, and then we speak of 
it as being a case of double pneumonia. When pleurisy and pneumonia co-exist, as 
they often do, the complaint is known as pleuro-pneumonia, 

A consideration of the causes of pneumonia may help to throw some light upon 
its nature and the place it should occupy in the classification of diseases. It is more 
frequently met with in climates presenting marked and rapid variations of tempera- 
ture than in those characterised by extremes of heat or cold. Thus in tropical 
regions it is uncommon during the continued hot seasons, and on the other hand 
in some of the expeditions to the North Pole, the complaint has been almost 
unknown. It is said also to be very rare in Iceland. In Egypt, too, it is rare, 
though bronchitis is common in the valley of the Nile. There is a general opinion 
that pneumonia is of more frequent occurrence among the labouring than in the 
wealthier classes of society, and that among the former those whose occupations 
involve the severest exertion and the greatest amount of exposure are most 
likely to suffer. In the army the soldiers are more frequently attacked than the 
officers. The greatest number of cases occur, as might be supposed, during those 
months of the year in which there are the greatest vicissitudes of temperature, 
notably in the months of April and May. Pneumonia attacks both the young and 
the old, and it is unquestionably a common disease of early life. Men suffer very 
much more frequently than women, and this is easily accounted for by their increased 
exposure to climatic and other injurious influences. Opinion differs as to whether 
pneumonia is more likely to attack the vigorous or those previously in bad health. 
It must be remembered that the robust are more likely to be exposed to the weather 
and to changeable climates and temperatures, for the weak and delicate stop at home 
and take care of themselves. It has been noticed that some neople are liable to 
repeated attacks of inflammation of the lungs — a peculiarity which may be due 
either to some special but unknown constitutional predisposition, or to the fact that 
previous attacks induce a proclivity to their return. The latter hypothesis is 
probably the true one. The most frequent exciting or immediate cause of pneumonia 
is cold, in some form or other, and in many cases the attack can be distinctly traced 
to getting wet through, sitting in a draught when heated, or some similar influence. 
Boys get heated playing football or by some other violent exercise, and then throw 
themselves down on the grass to get cool, and often enough the result is an attack 
of inflammation of the lungs. This is more likely to occur, the body being exhausted 
by the previous exercise. Excessive exertion seems to act as an occasional cause. 
In many instances pneumonia has been produced by things " going the wrong way " 
and getting into the lungs in eating or drinking. Inflammation of the lungs is not 



$84 THE TREATMENT OP DISEASES. 

unlikely to be set up in the course of other diseases, and it is a complication for 
which we must always be on the look-out. In Bright's disease, for example, it is 
not of unf requent occurrence. 

Pneumonia is commonly ushered in by restlessness with general febrile dis- 
turbance. At the end of from one to three days there are rigors, soon followed by 
nausea, cough, pain in the side, distressed breathing, a pulse reaching 140 or even 
1 60 beats in the minute, burning heat of the skin, thirst, loss of appetite, prostra- 
tion, headache, and sometimes even transient delirium. Not unfrequently the 
patient describes the succession of his symptoms as shivering, fever, cough, and 
breathlessness. 

The onset of pneumonia is most commonly marked by rigors, which are usually 
severe, their frequency and intensity being greater in this than in almost any other 
disease. Pain in the side appears to exist only in those cases in which the inflam- 
mation of the lung is accompanied by some degree of pleurisy. This, however, is of 
frequent occurrence, the pain being commonly felt on a level with or a little 
below one or other breast, but it may be experienced in almost any other part 
of the chest. Generally it is most severe at the beginning, and declines by degrees, 
ceasing altogether for some time before the pneumonia terminates. It is aggravated 
by cough, by a deep breath, and often by sudden changes in posture, or by pressure 
made on the ribs. Shortness of breath is also of constant occurrence, although it 
varies greatly in degree. Sometimes it is so slight that the patient is not conscious 
of it, and even the physician scarcely perceives it. Sometimes it is so extreme that 
the patient, entirely regardless of what is going on about him, seems wholly occupied 
with respiring, is unable to lie down, and what with the shortness of breath, cough, 
and pain in the side, can scarcely speak. The number of respirations in a minute 
is seldom less than thirty, often thirty-five to forty, and they may even reach sixty 
or seventy. The cough, which is one of the earliest symptoms, is short and hacking,, 
and rarely comes on in paroxysms. It is usually dry at the outset, but in a few 
hours is accompanied by a peculiar expectoration, which constitutes one of the most 
certain indications of the presence of pneumonia. The expectoration consists of 
transparent and tawny or rust-coloured sputa, uniting in the vessel containing it 
into a jelly-like and trembling mass of such viscidity that the spittoon may be turned 
upside down and shaken without spilling its contents. This characteristic appear- 
ance may perhaps not be noticed for the first day or two, but it is almost always 
present at some period in the course of the diseasa One of the most marked 
features of pneumonia, and one that will often suffice to distinguish it from other 
complaints, is the sudden and considerable rise of temperature which marks its 
invasion, and is usually maintained until the occurrence of the crisis. It is not 
uncommon for the thermometer to mark a temperature of 103 or 104 degrees within 
a few hours of the first feeling of illness. 

In the majority of cases pneumonia ends in complete recovery. Usually a 
marked crisis takes place, the temperature falling rapidly to the normal, while the 
pulse and respiration diminish in frequency and the other symptoms abate, con- 
valescence being soon established. This happens usually from the third to the 
tieventh day, most commonly about the end of the first week. It is often marked 



KFNGS — INFLAMMATION OF THE LUVOS. 385 

by profuse pergpiration or an abundant discharge of urine, and occasionally bj 
diarrhoea, bleeding from the nose, or the development of a skin eruption, 

The symptoms we have enumerated will, we trust, enable our readers to 
recognise the nature of the affection. This is a disease in which the attendance 
of a medical man is very necessary. It is always serious, especially in the 
very young, and those advanced in life. Other circumstances which increase the 
danger are the fact of the patient being a woman, the occurrence of pregnancy, 
the existence of debility from any cause, previous habits of intemperance, or 
previous disease of the heart, lungs, or kidneys. 

When it is really impossible to obtain medical advice, the following hints as 
to treatment may prove of service. In the first place, the patient must be 
confined to bed. A fire should be kept burning night and day, even in summer. 
It is a good plan to have a kettle of water on the hob, the steam from which 
will serve to maintain the air at a proper degree of moisture. The window or 
windows should be opened for an inch or two at the top, to insure proper 
ventilation, although care should be taken to avoid draughts. The bed-cover- 
ings should be light, and the patient should be well wrapped up, if, from 
any cause, it is necessary to get out of bed. With the prevalence of a high tem- 
perature it is of little or no use trying to give solid food. The diet should 
consist chiefly of milk, of which from two to three pints, or even more, should 
be given in the course of the day. Many people find that milk is not only 
more palatable, but is more readily digested, if flavoured with just a dash of 
brandy, although anything like excess in the administration of stimulants is to 
be avoided. It is not a bad plan to dilute the milk with an equal quantity of 
lime water or soda water. There is no objection to a sponge cake or two, or a 
few biscuits. Beef tea may be taken once or twice a day, although it is less 
nutritious than is generally supposed. Should the bowels be confined, a simple 
aperient, such as castor oil, may be given, but it is well to avoid anything like 
active purgation. Large linseed-meal poultices applied over the chest ■ and 
back, and renewed every two hours, or as often as they get cold, prove very 
grateful Moderate quantities of wine, or brandy, somewhat in accordance with 
the patient's ordinary habits, may be given, should signs of weakness become 
apparent. Ice to suck, and frequent sips of cold water, are useful in allaying 
thirst 

In quite the early stage, aconite is useful in this as in so many other febrile 
diseases. A drop of the tincture should be given every ten minutes for the first hour, 
and subsequently hourly for ten or twelve hours; or Pr. 38 maybe employed. It is 
most suitable for the first invasion of the cold when feverish symptoms, restlessness, 
malaise, pain between the shoulders or in the chest, and short cough are the prominent 
symptoms. A little later, or when the symptoms are more severe, phosphorus is pre- 
ferred by many. It is considered to be of most value when there are signs of exhaus- 
tion. A saturated solution of phosphorus in ether (Pr. 53) may be used, and of this 
a drop or half a drop may be given every hour for ten or twelve hours. It is not 
unfrequently administered alternately with aconite — first a dose of one, and then of 
the other. When the symptoms point to pleurisy as well as pneumonia, bryony 
2ft 



386 THE TREATMENT OF DISEASES. 

(Pr. 49) proves useful Dry cough, with little expectoration and stitching or 
catching pains in the chest, are generally considered to be indications for its adminis- 
tration. Of late years antimony has been much employed in pneumonia, and 
respecting its value there appears to be a general concurrence of opinion In many 
cases, under the influence of this drug, the pain in the side gives way, the expectora- 
tion, from being characteristic of pneumonia, changes to that met with in bronchitis ; 
the pulse and breathing are reduced in frequency, and the further spread of the 
inflammation is checked. To be of much service, it should be given quite at the 
commencement of the disease, and it is essential that the dose should be small and 
frequently repeated. A grain of tartarated antimony (tartar emetic) should be 
dissolved in half a pint of water, and of this one or two tea-spoonfuls should 
be given every ten minutes or quarter of an hour for the first hour, and after- 
wards hourly (Pr. 46). Should nausea or sickness be induced, the dose must be 
lessened. Antimony wine, given in doses of two or three drops in a tea-spoonful 
of water, will succeed equally well. These are both pharmacopceial preparations, 
and may be obtained without difficulty. 

We can only conclude with the recommendation to obtain medical assistance 
whenever possible. The foregoing measures may be adopted pending its arrival, 
should there be any likelihood of prolonged delay, for in pneumonia, as in so many 
other acut© diseases, prompt treatment is of the utmost importance. 



MEGRIM, OR SICK-HEADACHE. 

When speaking of headache generally, we pointed out that this especial form was 
of such importance as to merit a separate and more detailed consideration. There 
are several varieties of megrim — or migraine, as the French call it — which are 
known as hemicrania, blind-headache, and bilious-headache. We cannot convey a 
better idea of the general features of this distressing complaint than by giving an 
example. An eminent French physiologist and man of science has recorded his own 
case, which affords a good illustration of one of the simpler forms of migraine. 
He tells, that since about his twentieth year, though otherwise in good health, he 
has suffered from this complaint. Every three or four weeks he has an attack 
coming on, for the most part in consequence of some unhealthy influence, such as 
long and fatiguing evening entertainments, and so on. As a rule some constipation 
precedes it. The next morning he awakes with a general feeling of disorder, and a 
alight pain in the region of the right temple, which, without overstepping the middle 
line, gradually extends itself, reaching its greatest intensity at mid-day ; towards 
evening it gradually passes off. While at rest the pain is tolerable, but it is 
increased by movement to an extreme degree, and it is aggravated by stooping or 
coughing. The countenance is pale and sunken, and the right eye small and 
reddened. At the height of the attack, when it is a violent one, there is nausea, 
but it rarely culminates in vomiting. As the fit approaches its termination the 
right ear reddens and becomes very hot. Sleep often shortens the attack, which 
leaves behind it slight stomach disturbance; frequently also the scalp remains 
tender at one spot the following morning. For a certain period after a seizure he 



MEGRIM, OR 8ICK-HEADACHB. 887 

can expose himself with impunity to certain injurious influences which before would 
have brought on the migraine to a certainty. 

This, as we have said, is a very simple form of the malady, and in the majority 
of cases the phenomena are much more severe. Very frequently the pain continues 
to increase from the moment of onset until it is almost unendurable, and the patient 
seems almost as if he would go out of his mind. This is often accompanied by an 
intolerable sense of nausea, and sooner or later by repeated vomiting. The condition 
is at this time one of great misery and depression, the suffering closely resembling 
that of a person thoroughly sea-sick. The attack is often accompanied by affections 
of sight and other phenomena which will subsequently occupy our attention. 

Megrim undoubtedly occurs more frequently in women than in men ; or, at all 
events, women apply for relief more frequently than men. The first attack often 
makes its appearance at the age of seven or eight, or it may be earlier. The age at 
which the second teeth are cut appears to be especially favourable for its onset. It 
is not uncommon for women to tell us that the headaches first came on about the* 
age of thirteen or fourteen, "when the periods began." Even in those cases in 
which the attacks commenced early, and have persisted in a severe form throughout 
the greater part of life, they are generally found to abate when the patient attains 
the age of fifty or thereabouts, and they usually cease completely before the onset of 
old age. It is rare to meet with this malady in old people, and often the attacks 
appear to reach a maximum of severity about the age of thirty, after which they 
gradually decline in frequency. In women the seizures may become more severe 
about the change of life, and diminish again when the critical period has passed. 
Megrim is in a large number of cases hereditary, and nothing is more common than 
for the patient to assure you that it is "a family complaint." In one instance with 
which we are acquainted, the mother and all four daughters suffer from headache. 
There seems to be in these cases some inherited condition of the nervous system 
which favours the development of megrim. Sometimes, however, the children do 
not suffer from the same nervous affection as the parent, but from some allied 
disorder. For instance, one member of the family may have megrim, a second may 
be the victim of neuralgia, a third may be subject to fits, a fourth may be a hay- 
asthmatic, and so on. 

Sick-headache is essentially a paroxysmal or intermittent affection. The malady, 
it is true, is permanent, and may last a lifetime — we know of a case where it has 
lasted twenty-nine years — but it is only manifested at more or less distant intervals, 
in distinct attacks or seizures of well-defined character and limited duration, the 
sufferer, as a rule, enjoying good health in the intervals. The duration of the 
paroxysm is in different cases very variable, although, in the same individual, it is 
pretty constant. In some people it lasts only three or four hours, in others seven or 
eight, whilst it is not uncommon for it to last the whole of the day. We 
should say that the average duration was from six to twelve hours. In 
exceptional cases the suffering continues for two or three days, during which 
it ebbs and flows, the patient recovering a little, then getting worse again, 
and so on. A lady recently under treatment assured us that on one occasion 
she had an attack lasting almost continuously for over a month. The seizures 



388 THE TREATMENT OP DISEASES. 

usually subside gradually, generally terminating at night. "With some people — a 
limited number, unfortunately — a very short sleep, say of half an hour's duration, 
will completely dissipate an attack. Sometimes relief is afforded by vomiting, or by 
an unexpected action of the bowels, but this is somewhat exceptional. The abrupt 
transition from intense suffering to perfect health in this malady is very remarkable. 
" A young woman in the enjoyment of otherwise excellent health, well-nourished, 
cheerful and active, the life, perhaps, of her family circle, appears in the morning, 
once in every two or three weeks, a perfectly altered being, with a pale, inanimate 
face, dull, lustreless eyes, and with all her usual cheerfulness departed, and so 
remains throughout the day in a state of chronic nausea, and corresponding mental 
and bodily dejection, to which use alone has made her resigned; and yet the 
following morning she will be her former self again, as if nothing had occurred ; and 
thus she may continue to live two distinct lives, as it were, perhaps for a long series 
of years." 

The duration of the interval or period of freedom is also variable in different 
cases, though there is some approach to regularity in the same individual. Some 
people have an attack every fortnight, others every month or two months, and so on. 
With many women sick headache recurs at every monthly period, with some com- 
mencing a day or two before, and in others following it. The attack, however, 
seldom returns with the same regularity as does, for example, a fit of ague. In 
ague the patient can often tell almost to a certainty when the seizure will occur, but 
in megrim all he knows is that should he exceed his usual time he is not likely to 
remain free for many days. After an attack the patient usually feels certain that he 
will not be troubled for some time to come. Curiously enough a sort of compensation 
is sometimes observed between the severity of a seizure, and the degree of immunity 
which precedes or follows it. Many people are not anxious for long intervals 
between their attacks, t for they recognise the fact that they have a certain amount 
of suffering to go through, however it may be broken up or divided, and 
they would as soon have it regularly as not. In the majority of cases 
the exact time of the onset of an attack is determined by some apparently 
trivial circumstance — such, for instance, as a little indigestion or even confined 
bowels. Some articles of food are especially likely to bring it on, and among 
those most commonly credited with this property are butter, fat, spices, and 
alcohol in any form. One gentleman, the subject of megrim, says that for over thirty 
years he has not been able to take the smallest quantity of wine, not even the sacra- 
mental wine, without suffering from an attack. A patient, a woman, now under 
treatment, tells us that with her certain kinds of food are sure to bring it on. It is 
positive to come on after pastry, or pork, or bacon, or veal. Even the smell of pork 
cooking is quite enough. Mutton is almost the only kind of meat that will not bring 
it on, and even then it must be a very nice little piece. If she cannot get mutton she 
prefers going without anything. Eggs do not induce it, as a rule, nor does fruit 

Mental emotion and exertion are among the most influential of the occasional 
exciting causes of the megrim. One of our patients assures us that an attack is 
infallibly caused by worry or excitement, or emotion of any kind. Even " doing 
about the house," she says, will bring it on. She has known it come on immediately 



MEGRIM, OR SICK-HEADACHK. 389 

when she has just been a bit startled by seeing her little girl fall down, although it 
was really nothing, and was all over in a minute. The excitement of any one calling 
on her will often induce an attack, and on this account she never receives a visitor, 
if she can possibly help it. She likes to be by herself, and " has no mind for com- 
pany." For years she has been unable to go to any place of amusement. She 
remembers that even when she was quite a girl any preparation for a day's outing 
would be sure to bring on an attack, so she never went anywhere, not even out to 
tea. Going by train or omnibus, or even by the boat, would bring it on. At one 
time she tried to attend at a hospital as an out-patient, but all the good the doctor 
did her with his medicine was undone again by the excitement of having to go by 
the omnibus, so that instead of getting better she got worse. The idea of having to 
make haste to go anywhere, or having to be anywhere at a certain time, would upset 
her for days. 

Many women, as we have seen, always suffer from megrim at the monthly periods. 
In one instance the patient became irregular, and menstruated at intervals of a 
fortnight, and then the attacks followed suit. Often there is a suspension of the 
attacks during pregnancy, but this is not always the case, and some women suffer 
from them excessively when in the family way. 

Prolonged abstinence from food will often excite megrim. Many people say they 
suffer from it directly they feel " leer." The delay of half an hour beyond the 
accustomed time for taking food is with them quite sufficient. In many the transi- 
tion from sleeping to waking determines the time of the attack. In the patient to 
whom we have referred, the attack frequently comes on in the middle of the night, 
during sleep, and this is very likely to be the case when she has over-exerted herself 
on the previous day. 

Attention has been drawn by several writers to the influence which any circum- 
stance tending to tax or try the eyesight has in determining megrim. The case is 
recorded of a physician, the victim of this malady, who could at any time immedi- 
ately induce it by attempting to read on a full stomach. In another instance the 
paroxysm was always excited by the incidence of strong light, or the attempt to 
read small print. A very curious case was that of a person who always suffered 
from megrim after looking at a striped wall-paper or a striped dress. In many ner- 
vous people the sense of smell is so highly developed that it becomes the occasion 
of migraines. Our patient informs us that her attacks are readily excited by bad 
smells of all kinds. The smell of a " dirty drain " would be sure to do it. The 
smell of beer, she says, always brings on the headache, and turns her sick in a 
moment. If her husband has taken a drop of beer for supper, and she " catches his 
breath," it is quite enough for her. Often enough she has got up in the middle of 
the night, and has gone and slept on the sofa in the sitting-room. Sometimes the 
sin oil of tea will bring it on, particularly if she is any way inclined to be ill. A 
paraffin lamp burning on the table would be sure to upset her. She does not mind 
ni<e smells — they do not affect her in any way. She likes flowers, and is not at all 
afraid of them. She does not like scents, but cannot say positively that they would 
I 'ring on an attack — she would rather not try. These statements, it should be added, 
were taken down almost in her own words. 



590 THE TREATMENT OF DISEASES. 

Atmospheric changes, changes of season or weather, are regarded by some as 
exciting causes of the seizures. Our patient is always very bad when it is frosty, 
particularly if there should happen to be a cold, cutting wind blowing at the same 
time. When at home she always goes about with her head done up in flanneL 
The slightest exposure to the sun would be sure to bring on an attack. She is often 
afraid to open the door to any one when the sun is shining, for she knows that 
directly it falls on her head her sufferings begin. A bright light nev?* affects her 
in any way — it must be the sun. Heat, she says, is very unpleasant to her, and the 
heat of the fire would be sure to bring it on. She cannot even do a bit hi toast 
without holding something in front of her to ward off the fire. Cold is with her 
almost as bad as heat. Any little exposure of the head to cold or draught would be 
sure to excite it; even going out of the kitchen into the scullery for a minute 
would do it. 

The susceptibility to megrim is aggravated by anything tending to lower the 
standard of health — for example, exhausting discharges, prolonged indigestion, or 
disordered bowels. Mental exertion, if too close or continuous, has a similar effect — 
indeed, the complaint is not unfrequently developed by excessive study, coupled with 
a deficiency of out-door exercise. 

We must now describe more fully the headache which is so conspicuous a feature 
of megrim. The pain presents every variety in different individuals, and sometimes 
in different attacks, but in the majority of cases it is for a time at least very severe. 
Occasionally it exhibits that intense and agonising character often met with in 
neuralgia. It is generally moderate w"hen first felt, and gradually rises, sometimes 
very quickly, to a great pitch of intensity ; this is maintained for a certain time, and 
then it begins to decline again. With some there seem to be something like remis- 
sions and exacerbations ; the pain does not always maintain the same degree of 
severity throughout its course ; it is often extreme for some minutes, then subsides, 
to return again with the same intensity. The pain may be stabbing or darting in 
character, but it is differently described by different people. They are all agreed, 
however, that when it reaches its full development it is most distressing, and very 
hard to bear. Most sufferers state that it is terribly aggravated by movement of 
&ny kind. When at its height, light and noise are most unbearable, and the patient 
is compelled to be still and keep the room as dark and quiet as possible. In ex- 
ceptional cases, however, the pain may be of that intolerable character, that to keep 
in one position for any length of time is impossible, and the patient has to get up 
and move about. Sometimes the headache is limited strictly to one side, but more 
commonly it oversteps the median line. The pain, however, seldom affects the 
whole head, but one particular part of it, most commonly the forehead, over one or 
both eyes. Next to the brow the temple is the most common seat of the pain. In 
some cases it seems to be focussed on one spot, and then it is that it attains its 
maximum severity. In cases in which the pain has been most agonising, it has 
often been confined to a little spot over one eyebrow or temple. As a rule the 
excessive violence of the pain lasts only a few hours; mostly, however, it is not until 
from eight to twelve hours that the pain becomes bearable. It may be twenty-four 
hours or even longer before the last of the uneasiness disappears. 



MEGRIM, OR SICK-HEADACHE. 



391 



A certain amount of nausea is a pretty constant feature of megrim. In some 
cases it is slight, in others it attains a high degree of intensity, and is followed by 
vomiting. From the onset of the attack there is a total loss of appetite ; an aversion 
to every flavour, even to those which are at other times the most grateful. "When 
actual vomiting occurs it sometimes terminates the seizure. 

We have already referred to the fact that an attack of megrim is usually 
accompanied by some affection of the senses. One of the commonest of these is 
disorder of the sight, and often enough it is the first of the symptoms to make its 
appearance. Not uncommonly there is partial loss of sight. The patient to whom 
we have so frequently had occasion to refer suffers from this in a marked degree. 




Pig. 8.— SPECTRAL APPEARANCES IN MEGRIM. 

She describes it as being like a round curtain in front of her, so that she can see 
round it only at the sides. Many people liken it to the spot you see after having 
looked at the sun. 

In many instances the blindness or partial blindness i3 accompanied by certain 
spectral appearances. These are developed in different degrees in different indi- 
viduals ; in some they are faint and attract but little attention, in others they are so 
highly pronounced and sharply defined as to make a most powerful impression on 
the mind. In their simplest form they consist of a luminous border surrounding the 
black spot more or less completely, and expanding and widening as it expands. In 
almost every case this luminous border presents an appearance of rapid motion or 
oscillation ; sometimes it seems to be " glimmering," or " all alive," and some people 
describe " coruscations," and "showers of sparks." The luminous arc depicted 
^ound the blank space is coloured with some individuals, but colourless with others* 



392 THE TREATMENT OF DISEASES. 

It may be disposed in zig-zags, or may be like a fortification. Our patient tells us 
that before an attack comes on she often sees bright crescent moons, sometimes 
large and apparently close to her, and at others small, as if at a distance. Sometimes 
she sees specks " like little bits of smut " flying about ; when making pie-crust she 
" keeps picking at it," fancying there are " little black things " on it. Sometimes 
the specks moving about seem like a cloud of flies. 

Numbness and tingling of the hands and upper extremities generally are not 
unusual phonomena during or immediately after an attack. Sometimes it is de- 
scribed as being like pins and needles, at others the limbs seem to have gone to sleep. 
Exceptionally, the loss of sensation is accompanied by some impairment of movement, 
so that the grasp is less firm than it should be, and there is a danger of dropping 
things. It not unfrequently happens that an attack of the megrim gives rise to a 
certain amount of mental confusion. 

In many cases drowsiness or stupor is an occasional accompaniment. It is of a 
most uncomfortable and oppressive character, not at all like natural and grateful 
sleep, but often verging on coma. It is a noteworthy circumstance that this pheno- 
menon is not peculiar to megrim, but is occasionally met with in other nervous 
diseases. Thus it may attend the progress of asthma, and is of common occurrence 
after epileptic fits. 

The usual termination of an attack of megrim is in sleep not the lethargic 
condition which sometimes attends the development of the seizure, but a natural 
and refreshing sleep. This terminal sleep is probably the natural consequence of 
the exhaustion of the brain resulting from the unnatural state of activity through 
which it has passed, being similar to that which follows long sight-seeing or other 
exhaustive occupation of the senses. Sometimes sleep at any period of the attack 
will at once cut it short. Thus the case is related of a gardener, who, if seized with 
megrim when at work, would stretch himself out under a tree, go to sleep for half 
an hour, and then awake well. Sometimes the attacks end in vomiting, and not in 
sleep. Many people say that if they are not sick their attacks are prolonged, and 
hang about for days together. Guided by their experience, they often do their 
best to assist nature, and resort to artificial means. More rarely an attack ends 
in a copious flow of tears, a large secretion of urine, profuse perspiration, or an 
evacuation of the bowels. Sometimes the pain and other symptoms gradually 
subside without the occurrence of sleep, vomiting, or any other form of crisis. 

In some curious cases the attack of megrim assumes an irregular form, the 
headache being but slightly developed, or being entirely obscured by the intensity 
*)f the mental phenomena. This affords an explanation of many anomalous seizures, 
such, for example, as the following, described by an eminent divine and literary 
character : — " I was this morning engaged," he says, " with a great number of 
people, who followed each other quickly, and to each of whom I was obliged to give 
my attention. I was also under the necessity of writing much, but the subjects, 
which were various and of a trivial and uninteresting nature, had no connection 
the one with the other. My attention, therefore, was constantly kept on the 
stretch, and was continually shifting from one subject to another. At last it 
became necessary that I should write a receipt for some money I had received 



MEGRIM, OR SICK-HEADACHE. 393 

on account of the poor. I seated myself and wrote the first two words, but in a 
moment found that I was incapable of proceeding, for I could not recollect the 
words which belonged to the ideas that were present in my mind. I strained 
my attention as much as possible, and tried to write one letter slowly after the 
others, always having an eye to the preceding one, in order to observe whether 
they had the usual relationship to each other; but I remarked, and said to 
myself at the time, that the characters I was writing were not those which I wished 
to write, and yet I could not discover where the fault lay. I therefore desired, and 
partly by broken words and syllables and partly by gestures, I made the person who 
waited for the receipt understand that he should leave me. For about half an hour 
there reigned a kind of tumultuary disorder in my senses, in which I was incapable 
of remarking anything very particular, except that one series of ideas forced them- 
selves involuntarily on my mind. The trifling nature of these thoughts I was 
perfectly aware of, and was also conscious that I made several efforts to get rid of 
them, and supply their place by better ones, which lay at the bottom of my soul. My 
soul was as little master of the organs of speech as it had been before of my hand 
in writing. Thank God, this state did not continue very long, for in about half an 
hour my head began to grow clearer, the strange and tiresome ideas became less vivid 
and less turbulent, and I could command my own thoughts with less interruption. 

" I now wished to ring for my servant, and desire him to inform my wife to 
come to me \ but I found it still necessary to wait a little longer, to exercise myself 
in the right pronunciation of the few words I had to say ; and the first half-hour's 
conversation I had with her was, on my part, preserved with a slow and anxious 
circumspection, until at last I gradually found myself as clear and serene as in the 
beginning of the day. All that remained was now a slight headache. I recollected 
the receipt I had begun to write, and in which I knew I had blundered ; and upon 
examining it I observed to my great astonishment, that instead of the words ' Fifty 
dollars, being one half-years rate,' which I ought to have written, the words were 
' Fifty dollars, through the salvation of Bra — ,' with a break after it, for the word 
1 Bra — ' was at the end of the line." This case is so unlike the usual run of cases 
of megrim, that it might readily be mistaken for something more serious. 

Let us now briefly discuss the position of megrim in the classification of 
diseases. To what affections is it most closely allied % Obviously its most intimate 
relations are with other paroxysmal nervous diseases, such as epilepsy, asthma, 
angina pectoris, and neuralgia, and these together form a very natural group. They 
are all affections which are more or less persistent, the principal phenomena by 
which they are characterised being, however, discontinuous or intermittent, con- 
sisting of paroxysms recurring at variable intervals. Moreover, the tendency to 
these complaints appears in the great majority of cases to be innate and hereditary, 
being handed down from parents to children, or from grandparents to grandchildren. 
Not unfrequently the parent suffers from one member of this group, whilst his 
offspring suffer from others. For example, a predisposition to epilepsy will some- 
times appear in some individuals of a family, whilst their nearest relatives are 
affected by other maladies of the same class. Another remarkable fact is that these 
different varieties of nervous affection have each their own particular period of 



394 THE TREATMENT OP DISEASES. 

life at which they are manifested. We have already seen that angina pectoris 
rarely occurs in young people, whilst megrim is seldom met with after the age of 
forty-five or fifty. In all these paroxysmal diseases it should be noticed that 
during each attack the symptoms gradually increase in severity, reach a culminating 
point, and then decline. Another feature common to the paroxysms of these 
several nervous affections is their periodical return ; not an exact periodicity, it is 
true, but a rough approximation to regular recurrence, as if the result of a gradually 
accumulating tension. 

Intimately connected with this periodicity is a kind of compensation, observable 
fn many of these affections. There is obviously some relation between the time 
of exemption and the violence of the succeeding attack, a longer interval being 
followed by a more severe seizure, or an unusually severe seizure by a longer exemp- 
tion. The exciting causes of many of these nervous outbreaks are strikingly similar. 
We have already seen that muscular exertion will determine the occurrence of 
megrim with many patients, and the same is the case with epilepsy, and especially 
with angina pectoris. Indigestion is a very frequent exciting cause of a fit of asthma 
— in fact, one of the commonest varieties of asthma is called " peptic " asthma, the 
attacks being controlled entirely by the state of the digestive organs. We have 
already referred at some length to the influence of certain kinds of food in inducing 
sick-headache. The transition from sleeping to waking is singularly influential in 
determining the occurrence of many of these seizures. Passion and mental emotion 
are especially efficacious in determining attacks of asthma and angina pectoris, as 
they are in exciting megrim. The influence of prolonged fasting or exhaustion is 
also worth bearing in mind. We think the evidence we have adduced will be regarded 
as affording a conclusive proof that megrim belongs to the same family group of 
diseases as do asthma, angina pectoris, epilepsy, and neuralgia. If further evidence 
were wanted it would be found in the fact that in the same individual one form of 
seizure is often replaced temporarily, or it may be permanently, by another. For 
example, epilepsy and asthma are occasionally observed to be interchangeable affec- 
tions, and in illustration of this the following case is related : — " The patient was a 
man about fifty years of age, subject to epilepsy. His fits had certain well-known 
premonitory symptoms, and occurred with tolerable regularity about once a fortnight. 
On one occasion his medical attendant was sent for in haste, and found him suffering 
from violent asthma. The account given by his friends was that at the usual time 
at which he had expected the fit he had experienced the accustomed premonitory 
symptoms, but instead of these being followed as usual by convulsions, the shortness of 
breath had come on. Within a few hours this passed off, and left him as well as usual. 
At the expiration of the accustomed interval after this attack the ordinary premoni- 
tory symptoms and the usual epileptic fit occurred. On several occasions this was 
repeated, the epileptic seizure being, as it were, supplanted by the asthmatic." 

And what, it may be said, is the real cause of megrim 1 What is it due to ? Is 
it an affection of the liver, or the spleen, or the stomach, or what ? This is a question 
by no means easy to answer, although it is a subject that has occupied the best 
energies of some of the foremost physiologists and pathologists, not only of this, but 
we may say of almost every age. It would be wearisome even to enumerate the 



KSG&XM, OS SICK-HKADACHK. $95 

different theories that have been brought forward, much less to cite the various 
arguments adduced in their support. Let it suffice to say that nowadays no one 
believes that sick-headache is merely a bilious complaint, or even that it has any- 
thing to do with bile, and that the general opinion is that the real seat of the disease 
is in the brain. 

Let us now consider what can be done in the way of treatment. There appears 
to be a very prevalent opinion that megrim is a complaint in which it is of no use 
trying to do anything — an opinion with which we venture to disagree, for we must 
confess that we have an almost unlimited faith in the power of medicines — that is, 
of medicines properly used. 

Of course something can be done in the way of general treatment — hygienic 
measures and so on. The patient may have to be instructed what to eat and what 
to drink, and still more important, what to avoid. Megrim is of constant occurrence 
in those who are weakened by a poor and insufficient diet, by too frequent child- 
bearing, and a prolonged suckling. It often arises from excessive hours of labour, 
or occupations whioh entail close confinement in unwholesome and ill-ventilated 
workshops and dwellings. The treatment of these cases is obvious, however difficult 
to fulfil. The workman may not be able to induce his employer to get him a light 
well-ventilated shop to work in, but knowing the value of fresh air he will pass as 
much of his leisure time as possible out of doors. Women often ruin their health 
by suckling their children for twelve, fifteen, or eighteen months. With 
town-dwellers the baby should be weaned at the latest when nine months old. The 
poor should remember that if they have large families they must make an extra 
effort to provide for them. In a somewhat higher grade of society we find the 
malady brought on, or at all events aggravated, by excessive brain-work, with a 
deficiency of bodily exercise, short restless nights, and insufficient sleep. 

So long as a brain-worker is able to sleep well, to eat well, and to take a fair 
proportion of out-door exercise, it is not necessary to impose any special limits on 
the actual number of hours he devotes to his labours. But when what is generally 
known as worry steps in to complicate matters, when cares connected with family 
arrangements, or with those numerous personal details which we can seldom escape, 
intervene, or when the daily occupation of life is in itself a fertile source of anxiety, 
then we find one or other of these three safeguards broken down. Probably the 
man of business or the successful lawyer fails to shake himself free from his 
anxieties at night, and slumber becomes fitful or disturbed. The nervous system, 
unsettled by the mental strain, brings about various defects in nutrition ; the 
appetite fails, and then we meet with the sleeplessness, the dyspepsia, the irresolution, 
the irritability, and the depression which are the chief miseries of the over- worked. 
The great thing in these cases is to get a rest at any cost. By rest we do not 
mean doing nothing, but rather change of scene, of thought, and occupation. If you 
tell a busy man that he must do nothing, he may endeavour to obey you, but he 
will soon find out that he cannot, for his brain keeps on working in the same old 
groove, and he is as much, or even more, worried about his business as if he were 
still in the thick of it. The great thing is to get a rest by substituting one kind of 
work by another, to have for a time a nice comfortable sort of occupation to replace 



396 THE TREATMENT OF DISEASES. 



the old weary round of troubles. One of the most important remedial agents is out- 
door life and exercise, which may be taken in any form most congenial to the individual 
— riding, walking, field sports, or what not. This is at once the most natural, and 
often the most effectual promoter of sleep we can employ. Active bodily exertion 
is well known to be incompatible with the maximum of intellectual work, and full 
advantage should be taken of this fact. The only thing to avoid is excessive fatigue. 
It is a remarkable fact that a very large number of distinguished literary and 
scientific men have suffered severely from megrim, and it would seem that some 
of them have succeeded in ridding themselves of the malady by the adoption of 
some simple hygienic measure. One, for instance, cured himself by following the 
prescription of a farrier, who advised him to drink water, eat little, and take 
exercise. Another was cured by drinking every day a large quantity of fresh 
water, and exchanging a highly nutritious regimen for a much lighter dietary. A 
third got rid of his old enemy by the same means, and by taking exercise every day 
before dinner. There can be no doubt that in many cases great benefit would be 
derived from a thorough change of locality or climate. Long sea-voyages are not 
unfrequently attended with excellent results, the attacks being absent for months at 
a time. Unfortunately these are remedies not within the reach of alL 

Now as regards diet. In cases of megrim in any degree dependent on or associated 
with indigestion, the meals should be moderate and regular, with a simple and 
nutritious dietary, especial care being taken to avoid all articles of food that are 
notoriously unwholesome, or are known to disagree. The great thing is to live 
plainly. As a rule it will be found that beef and mutton digest more readily than 
veal or pork. When indigestion is a prominent symptom, it will have to be treated 
according to the rules already given (see Indigestion). Vegetable bitters, such as 
infusion of quassia, or infusion of calumba, enjoy a high reputation for megrim 
depending on stomach derangement. The gentian and soda mixture (Pr. 14) maybe 
used for a similar purpose. As a rale it should be taken about half an hour before 
meals, but when acidity is a prominent symptom it should be taken about the same 
time after meals. It is in all cases important to regulate the bowels, for nothing goes 
right when they are confined. When the patient is pale and anaemic, and is evidently 
suffering from poorness of blood, iron is the best remedy, and other measures will in 
all probability fail until it has been supplied. It may be given in the form of pills 
(Pr. 63), or one of the iron mixtures (Pr. 1 or 2) may be resorted to. Cod-liver 
oil will do much to improve the general nutrition, but sufferers from megrim 
often experience great difficulty in taking it. It is well worth trying, however. 
Pancreatic emulsion may in some cases prove useful. 

We now pass on to the consideration of what may be called the specific remedies 
for megrim. It is difficult to say positively what drug will succeed in any individual 
case. The patient should never despair of being cured, or at all events veiy 
materially benefited, till he has tried them all. 

Croton chloral is a valuable remedy in this complaint. It should be given in five- 
grain doses, dissolved in water, every three hours for a week or two. This is a 
moderate dose, and ten grains can be taken at a dose without inconvenience. We 
have employed it in many cases with success. We usually prescribe it only in the 



MEGRIM, OB SICK-ETEADACHB. 397 

milder forms, and when sickness is not a prominent symptom. It is extremely effica- 
cious in relieving the slight attacks many delicate and nervous women experience 
after fatigue or excitement. 

Cannabis indica, or Indian hemp, is another valuable remedy. It is found 
serviceable, both in cases with little or no nausea, and in cases accompanied by 
severe vomiting. It is useful in attacks accompanied by spectra, and is especially 
effective when, from fatigue, anxiety, or change of life, the attacks are becoming 
more frequent A third of a grain of extract of Indian hemp should be taken twice 
or thrice daily. This dose can be made up into a pill by any chemist It is a 
pharmacopceial remedy, and it may be taken for a month or more without any 
fear of ill effects. Should the dose we have recommended fail to do good, it 
may be increased to half a grain twice or thrice daily (Pr. 67). It is one of the best 
remedies we have for megrim, and its use should not be discarded without a fair 
trial. 

Of the use of valerianate of zinc we have already spoken when dealing with the 
subject of headache generally (see Headache). 

Guarana, or Brazilian cocoa, has been somewhat extensively used during the last 
five or six years in the treatment of sick-headache. It consists of the powdered 
seeds of Paullinia sorbilis, and is usually given in fifteen-grain doses. One of these 
powders should be taken every night, and on the occurrence of an attack, every 
three hours. It is especially recommended when the pain is confined to the right 
side. It is a little bit uncertain in its action, but it sometimes acts quite like a 
charm. Guarana belongs to the same botanical family as tea and coffee, and the 
active principle of the latter — caffeine— has been used successfully in the treatment 
of sick-headacha 

Iodide of potassium is a remedy often employed with success in these cases. It 
is especially indicated in any case in which there is a syphilitic taint, but even when 
there is nothing of the kind it often succeeds admirably. Two table-spoonfuls of 
the mixture (Pr. 32) should be taken three times a day for a week Or more. 

Bromide of potassium is most likely to succeed in women exhibiting a marked 
hysterical tendency, or in those who have some derangement of the womb. Two or 
three table-spoonfuls of the mixture (Pr. 31) should be taken three times a day, for 
at least a fortnight 

Chloride of ammonium not unfrequently does good. The dose is from thirty to 
forty grains three or four times a day, and it is best given in milk. The great point 
is to take plenty of it, for small doses seldom do any good. Should it not succeed 
quickly it will probably not succeed at all. 

Common salt has been recommended, but we have had no experience of its 
use. An author of repute says : — " I will only mention as a contribution from my 
own experience of such cases, that long periods of exemption from returns of 
their headaches have occurred to patients who have faithfully observed my direc- 
tions &hai they should drink a tumbler of common salt and water every morning 
an hour before breakfast." It is curious that so simple a remedy should not have 
come into more general use. We suppose the fact is that patients who consult 
a physician for their ailments expect to have some more potent remedy prescribed 



398 THE TREATMENT OP DISEASES. 

for them than common salt. Many people Talue a drug and estimate the good 
it does them by its rarity, or the price they pay for it — a very pernicious 
principle. 

ISTux Vomica (Pr. 44) will sometimes be found useful, especially when the 
stomach symptoms predominate. Small doses of carbolic acid are sometimes used. 
A tincture made from the Iris versicolor, or common blue-flag, has proved successful ; 
it is said to be indicated when the headache is preceded by a film before the eyes. 
A small piece of aconitia or veratria ointment, rubbed into the forehead quite at 
the commencement of an attack, will sometimes cut it short (see Neuralgia). An 
ever popular remedy is blue-pilL Friedrichshall water often does good. 

Next as to the treatment during an attack. As the suffering in megrim is 
greatly aggravates! Sy every form of motion and muscular exertion, and is 
relieved by recumbency and quiet, the patient from the commencement should 
retire to a darkened room, as far from noise and disturbance as possible, and, 
lying down, should endeavour to maintain the position that appears to be most 
comfortable. If he can succeed in falling off to sleep the attack may be cut 
short, and in any case the suffering will be less than if he had attempted to keep 
about. Many doctors recommend that the position should be a slight incline, with 
the head highest ; and this position may undoubtedly be adopted with advantage 
when there is throbbing or pulsation of the head. Should there be chilliness, a 
plentiful supply of blankets and a hot-water bottle to the feet will probably do 
good. A diffusible stimulant, such as a stiff glass of brandy-and- water, given quite 
at the commencement, will sometimes cut short the attack. A dose of bromide of 
potassium — three or four table-spoonfuls of the mixture — will often induce sleep 
and quickly afford relief, but not unfrequently it fails. Sometimes a dose of 
bicarbonate of potash has a similar effect A cup of strong tea or coffee often 
prevents a threatened megrim seizure, especially if the patient can remain quiet 
for a time. A gentleman informs us that he obtains greater relief from a bottle 
of soda water, in which a lemon has been squeezed, than from anything. Should 
it fail, he takes another after a short interval. A dose of guarana may do good, 
but, as we have said, it is somewhat uncertain in its action. Some people resort to 
an emetic, and a patient of ours always endeavours to make herself sick by 
thrusting her fingers down her throa,t; but it is not the pleasantest of remedies. 
The inhalation of a little chloroform or ether from a handkerchief or piece of 
lint may afford temporary relief, but it is not a measure one is justified in 
resorting to without the presence of another person. Nitrite of amyl has been 
employed as an inhalation with success. It is to be used in the manner indicated 
when speaking of angina pectoris (see Angina Pectoris). When the pain is limited 
to one side, keeping up pressure on the head with the hand, or rubbing the forehead 
often does good. Many people obtain relief by plunging the head into cold 
water, or tying a damp towel round the head. Others advise that in addition 
mustard plasters should be applied to the calves of the leg. It must be confessed 
that often enough these measures do little or no good, and many people will be 
found to endorse the following opinion : — " During the paroxysm there is scarcely 
anything to be done ; moreover, the patients are so much afraid of all noise, motion, 



vsusALeiA. 399 

or anything approaching them, that they infinitely prefer to be left perfectly quiet, 
than tormented with useless measures." 



NXUKALGZA. 

The first point to be noted in connection with neuralgia is that the condition of 
the patient at the time of the onset of the disease is always one of debility. 
More than one-half of the sufferers are either decidedly ansemic or have recently 
undergone some exhausting illness or fatigue, and of the rest there will be found on 
careful inquiry some evidence of previous nervous weakness. 

In neuralgia, of whatever form, the pain is more or less intermittent. The patient 
never suffers from it continuously with equal severity ; there are times when it 
is either considerably better or altogether absent, and this is an essential feature of 
the complaint. 

Another characteristic is that depressing influences of all kinds favour the induc- 
tion of an attack of acute pain, and distinctly aggravate it when already existent. 

In the vast majority of cases neuralgia arises by itself, as we say — that is, as the 
result of constitutional causes ; but in exceptional instances it has a mechanical 
origin, and of this we will adduce an example. A sailor was wounded by a musket- 
ball in the arm. The wound healed ; but the patient remained affected with 
agonising pain, beginning in the tips of the thumb and fingers, except the little 
finger, and extending up the fore-arm. His sufferings were so great that he 
willingly submitted to have the limb amputated ; and the operation gave him 
complete and immediate relief. When the severed limb was dissected a small 
portion of lead, which doubtless had been detached from the ball when it struck 
against the bone, was found embedded in the substance of one of the nerves. Neu- 
ralgia may be produced by a shock, such as results from a bad fall or a railway 
accident, or even by severe mental emotion acting on a delicate organism. 
Under these circumstances the development of the affection seldom occurs at 
once, but ensues after a variable interval, during which the patient exhibits 
symptoms of general depression, with perhaps loss of appetite and strength 
When once fully developed, there is nothing to distinguish this from the more 
ordinary forms which result from purely constitutional disturbanca Sometimes 
a cut, which perchance has severed a nerve, may be the starting-point of neu- 
ralgia. In one case paroxysms of excruciating pain in the little finger followed 
a gash with a tolerably sharp bread-knife at a point a little above the wrist. These 
attacks recurred for more than a month, long after the original wound had com- 
pletely healed. Curiously enough, injury to a nerve may set up neuralgia in quite 
a different part of the body, and the removal of a small piece of glass from the 
cicatrix of an old wound has been known to cure neuralgia in a distant situation, 
for which remedies had long been tried in vain. 

Neuralgia sometimes arises as the result of ague, and in this country this variety 
was formerly far more prevalent than at present. We often meet with it in 
people who have suffered from ague abroad. The term " brow ague," is to this 
day applied by many to that variety of neuralgia which is experienced just over 



400 THE TREATMENT OF DISEASE8. 

one or other eyebrow. The fact of the attacks coming on at regular intervals is 
one of the great characteristics of neuralgia really resulting from ague. 

Neuralgia is seldom met with in young children, but not unfrequently it makes 
its appearance about the age of fourteen. Usually, however, it comes on later, 
between the ages of twenty -five and forty-five. It is at this time that the indi- 
vidual is subjected to the greatest strain from external circumstances. A man, if 
poor, is engaged in the absorbing struggle for existence, in the endeavour to main- 
tain his wife and family, or if rich and idle he is immersed in dissipation or 
haunted by the mental disgust generated by ennui. A woman, if married, is going 
through the exhausting process of child-bearing, or if single is probably idle and 
weary with waiting, fearing lest she should lose her chance of fulfilling those duties 
which so essentially constitute her mission in life. Sometimes neuralgia makes its 
first appearance when the race of life is well-nigh run, and indications of physical 
decay are already making themselves apparent 

Neuralgic pains may occur in any part of the body, but they are met with 
most frequently about the head and face. One variety of neuralgia of the head is 
more or less familiar to us all under the name of " tic " or " tic douloureux." 
Neuralgic pains are usually suspended during sleep. The tic, for example, may 
keep the sufferer awake for hours and hours, but once asleep lib slumber is likely 
to remain undisturbed. Sometimes the pain is experienced chiefly in the region 
of the lower jaw, and then it usually affects the lips, the teeth, the chin, and it 
may be even one side of the tongue. Curiously enough the pain is usually 
strictly limited to one side, often stopping abruptly in the middle line. The 
paroxysms of suffering in this frightful disease are apt to be induced by the most 
trivial causes ; a sudden jar, a current of cold air blowing on the face, a slight 
touch, or even the mere mention of the malady, may be sufficient to excite it. 
The necessary movements of the face in speaking or eating may bring on the 
pain, and the patient is in constant dread of a visit from his enemy. Often 
enough neuralgia is associated with toothache, and still more frequently a decayed 
tooth, or long-forgotten stump, although not itself painful, is found on examina- 
tion to be the exciting cause. Wonderful instances of the cure of long persistent 
neuralgia are attributable to the dentist's art In one case, and this is but one 
of many, attacks of agonising pain coursing along one half of the jaw were at 
once arrested by stopping a hollow molar on that side. 

The pain of some forms of neuralgia is agonising, and it has been supposed 
by many that it is the most severe the human frame is capable of suffering. 
Usually it comes on in sudden twinges, which are very characteristic of the 
complaint. Some people compare it to an electric shock of great intensity, 
others to the conflagration of gunpowder, or to the explosive violence of fulminating 
powder whilst others declare that it is simply indescribable. A well-known 
physician, now dead, is reported to have stamped out the bottom of his carriage 
during a paroxysm, and another member of the medical profession was induced 
by the excessive agony to make deep cuts into his face and then to apply a 
red-hot iron to the wound, and the pain not being mitigated, he several times 
attempted suicide. Even in comparatively mild cases the patient often on the instant 



NEURALGIA. 401 



of the attack becomes fixed like a statue, fearing to move a muscle or a limb, 
lest lie should aggravate the pain or reproduce the seizure. 

One of the commonest forms of neuralgia of the limbs is that which is 
experienced in the little finger and the contiguous side of the next finger. Often 
enough it extends downwards from behind the elbow to that spot. The nerve 
affected in these cases is the "ulnar," a blow on which gives rise to that peculiar 
sensation experienced on striking what we call the " funny-bone," which is in 
reality nothing but this nerve. This form of neuralgia is often kept up and 
revived when apparently dying out by muscular movement. In the case of a 
lady, a highly accomplished musician, pianoforte-playing had to be abandoned 
on this account, the slightest exertion with the hands infallibly bringing on an 
attack of pain. 

Neuralgia of the side is by no means an uncommon affection, and it is frequently 
one involving much suffering. A variety not uncommonly met with is the pain 
beneath the left breast, which women with neuralgic tendencies so often experience, 
chiefly as the result of over-suckling, combined, perhaps, with some menstrual 
irregularity. Neuralgia of the side *is not uncommonly associated with shingles, 
and an attack of shingles often leaves behind it for some time a legacy of neuralgic 
pains. It is important to distinguish neuralgia of the side from the purely 
muscular affection to which the term myalgia has been applied (see Myalgia). 
Neuralgia is non-dependent, or much less dependent than myalgia, on excessive 
or long-continued muscular exertion. Moreover, there is marked intermittence 
in the neuralgic affection, the pains not being constant, but only occasional. 

A curious fact in connection with neuralgia of the face is, that after a severe 
attack the hair on that side of the head often turns grey, the colour being after a 
time gradually restored to its original tint. This may at first seem difficult of 
belief, but it is true, and has been observed in many instances. 

With regard to the duration of neuralgia we must say a word or two. Some 
cases run an acute course, lasting only a few days or weeks, the disease terminating 
after a short series of more or less violent paroxysms. In other cases the disease is 
chronic, lasting for weeks and months, and even, if the successive and frequent 
relapses be included, for years. In exceptional instances, neuralgia is persistent 
throughout life, though with intermissions of longer or shorter duration, and with 
considerable variations in intensity. On the whole it may be stated that the 
majority of cases terminate in complete recovery. 

Let us now consider what steps may be taken to ward off neuralgia in those who 
are constitutionally or hereditarily predisposed to it. Much may be done to prevent 
the development of the affection by timely care and attention. Good diet is of 
primaiy importance. It should be abundant, and should include a fair allowance of 
meat, bread, eggs, and especially milk, given in conjunction with cod-liver oil, and 
no apprehension need be entertained of its proving too stimulating. Regular and 
systematic exercise is an invaluable adjunct to good feeding, powerfully contributing 
as it does to the strengthening of the nervous system. Exercise, in whatever form 
it may be taken, should not be excessive, and should be alternated wHth a due pro- 
portion of rest A sufficient amount of sleep, especially during the period of youth 
28 



402 THE TREATMENT OF DISEASES. 

and development, is very essential, and for growing boys and girls nine or ten hours 
is not too much. A good portion of the day should be passed in the open air, and 
close, badly ventilated school-rooms are to be sedulously avoided. The dull, heavy 
headache from which children often suffer after prolonged study not unfrequently 
ends in neuralgia. In the warmer months of the year, it is a capital plan to make 
children learn their lessons out in the fresh air or in a summer-house. Of course 
in many cases this is impossible, but with people living in the country and having a 
garden, however small, it might be done without the slightest trouble, and it is a 
little point well worth attending to. No stimulants of any kind should be taken 
either in the form of tea, coffee, or spirituous liquors. Milk is a capital drink 
for young people, and what can be better than a draught of pure spring water — 
if you can get it The cold bath, or sea or river bathing, will do much to ward 
off that condition of general debility which is so favourable to the develop- 
ment of all neuralgic affections. The greatest attention must be paid to 
the mental and physical development, but there should be no superfluous 
loading of the mind with useless knowledge. Young people should be led to 
devote themselves to earnest, systematic, and yet interesting study. No culti- 
vation of vanity or ambition should be permitted ; there should be no attendance on 
frivolous or vicious theatrical performances, but the great aim should be a true 
devotion to poetry, music, and art. Excessive reading of trashy novels is one of 
the conditions most favourable to the development of neuralgia. The increasing 
precocity of boys and girls, in their familiarity with the most objectionable aspects 
of passion an 1 intrigue, is steadily fed, in the present day, by a system that only too 
frequently allows unlimited access to literature which is at once devoid of all true 
literary and artistic merit, and replete with sensational incidents of the most per- 
nicious character. The same degrading tendency is to be noticed in many of the 
most popular dramatic and public exhibitions of the day, their main characteristic 
being too often bad art and thinly- veiled sensuality, which is all the more hurtful for 
being veiled at all. As has been truly said, it would be a hundred times better that 
a boy, or even a girl, should study the frank, out-spoken descriptions to be found in 
Shakespeare or Fielding, with all their occasional coarseness, than that they should 
enervate their minds with the sickly trash that is most current and most popular 
at the present day in the theatre and circulating library. 

Those who have already suffered from neuralgia and are anxious to avoid a relapse 
should carefully avoid all influences which are known to be hurtful, such, for instance, 
as exposure to cold, insufficient or indigestible food, and mental or bodily over- 
exertion. People engaged in business or professional work should endeavour to get 
a month or six weeks' holiday every summer, and should utilise it for obtaining a 
renewed supply of health and energy. Care should be taken to avoid mental excite- 
ment, disturbances of the digestive organs, and, speaking generally, all those 
injurious influences which are recognised as being favourable to the induction of a 
paroxysm. Avoidance of exposure to cold and wet, and to draughts of air, is 
especially important. 

When neuralgia is fully developed these measures will have to be observed with 
Increased care and attention. The food should be good and abundant, especially in 



NEURALGIA. 



403 



the case of vfsry young or aged persons. It is advisable to give a larger supply of food 
than would* be necessary for the maintenance of health in people not subject to this 
affection. Fat is of especial value when taken in conjunction with plenty of meat, 
milk, ep^gs, and bread. On this account the continued use of cod-liver oil is strongly 
recommended, and when it cannot be taken attempts must be made to supply its place 
by the free use of Orange County cream, plain cream, butter, olive oil, or pancreatic 
emulsion. Unfortunately neuralgic patients have an almost insurmountable aversion 
to fat, and the greatest tact and patience will be required to overcome this difficulty. 
Many doctors find pulsatilla useful in removing the objection to fatty food. Wine 
or beer should be taken, if at all, only at meal-times, and then in the strictest 
moderation, anything like excess being scrupulously avoided. The advantages of 
uniformity of temperature are not to be overlooked, and the clothing should be care- 
fully adapted to give protection against sudden cooling of the body or catching 
cold. 

No treatment is likely to prove of much avail in neuralgia unless anaemia, if 
present, be previously removed. Poorness of the blood appears to be especially 
favourable to the maintenance of all neuralgic affections. The sulphate of iron pills 
(Pr. 63) may be given with great advantage. Another good preparation of iron is 
the tincture of steel, and this may be given in thirty or even forty-drop doses, well 
diluted with water, three times a day, about an hour after meals. The perchloride 
of iron mixture (Pr. 1) may be employed if preferred. A good combination is 
fifteen drops of tincture of steel and six drops of tincture of nux vomica in a wine- 
glassful of water three times a day. In some cases the arsenic mixture (Pr. 40) 
does much to improve the quality of the blood, but it is, as a rule, inferior to iron. 
Further directions for the treatment of ansemia will be found under that heading 
(see Anemia). 

One of the best remedies for neuralgia is quinine. In all cases in which there 
is any suspicion of ague, or when the patient is residing in a district where ague is 
prevalent, this is the remedy to give. It is indicated, too, when the attacks come 
on at regular intervals. It has long been recognised that quinine readily controls 
that form of neuralgia in which the pain is experienced at a spot just above one or 
other of the eyebrows. Quinine, to do any good in neuralgia, must be taken in 
fairly large doses — thus two table-spoonfuls of the strong quinine mixture (Pr. 10) 
should be taken every four hours. Some chemists now keep five-grain quinine pills, 
made up with a drop or two of syrup ; and, by many, these will be preferred to the 
mixture ; one should be taken every four hours. Quinine is said to control neuralgia 
and ordinary faceache more effectively when the powder is taken in small quantities 
every few minutes — as much, for instance, as will adhere to the tip of the finger 
dipped into the powder. We need hardly point out the importance of getting your 
quinine pure. The three great indications for the use of quinine are — (1) history oi 
ague; (2) paroxysms being periodical; (3) pain being experienced chiefly over 
eyebrow. In very obstinate cases of neuralgia, which have resisted all other treat- 
ment, the Germans often give what we should consider enormous doses of quinine — 
from forty grains to two drachms a day. 

Croton chloral must take a high place as a remedy for neuralgia. It succeeds 



404 THE TREATMENT OF DISEASES, 

even when the complaint is due to decayed teeth, and it will often obviate the 
necessity for an appeal to the dentist. It frequently cures the neuralgia of old 
people, in whom the complaint is generally most obstinate and severe. It will be 
found serviceable in neuralgia of the back of the head, and also when it affects the 
back of the neck, the pain radiating to the shoulders. It must be taken in five- 
grain doses, dissolved in water, every three hours ; and should this dose fail it must 
be doubled. It should be given simply in water, and without anything to flavour it. 

Phosphorus is another excellent remedy, and some regard it as almost a specific. 
It appears to be efficacious in neuralgia of any part of the body, and is admirably 
suited for people advanced in life. It should be given in doses of about one- 
twentieth of a grain every three or four hours, and it may be conveniently 
taken in the form of a pill, although the phosphorus pills of the pharmacopoeia, 
from being made with wax that melts at a higher temperature than that of thf 
body, are useless. Phosphorus capsules (Pr. 54) may be employed with advantage. 
The pharmacopceial phosphorated oil is a reliable preparation, and may be taken in 
from five to ten-drop doses in a little milk every three hours. A saturated solution of 
phosphorus in ether (Pr. 53) is very useful, and in five-drop doses every three hours 
has been known to work some wonderful cures. It is best taken on sugar or 
in a little milk. It must never be added to water in a bottle, with the idea of 
forming a mixture, for it would float on the top, and the patient might take 
a week's medicine with the first dose. We have seen benefit derived from it 
in neuralgia of the forearm. Phosphorus is a remedy on which we place great 
reliance in the treatment of neuralgia of all kinds. As might be expected, long- 
standing cases take the longer to cure ; but even in them relief often follows the 
first few doses. 

Chloride of ammonium enjoys a high reputation in the treatment of neuralgia. 
It sometimes succeeds admirably in neuralgia of the face. It is to be given in 
thirty-grain doses every four hours, and may be taken either alone in water or 
mixed with milk. Should it fail to afford relief in three or four days, it will 
probably fail altogether, and may be regarded as unsuited to the casa 

Tincture of gelseminum is capital for neuralgic pains running along the lower 
jaw. It will often succeed admirably when the neuralgia is the result of decayed 
teeth. From five to ten drops should be taken in a wine-glassful of water every 
three hours. It in exceptional cases produces giddiness, double vision, and 
unsteadiness of gait ; but these symptoms are quite temporary, and will all have 
disappeared in an hour or two on discontinuing the medicine. It often happens 
that gelseminum cures neuralgia, but leaves a toothache with which it may be 
associated unaffected. To get any good out of gelseminum you must take it alone 
in water, and not with other things in a mixture. This is a point often neglected. 
Pr. 41 may be employed. 

Arsenic proves highly beneficial in some cases of neuralgia. It is said to 
succeed best when the pain is limited to the left side. The pain which it most 
frequently cures is of a burning or agonising character, and is accompanied by 
great restlessness. It is generally made worse by the application of cold, is 
increased by rest, and diminished by exercisa The arsenic may be given in tea- 



NEURALGIA. 405 



spoonful doses of the mixture (Pr. 40) four times a day, or half the quantity 
may be given twice as frequently. Arsenic succeeds best in the sufferers from an 
exhausted or debilitated condition, who have a small pulse, and cold hands and feet. 

Tincture of belladonna is not unfrequently given in neuralgia. It is indicated 
when there are acute, throbbing, intermittent pains, with redness of the affected part, 
and unusual sensitiveness to light, noise, and movement. It should be given in three- 
drop doses every three hours in a little water, or a smaller dose may be administered 
more frequently. Pr. 39 may be used Belladonna does most good when the patient 
is full-blooded, and of a plethoric habit. 

Bromide of potassium seems to be useful in a certain limited number of cases. 
It is said to succeed best in young men and women of high principle and high mental 
culture, to whom marriage is delayed by fate, till long after the natural period for it. 
It is not to the sufferers from the effects of masturbation that the remedy is specially 
applicable ; on the contrary, it is rather to those who have kept themselves free from 
the taint of vice at the expense of a perpetual and almost fierce activity of mind and 
body. It is most suitable for the unconscious struggles of the organism of a pure- 
minded person with the tyranny of a powerful and unsatisfied sexual system. It is 
in such cases that it is sometimes possible to do striking service with bromide of 
potassium, but it will be necessary to see that the patient has a generous diet, and in 
many cases to insist upon the necessity of taking cod-liver oil. The dose of the 
bromide has much to do with the success of the treatment. We may commence 
with two table-spoonfuls of the mixture (Pr. 31) three times a day, but it will probably 
be necessary to double the quantity before its full benefits are obtained. 

So much, then, for what may be called the specific remedies for neuralgia. But 
even when we cannot cure the complaint, we can do much to alleviate pain ; and we 
should do well to consider what means are at our disposal for effecting this purpose. 
First and foremost comes the hypodermic injection of morphia. The great advantage 
of administering opium by the skin instead of by the mouth is, that it does not upset 
the stomach, and, moreover, a smaller dose will suffice. Indeed, the case is hardly 
expressed with sufficient strength when we say that the hypodermic injection of 
morphia is usually harmless to the digestive functions, for in a great number of 
instances it will be found actually to give an important stimulus both to appetite 
and digestion, and the patient, who without its aid could hardly be persuaded to take 
food at all, will not unfrequently eat a hearty meal within half an hour after the 
injection. Such a case has quite recently come under our notice. "We are thus 
enabled, not only to alleviate pain, but to carry out simultaneously that plan of 
generous nutrition which is so essential to successful treatment. The dose required 
is usually one-sixth of a grain of acetate of morphia to begin with, corresponding, to 
two drops of the pharmacopceial solution. There is not the slightest occasion to 
inject the drug over the seat of pain, for it will prove equally efficacious if introduced 
under the skin of the arm or leg. We can hardly recommend the patient to adopt 
this mode of treatment for himself, but, still, in exceptional cases, where the 
paroxysms are very severe, and other treatment has proved unavailing, it may have 
to be resorted to under medical advice. It is very important not to repeat the in- 
jection with unnecessary frequency ; once a day in the milder, and twice a day in 



406 THE TREATMENT OF DISEASES. 

very severe cases will be all that is advisable, the great thing being to administer it 
as quickly as possible after the commencement of an exacerbation. If by these 
means we can prevent the recurrence of severe pain for several days, time is given 
to the affected nerve to recover itself, and the tendency to neuralgia may be broken 
through. In some cases a friend or relative might be instructed by the doctor how to 
give the injection, and in this way a great boon would be conferred on the sufferer. 
We not unfrequently meet with cases where hypodermic injections of atropia have 
done more good than anything. 

A single dose of chloral, say one or two tea-spoonfuls of the syrup, will often 
enable the patient to obtain much needed rest Chloral, like opium, is not a remedy 
that can be used indiscriminately and without caution. Nothing can be worse than 
for the sufferer from neuralgia to acquire a habit of using either of these drugs for 
the relief of pains. But still, the possibility of a drug being abused does not justify 
us in altogether rejecting its use. It is very important that the habit of long 
neuralgic paroxysms should not be set up, and if two or three attacks are promptly 
stopped by the induction of a sound but not too profound a sleep, time is allowed 
for so modifying the constitution by tonics and general regimen and diet as to 
eradicate the neuralgic disposition, or, at least, to reduce it to a minimum. Indian 
hemp {Cannabis indica) may sometimes be used as a substitute for chloral or 
morphia. Half a grain of the extract of Indian hemp should be taken in the form 
of a pill (Pr. 67), and repeated in two hours should the desired effect not be produced. 

There are many local applications which are used for the relief of the pains of 
neuralgia. Blisters are often of essential service. A blister to the temple or behind 
the ear generally relieves neuralgic pains of the forehead or any part of the face. 
The obstinate form of facial neuralgia dependent on a diseased tooth often yields to 
a blister, the neuralgic pains ceasing, although the toothache may continue. Blisters 
relieve the shifting neuralgic pains common in nervous, sensitive women. The 
obstinate neuralgia of the side left by shingles, and occurring mostly in old people, 
generally yields to blisters. There is no occasion to make the blister large ; if of the 
size of half-a-crown it will be quite enough. Blistering paper, although mild in its 
action, requiring some hours' application, generally produces enough irritation to 
relieve neuralgia of the face, but should the pain continue unabated it may be 
necessary to paint on a little blistering fluid with a brush. For application to the 
side, nothing can be better than a piece of cantharides plaster, as big as half-a-crown. 
It will probably take from six to eight hours to raise a blister, and it should then be 
removed. It is better not to cut the bleb, or prick it in any way, for it serves to 
protect the subjacent raw surface from the action of the air and other irritants. All 
that is necessary is to cover the side with a thick layer of cotton- wool to ward off 
pressure. Other counter-irritants, such as mustard and iodine paint, are used for 
neuralgia, but they are decidedly inferior to cantharides. Blistering is distinctly a 
good mode of treatment. 

The external application of aconite is often very useful in neuralgia, although in 
our present state of knowledge it is impossible to say in what cases it will succeed 
and in what fail In neuralgia of the face we have often known it do a great deal 
of good. In cases in which it effects a cure its action is usually very speedy. A 






NEURALGIA. 407 



piece of aconite ointment the size of a bean or nut should be rubbed into the painful 
spot, and this quantity may be repeated at intervals until a feeling of tingling is 
induced, after which it should not be continued. The aconite liniment, or the 
tincture of aconite may be applied, by means of a brush, along the course of the 
painful nerves. A very good plan is to mix the aconite liniment with an equal 
quantity of chloroform liniment, which assists absorption. Sometimes it will suffice 
to make the application over the most painful spot. In using a powerful remedy 
such as aconite, the greatest care must be taken not to rub it into wounds or cracks 
in the skin, and above all to avoid bringing it into contact with the lips or eyes. In 
some cases veratria ointment mixed with an equal quantity of lard may be used in 
place of the aconite ointment, but it, too, must be used with a certain amount of 
discretion. 

A liniment made by rubbing together equal parts of chloral and powdered cam- 
phor often affords relief in neuralgia, when painted on the painful part. A great 
advantage is that when successful the relief is almost instantaneous. 

A solution of morphia in oleic acid, of the strength of one or two grains to the 
drachm, often succeeds admirably as an external application. Any city chemist 
would quickly make this preparation. From five to ten drops should be rubbed into 
the painful spot with the tip of the finger. It should be used once or twice a day. 
Freezing the part by means of the ether spray often gives great relief in neuralgia, 
and is by no means a bad mode of treatment. 

Electricity is undoubtedly destined to play an important part in the treatment 
of neuralgia. We can hardly enter into a discussion of the whole subject, but a 
brief statement of the present position of medical opinion on the subject may be of 
use to some of our readers. So many people nowadays are acquainted with at least 
the elements of electrical science, that the sufferer, once knowing the form of elec- 
tricity he requires, will have but little difficulty in getting the requisite application 
made. In the first place, then, Faradic electricity is of little or no value in 
neuralgia, and the same may be said of frictional electricity. The constant current, 
on the other hand, is a remedy unapproached in power by any other, save only 
blistering, and the hypodermic injection of morphia ; and even the latter is often 
surpassed by it in permanence of effect, while it is applicable in not a few cases 
where blistering would be useless. The greatest care is necessary in the choice of 
an apparatus, and the mode of application of the electricity. The battery should be 
constant, and not merely continuous. Many of the chains ordinarily sold for this 
purpose fail to afford relief on this account. A sufficiently constant current may be 
obtained from either a Daniell's, a Bunsen's, or a Smee's apparatus. Stohrer's 
modification of Bunsen's battery is one of the best. It is made so that the elements 
are not immersed in the exciting fluid until the moment of use, a simple mechanism 
at once throwing the battery into or out of gear. Few people would care to pur- 
chase an expensive apparatus such as an electrical battery, even on the chance of 
being cured of a persistent neuralgia ; but this difficulty may be overcome by borrow- 
ing the apparatus, or hiring it from a surgical instrument maker. This may be done 
at a comparatively small cost, and a very little instruction would soon teach the 
patient or some friend or relative how to use it. The use of a current intense enough 



408 THE TREATMENT Of DISEASES. 

to produce pain, or even severe discomfort, is never to be thought of in the treat- 
ment of neuralgia, and such practice would inevitably do harm. Only such a 
current is to be used as produces merely a slight tingling, and, on prolonged applica- 
tion, a slight burning sensation, with a little reddening of the skin at one electrode. 
This is a point of the utmost importance, and anything like a shock is quite out of 
the question ; in fact, it is a different kind of electricity altogether. The application 
of the current should be made at regular intervals, and at least once a day ; in most 
cases this is enough, but sometimes it is useful to do it twice a day. The matter of 
regularity is of importance, and it will not do to abandon the treatment immediately 
on the occurrence of a break in the neuralgic attacks, but it should be continued for 
some days longer. The length of the application at each sitting should be from five 
to ten, or at the utmost fifteen minutes. 

Respecting the surgical treatment of neuralgia we have little or nothing to say. 
Division of the affected nerve is alike unscientific and useless. Surgical interference 
is of course justifiable when, along with decided and intractable neuralgic pain, there 
is distinct evidence of the presence of some foreign body or of an old scar pressing 
on the nerve, but these cases are rare and exceptional. In some cases, too, decayed 
teeth may have to be removed for the cure of neuralgia, but it should be re- 
membered that thousands of teeth have been extracted from the mouths of patients, 
not only without benefit, but with the effect of distinctly aggravating the complaint. 



NIGHT-SWEATING. 

Night-sweating is of frequent occurrence as a symptom of consumption. It is 
not present in every case, but it is in a good many. Curiously enough, the perspi- 
ration seems to have a close connection with the sleep of the patient : it seldom 
comes on while he continues to lie awake ; but after sleeping he wakes, and finds 
that he is sweating. In a very large number of cases it comes on about three or 
four in the morning. It varies very much in degree in different cases ; sometimes it 
is merely a little dampness about the head and face, at others it is enough to wet 
the flannel and night-shirt, and even the sheets. In one case the patient assures us 
that the bed was wet through right to the mattress. We have heard a man say that 
he was so wet, that it was "just for all the world as if he had been in a bath." We 
have known instances in which the unfortunate sufferer has been obliged to get up 
in the middle of the night to change his wet things. The perspiration is generally 
more profuse about the head and chest than the rest of the body, but sometimes 
the patient sweats all over, even down to the tips of his toes. Sometimes the 
sweating exhibits a good deal of capriciousness — the patient may suffer from it 
terribly for a week or two, and then it may suddenly take its departure, there being 
no return for a month or mora The sweating is no evidence of the existence of 
high fever, for we have often observed it when the temperature has been but little 
above the normal. It is most exhausting, and it is always desirable to stop it with 
as little delay as possible. Fortunately the remedies at our command usually enable 
us to do so without much trouble. 

A very good remedy for night-sweating is oxide of zinc. One or two of the oxide 



oBEsmr. 409 

of zinc pills (Pr. 66) should be given every night at bed-time, until the sweating 
ceases. This is a mode of treatment which has been in use for years at the Brompton 
and other hospitals for consumption. 

Dover's powder is a remarkably good remedy. "We usually give ten grains 
every night at bed-time. We have employed it in a large number of cases, and 
have rarely known it fail. Five grains of the powder may be made into a pill, and 
two of these may be given at bed-time. 

The injection of atropia under the skin usually proves successful We employ 
a solution made by dissolving one grain of atropia in two hundred minims of water, 
and then inject one or two drops of this at bed-time under the skin of the arm. It 
is a valuable remedy in the hands of any one who knows how to give a hypo- 
dermic injection. We have employed it in nearly a hundred instances, and with 
almost uniform success. Very often a single injection will stop the sweating for 
three or four nights, or even longer. Occasionally it fails the first night, but sub- 
sequently succeeds. The atropia not unfrequently relieves the cough — at all events, 
temporarily. Atropia is the active principle of belladonna ; but we have never seen 
much good come from the application of the tincture or extract of belladonna to the 
skin at night — a practice sometimes recommended. 

A dose of the astringent mixture (Pr. 29) given at bed-time often does good; but 
we are inclined to think that it is inferior to the remedies we have already indicated. 

A two-tablespoonful dose of the strong quinine mixture (Pr. 10) the last thing on 
going to bed often succeeds admirably. 

The practice of sponging the body with vinegar and water at bed-time to prevent 
sweating is not a bad one, and often proves successful It is rather more trouble- 
some than simply taking a pill or dose of medicine, and the exposure may possibly 
give the patient cold. 

In some instances we have given a few drops of tincture of jaborandi in water at 
bed-time, with manifest advantage. 

Many doctors, regarding the sweating as an indication of debility, always order a 
light supper to be taken just before retiring to rest A glass of port wine and a 
biscuit or two usually answers the purpose. This mode of treatment may be used in 
conjunction with one or other of the specific remedies. Nine times out of ten relief 
will be obtained from either the oxide of zinc pills or the Dover's powder. 



OBESITY. 

By obesity we mean excessive fatness, or the accumulation of fat under the skin, 
and around some of the internal organs, to such an extent as to exercise a prejudicial 
influence on the health or comfort of the individual. The term corpulence is usually 
restricted to slighter cases, in which the quantity of fat is not so great as to cause 
positive inconvenience or discomfort. 

A moderate amount of fat is one of the signs of health, and conduces greatly 
to our comfort and well-being. The uses of this substance in the animal economy 
are many and various, and merit a brief consideration. In the first place, it serves 
the merely mechanical purpose of a iignt, soft, and elastic packing material, which 



410 THE TREATMENT OP DISEASES. 

being deposited between and around the different organs of the body, affords them 
support, and protects them from the injurious effects of pressure. Further, being a 
bad conductor of heat, the fat beneath the skin serves to some extent as a means of 
retaining the warmth of the body. But the most important use of fat is seen in 
what occurs during the process of nutrition, for when more fat-forming material is 
taken into the system than is absolutely required for the maintenance of the body, 
it is stored up and laid by in the form of fat, to become available for use when the 
expenditure exceeds the immediate supply. When the direct supply of nourishment 
is cut off by withholding it, or by interruption of the process of digestion, Nature has 
recourse to that which has been laid up in reserve in the form of fat. As every one 
knows, in the wasting of the body which ensues as the result of starvation, fat is 
the part first consumed. 

Although the uses of fat are so many, and although it is such a valuable con- 
stituent of the body, it when in excess becomes not only burdensome and unsightly, 
but a real and serious evil. 

It has been estimated that the mean quantity of fat in the body of a man should 
be about one-twentieth of his weight, and in a woman about one-sixteenth ; but 
from what we have said, it is obvious that the proportion must be subject to great 
fluctuation. 

Obesity is not peculiar to any particular period of life. Age, however, does 
undoubtedly exercise a considerable influence on the production of fat — for example, 
children are usually relatively fatter than adults ; and, again, after the middle period 
of life fat often accumulates in large quantities. Females are more predisposed to 
the occurrence of obesity than are men, and women who have never borne' children 
seem to be more frequently affected than those who have had several pregnancies — 
or rather perhaps, we should say, than those who have had the cares and anxieties 
of bringing up a large family. It is said that hereditary tendency exercises a marked 
influence in the production of corpulence, and this statement is in conformity with 
our every-day experience. Race, again, is an important element in the question : 
the Americans are remarkable for their thinness, and the Arabs are almost destitute 
of fat ; whilst on the other hand Europeans, and more especially the English and 
Dutch, are proverbial for the fulness of their figures. In Hottentot women, fat 
accumulates largely in the neighbourhood of the posterior region, so as to form a 
considerable prominence ; and it is said, we know not with what truth, that if they 
fall down on the side of a hill they experience considerable difficulty in getting up 
again. Individual peculiarity or idiosyncrasy comes in as an important factor in 
the production of obesity. Some people are naturally fat, others lean ; some become 
corpulent on a moderate diet, others remain thin when reared in the midst of plenty 
and in the lap of luxury. Over- feeding will in the majority of people induce fat, 
and so will the habit of taking a great deal to drink, though it be only water. Fat 
people are not always great eaters, but they have invariably a great capacity for 
imbibing fluids. Farinaceous and vegetable foods are fattening, and sugar in all 
forms is an especially powerful agent in the production of fat. In sugar-growing 
countries, the negroes and cattle employed on the plantations grow remarkably stout 
while the cane is being gathered and the sugar extracted During this harvest the 



OBESITT. 411 



Baccharine juices are freely consumed, but when the season is over the superabundant 
fat is gradually lost. Ease of mind and repose of body are conditions highly favour- 
able to the formation and accumulation of fat, and so are insufficient exercise and 
indulgence in much sleep. Anxiety, fretfulness, and that condition to which we 
refer when we say a person is " fidgety," have a directly opposite effect. 

It has been found that when diet and exercise are opposed to each other, diet is 
the stronger. The story is told of a publican living near Newmarket who indulged 
himself immoderately in eating and drinking. To keep the result of this intem- 
perance in check he took a great deal of exercise, and twice a week he swallowed 
two ounces of Epsom salts, which always had the effect of making him more hungry. 
He grew to be prodigiously large and fat, and weighed 392 pounds or 28 atone. 
His case also serves to illustrate the occasionally beneficial effects of a reverse of 
fortune, for he failed in his business ; and in one year from that time was reduced, 
under hard work and harder fare, to the weight of fourteen stone, with no 
suffering whatever to his health. 

The consequences and inconveniences of obesity are often more serious than is 
generally believed. For directing the attention of the public to this subject we are 
in a great measure indebted to the late Mr. Banting, whose widely read " Letter on 
Corpulence" is probably familiar to most of our readers. In August, 1862, that 
gentleman was sixty-six years of age, about five feet five inches in stature, and 
weighed fourteen stone six pounds (202 pounds). He tells us that none of his 
family on either side exhibited any tendency to obesity, and that during fifty 
years' business career he had led a most active life, so that his complaint was not 
owing to neglect of necessary bodily activity, and did not arise from excessive 
eating, drinking, or self-indulgence of any kind He describes most graphically the 
suffering induced by his " lamentable malady." He says that although of no very 
great size or weight, he could not stoop to tie his shoe, and could not attend to the 
little offices humanity requires without considerable pain and difficulty. He was 
compelled to go down-stairs slowly backwards to save the pain of increasing weight 
upon the ankle and knee-joints, and had to puff and blow with every slight exertion, 
particularly that of going up-stairs. He speaks very feelingly of the unkind sneers 
and remarks of the " cruel and injudicious " in public assemblies, public vehicles, or 
the ordinary street traffic, and of the annoyance of finding no adequate space in a 
public assembly, if he should seek amusement or require refreshment. 

It may be taken as a general rule that obesity does not conduce to strength or 
longevity. It is usually followed by diminished vital power and loss of both bodily 
and mental activity. In many cases there are disturbances of the organs of respira- 
tion, circulation, and digestion ; the blood suffers in quality; the muscles are weak 
and have little firmness, and the countenance is bloated and sallow. 

There can never be any difficulty in recognising the condition of which we have 
been speaking. Sometimes the obesity is partial as in what we call " pot-belly," but 
in the majority of cases it is general, and affects the whole body. 

We must now speak of the treatment of obesity. Mr. Banting's simple narrative 
of his experience proves that a proper diet is alone sufficient to remove that con- 
dition, and that the use of drugs is not necessary. He tells us that for years he 



412 THE TREATMENT OP DISEASE!. 

struggled in vain against constantly augmenting fatness, and that under the advice 
of numerous physicians he tried all kinds of different treatments without deriving 
the slightest benefit. 

He says : " I have tried sea-air and bathing in various localities, with much 
walking exercise ; taken gallons of physic and liquor potassse advisedly and 
abundantly; riding on horseback; the waters and climate of Leamington many 
times, as well as those of Cheltenham and Harrowgate frequently ; have lived upon 
sixpence a day so to speak, and earned it if bodily labour may be so construed." 
At one time he took a course of ninety Turkish baths, but never during the whole 
of the treatment managed to lose more than six pounds in weight. On another 
occasion he was recommended to take increased bodily exertion before his daily 
labours began, and with that object he lived near the river, and tried rowing a good 
heavy boat for a couple of hours every morning. The only result was that he 
gained in muscular vigour, and with it a prodigious appetite which he was 
compelled to indulge, and consequently increased considerably in weight instead of 
getting thinner. At last, his hearing being greatly impaired, he went to a well- 
known aural surgeon, since dead, who advised him to abstain as much as possible 
from fat or fat-making articles of diet Thereupon he almost abandoned the use of 
bread, butter, sugar, beer, and potatoes, eating freely and fully, however, of other kinds 
of food. In this way he was reduced many inches in girth, and lost in thirty-eight 
weeks thirty-five pounds in weight. In addition he improved wonderfully in 
general health, comfort, and symmetry, and the improvement was permanent. 

The following is, with a little modification, the plan of dietary adopted by Mr. 
Banting. 

Breakfast (about 8.30 a.m.). — Four or five ounces of beef, mutton, kidneys, 
boiled fish, bacon or cold meat (except pork or veal), or a couple of eggs (not hard 
boiled), a large cup of tea or coffee (without milk or sugar), a little biscuit, or an 
ounce of dried toast, brown bread, or crust off a common household loaf. 

Dinner (about 1 p.m.). — Five or six ounces of any fish (except salmon, herrings, 
or eels), any meat (except pork or veal), any vegetable (except potatoes, parsnips, 
beetroot, turnips, or carrots), one ounce of dry toast, or crust from the loaf, fruit 
out of a pudding (without sugar), any kind of poultry or game, and two glasses of 
dry sherrry, or three of good sound claret (champagne, port, and beer are 
forbidden). 

Tea (about 5 p.m.). — Two or three ounces of fruit, a rusk or two, and a cup of 
tea (without milk or sugar). 

Supper (about 8.30 p.m.). — Three or four ounces of meat or fish, and a glass or 
two of claret. 

On rising in the morning Mr. Banting was in the habit of taking a " special 
corrective cordial " containing a drachm of aromatic spirits of ammonia, and ten 
grains of carbonate of magnesia, with the object of obviating any tendency to gout. 

This plan of treatment is in many cases undoubtedly a good one, but it should 
not ^e adopted indiscriminately. Mr. Banting gives a very sensible bit of advice 
when he says, " I do not recommend every corpulent man to rush headlong into 
such a change of diet (certainly not), but to act advisedly, and after full consultation 



OBSTRUCTION OF THE BOWELS, 41 8 

with a physician." We have heard of cases in which a too close addiction i© 
" Bantingism " has been followed by very unfavourable results. 

With obesity, as with most other things, prevention is better than cure. It will 
be found in the great majority of cases that if a man increases much in weight 
between the ages of thirty and sixty he is either eating or drinking too much, or is 
less active in body and mind than he should be. Before resorting to Bantingism he 
should try if he cannot bring himself down by giving up wine, spirits, and beer, by 
lessening the amount of food by one-third or even more (without altering its nature), 
and by taking more exercise. This plan will often lessen fat without reducing 
the strength or injuring digestion. Should this fail after a fair trial, Mr. Banting's 
plan, either in its integrity, or in a somewhat modified form, should be cautiously 
adopted. 

We know of no drug, or combination of drugs, which will cure obesity without 
injuring the health. Of course, the unexpectedly favourable result of Mr. Banting's 
experiment was not in any way due to his morning draught. At one time it was 
quite the fashion to take potash and other alkalies to diminish fatness. The result 
of this method of treatment is that the mucous membrane or lining of the stomach 
becomes disorganised, the appetite is lessened, and food is not assimilated. There is 
no doubt that it will indirectly by this means cause considerable wasting of the body, 
but it is surely very injudicious to damage the health, and perhaps endanger life, 
with this object. Yinegar is also employed by many people for the same purpose, 
but it acts in exactly the same way, and its use cannot be too strongly condemned. 

It is very essential that every one who undergoes a course of treatment for obesity 
should be regularly weighed, and that a careful watch should be kept on the condi- 
tion of the general health. Particular care sirouid be taken that the appetite does 
not fail, the power of digestion fall off, constipation ensue, the action of the heart 
become enfeebled, or the blood get impoverished. As a rule, it is not advisable to 
diminish the weight at a greater rate than a pound a week, and the experiment 
should not be carried too far. 



OBSTRUCTION OP THE BOWELS. 

Obstruction of the bowels is a fearful disease, which may arise from a great 
number of different causes. It is a very much more serious complaint than mere 
constipation ; on the one hand we have to deal with a condition which usually yields 
to a little judicious treatment, whilst on the other we have a disorder which too 
often defies our best efforts. 

The causes of obstruction are many, and often it is quite impossible to distinguish 
between them during life. The ordinary contents of the bowels, however unwhole- 
some and indigestible they may be, seldom give rise to a permanent stoppage, and 
even hard, foreign bodies, such as coins, bits of bone, teeth, marbles, plum-stones, 
and the like, generally traverse the intestines without doing any harm. Pins and 
needles have been known to prove equally innocuous. Unfortunately, however, 
foreign bodies occasionally form accumulations sufficiently bulky to obstruct the 
bowels. The case is recorded of a French soldier who was seized with all th» 



414 THE TREATMENT OF DISEASES. 

symptoms of obstruction fifteen or twenty days after gluttonously swallowing some 
pounds of cherries, stones and all. He died, and on opening his body a mass of 
cherry-stones, almost as big as a man's fist, was found completely blocking up the 
bowels. Sometimes a large gall-stone may prove fatal in a similar way. Insoluble 
matters in the form of powders or of fibres when habitually swallowed, even in 
small quantities, are often concocted into hard masses. Sometimes a collection of 
purgative pills may give rise to trouble. It is astonishing, however, what a lot of 
pills some people will swallow without seeming any the worse for it. In a recent 
breach of promise case it transpired that the defendant, a clergyman, had taken five 
pills a day for a period of over thirty years — and he survived. Round-worms have 
been known to cause obstruction ; sometimes there are great numbers of them, and 
they may be twisted up together so as to form a big balL If in such a case it were 
possible to ascertain the nature of the obstruction, probably little difficulty would be 
experienced in effecting a cure. 

Sometimes the obstruction is due to stricture of the bowel, and then the hopes of 
a favourable termination are indeed small. The stricture may possibly depend on 
some condition of spasm which is merely temporary, but the contraction of the 
bowel is far more likely to have risen from the healing of some old ulcer, or it may 
be from the deposit of cancer or some other malignant growth in the wall of the 
intestine. We have already seen that in typhoid fever we get ulceration of the 
bowel, but fortunately the healing of these ulcers seldom or never give rise to 
stricture, probably because they are too small. Children are sometimes born with 
stricture of the bowel, or even without any passage. 

Occasionally the bowel is obstructed by something pressing on it from the outside. 
In rare cases there has been some tumour connected with the womb or some other 
organ which has given rise to the mischief. Sometimes the bowel may become what is 
called " strangulated," or constricted internally, a knuckle of the bowel being nipped 
in some little hole in the tissue so that nothing can pass through it. In other cases, 
what we call "intussusception," or "invagination," takes place, one part of the 
bowel being drawn into another portion, just as the finger of a glove can be made 
to glide within itself. The passage of the gut then gets more or less obstructed by 
the congestion and inflammation which result. Usually the intussusception is single, 
though three or four, or even ten, distinct invaginations have been found in the 
same subject. This kind of obstruction is most common in children, and also in old 
age. Perhaps one of the most frequent causes of obstruction is a rupture, and 
consequently in every case of obstinate constipation a careful examination would 
have to be instituted by the doctor of those parts of the abdomen, thigh, and hip 
through which the intestines could protrude. 

Such are the chief causes of this fearful malady, and we should be thankful that 
the complaint is not more common, for there are few cases of disease more painful 
to witness than those resulting from invincible obstruction and closure of the 
intestinal tube. 

Next as to the symptoms. Sometimes the attack is quite sudden, and the 
patient experiences a sensation as if something had gone wrong in his inside. 
At others the onset is gradual, and there is nothing to indicate anything at all 



OBSTRUCTION OF THE BOWELS. 415 

serious. Wliat happens is often of this kind : A person thinks it expedient to 
take some aperient medicine. This has no effect, and he repeats the dose. It 
causes pain and griping, and probably sickness as well, but still the bowels are 
unmoved. Then, perhaps, something stronger is tried, such as jalap, or calomel, 
or eleterium, or cro ton-oil, or injections are given, but all in vain The patient 
is often conscious that food or medicines reach a certain spot, and there stop. 
Very often they are rejected, or if they are retained they only serve to augment 
the feeling of anxiety and distress. The abdomen gradually becomes distended, 
especially if the patient is able to retain food. The intestines act powerfully, 
and do their best to overcome the resistance, but their efforts are in vain, and 
often give rise to the most agonising pain. Sometimes the great coils of 
intestines can be made out through the abdominal wall rolling over and over 
like a lot of snakes. Vomiting soon sets in, and everything may be rejected. 
After a time the vomited matter becomes " stercoraceous," that is, it has the 
odour and appearance of a motion. If relief cannot be afforded, the sufferings 
of the patient are often very great, and his mental distress is agonising. In fatal 
cases the mind is usually clear to the last, the sufferer's attention being intently 
and distressingly riveted upon the possibility of obtaining relief. 

When the obstruction is in the upper part of the intestines, and our treatment 
fails to remove it, death usually ensues in a period varying from five to ten days, 
but when occlusion occurs lower down life may be prolonged for a much longer 
period. Cases are on record of patients having lived on without any evacuation 
of the bowels for four, or five, or even six weeks. It is in these protracted 
cases that recovery occasionally occurs spontaneously. 

What should be the treatment of obstruction of the bowels 1 II. the first 
place, the attendance of a medical man is absolutely necessary — in fact, we 
know of no disease in which skilled assistance is of more importance. Whenever 
there is obstinate constipation which cannot be overcome by ordinary purgatives, 
you should bear in mind the possibility of there being some obstruction. If 
you are in any doubt, send for the doctor. In any case in which you are 
convinced that there is a mechanical obstruction to the use of the bowels, you 
should at once cease giving purgatives. To persist in the use of powerful 
purgatives under these circumstances is to inflict wanton and needless suffering 
on the patient. You must remember that the bowel is already contracting 
powerfully, and requires no stimulating. Rather should an endeavour be made 
to moderate the propulsive force, and relax spasm by the administration of opium. 
A dose of laudanum will often do more to relieve the patient's sufferings and 
to produce an evacuation than any quantity of calomel or colocynth. 

With the view of averting, or at all events postponing, the distension of 
the bowel above the seat of obstruction, it is necessary to limit the amount of 
fluid taken by the mouth, and to regulate its kind. The nutriment should be 
Liquid, and small quantities only should be given at a time. Large injections 
gradually and gently introduced into the bowel, and repeated three or four 
times a day, often prove of great value. When the obstruction is due to some 
hard mass, they may in time succeed in breaking it down, or at all events by 



416 THE TREATMENT OP DISEASES. 

fomenting the obstructed part, they may facilitate the passage of fluids which 
have accumulated above. Moreover, if these enemata are composed of beef-tea 
or milk, and are retained as long as possible, they serve materially to maintain 
the strength of the patient. Injections of very large quantities of warm water 
have sometimes been attended with the happiest results. Fomentation of the 
abdomen externally by large hot poultices, of gentle friction of the surface with 
warm oil, may do good. All manipulation must be performed with the greatest 
care and gentleness, for you might easily rupture the thin, distended bowel by 
rough or careless handling. 

But should these remedies prove unavailing, can nothing more be done ? Yea, 
life may sometimes be reprieved by a surgical operation Inflation of the obstructed 
gut by the injection of air into the bowel has been practised with success. In the 
case of a young lady, about ten years of age, inflation was performed on the fifth 
day after the setting in of symptoms of acute intestinal obstruction, supposed 
to depend on intussusception The proceeding was followed by perfect success, the 
patient felt " as if a bone had broken " in her abdomen, the obstruction was 
removed, and motions followed in three hours, although all previous treatment had 
failed. Other methods of treatment are sometimes resorted to. The gut may be 
punctured above the seat of obstruction and allowed to discharge its contents 
through what is -known as an V artificial anus." There are at the present time many 
people living and in good health whose lives have doubtless been prolonged by this 
operation. Occasionally the abdomen has been opened with the view of dis- 
entangling or setting free the intestine strangulated within. It should always be 
remembered that in cases apparently hopeless a spontaneous cure sometimes takes 
place almost at the last moment, and that the more protracted the duration of the 
disease the greater are the chances of recovery. 

OFFENSIVE BREATH. 

Nothing can be more disagreeable than an offensive breath. In health the breath 
flhould be perfectly sweet and tasteless. We have already had occasion to refer 
incidently to the condition of the breath in several disorders. Thus we have seen 
that in diabetes mellitus it has a peculiarly sweet odour, which has been likened by 
some to the smell of chloroform, and by others to that noticed in an apple-room. 
In Bright's disease the breath may acquire an odour of sal-volatile, or it may 
resemble that of the urine, especially when the patient is suffering from the condition 
known as ursemic poisoning. During the progress of most fevers the breath is not 
only disagreeable but infectious. In malignant sore throat, in scurvy, and in people 
who have been salivated by mercury, the breath is often extremely disagreeabla 
But probably the disease in which the breath becomes most offensive is gangrene of 
the lung. This condition sometimes occurs in the course of advanced consumption, 
and its onset is only too readily recognised by the foul smell of the breath. 

In the majority of cases, however, offensive breath occurs not in the course of 
any of these diseases, but simply as the result of indigestion or want of attention to 
the teeth. The advertising dentist usually draws a ghastly picture of the horror* of 



OLD AGE. 417 



an offensive breath, the moral being, of course, that you are to go to him and have 
your teeth set to rights. His hint is by no means to be despised, and there is no 
doubt that one of the commonest causes of offensive breath is the presence of decayed 
teeth in the jaw. The sooner they are stopped or taken out and replaced by new 
ones, the better. But even when the teeth are sound they may, .from want of 
attention, taint the breath. It is an excellent plan to clean the teeth with a soft 
brush after every meal. In the case of men, who during the greater part of the day 
are out and at work, this may be impossible ; but surely in the case of young women, 
who are at home all day, it is no great hardship. At all events, the teeth should be 
brushed inside and out at least twice a day, morning and evening. The addition of 
a few drops of Bromo-CLloraJuin to the water is useful Camphor may advantageously 
enter into the composition of any dentifrice ihac may be employed Wheo dyspepsia 
is present it should be removed as soon as possible, not only for the sake of the 
breath, but for the general health as welL 

Most of us are acquainted with the peculiar smell of the breath observed in 
people who are addicted to the abuse of ardent spirits. It is not actually the odour 
of the gin, or brandy, or rum, or whatever it may be, that one perceives, but it is 
something over and above this. It is a sour, acid, " vitrioly " smell, which is very 
characteristic of the tippler. You may even notice it through the odour of the fresh 
spirits. Then, again, the breath of the tobacco smoker is often none of the sweetest, 
and we are all disposed to give a wide berth to any one who has been indulging in 
onions or garlic. 

The treatment of offensive breath consists essentially in the alleviation of the 
condition on which it is dependent In many cases the care and skill of the dentist 
will do more for you than will medicine. If you have artificial teeth, you should 
see that no preparation of mercury, such as vermilion, is used in the colouring of the 
india-rubber framework, now so commonly employed. Several cases of injury from 
local mercurial poisoning have been recorded of late years from the red frames used 
to imitate the gums. When the condition of the breath depends on the stomach, 
the rules laid down for the treatment of dyspepsia should be consulted. A dose of 
wood-charcoal taken three times a day for a week or ten days often proves beneficial 
(Pr. 75), or nux vomica may be used with advantage (Pr. -44). When the offensive 
breath is associated with, if not dependent on, a sore or ulcerated mouth, small doses 
of mercury according to Pr. 48 will prove the best treatment. In many cases per- 
fumed carbolic acid used with water as a wash for the mouth proves useful. 



OLD AGS. 

Old age, although not strictly speaking a disease, presents many points of interest 
that may fairly occupy our attention. As life advances, the tissues become more 
condensed, the bones firmer, the cartilages harder, and the articulations closer ; the 
muscles fail in their tension ; the organs of the senses lose their refined adaptations, 
and the skin falling into wrinkles and folds loses its colour, softness, and elasticity. 
But these cannot be regarded as phenomena of disease, for they belong as naturally 
to the declining period of life as certain phenomena of development — the cutting 
27 



418 THE TREATMENT OP DISEASES. 



and the shedding of the teeth, for example — belong to infancy and childhood. Some 
people as they grow old seem only to wither and dry up — sharp-featured and 
shrivelled old folk, yet withal wiry and tough, clinging to life and letting death 
have them, as it were, by small instalments slowly paid. With others — women 
more often than men — the first sign of old age is that they grow fat, and this 
abides with them till, it may be, in a last illness sharper than old age, they are 
robbed even of their fat 

Death by extreme old age may in many instances be considered as the desirable 
end of a long continued and perhaps weary journey. The sufferer falls asleep as he 
might do after severe fatigue, and the long pilgrimage of life is brought to a close 
with little apparent derangement of the ordinary mental powers. Without pain, 
anger, or sorrow, the intellectual faculties lose their brightness ; ambition ceases or 
is merged into the desire for repose ; ideas of time, of space, and duty, lingeringly pass 
away ; to sleep and not to dream is the pressing and still more pressing need, until at 
length it whiles away nearly all the hours. The awakenings are short and shorter, 
painless, careless, happy awakenings, to the hum of a busy world, to the merry 
sounds of children at play, to the sounds of voices offering aid, to the effort of 
talking on simple topics and recalling events long since past, and then again to 
overpowering sleep. The final scene is often brief, and the phenomena of dying 
are almost imperceptible. The senses fail, as if sleep were about to supervene, the 
perceptions become gradually more and more obtuse, and quietly and calmly the 
long last journey is undertaken, so that we can scarcely tell the precise instant at 
which the solemn change from life to death has been completed. It would seem 
that the act of dying may be as painless as that of falling asleep ; indeed, those who 
have recovered after apparent death from drowning, and after sensation has been 
completely lost, assert that they have experienced no pain. The mind at the solemn 
moment may be absorbed in an instantaneous review of those impressions made upon 
the brain in bygone times, which are said to present themselves with such over- 
whelming power, vividness, and force. This purely painless process, this descent by 
oblivious trance into oblivion, is the true euthanasia — the sequel of health, the 
happy death engrafted on the perfect life. 

So much, then, for euthanasia ; a death like this may be desirable, but, practically, 
the majority of us like to live as long as we can, and we may advantageously 
consider what steps we may take, when advanced in years, to prolong life and 
preserve our faculties unimpaired. 

In the first place old people have undoubtedly certain advantages over "theii 
younger brethren. They have passed the ordeal of epidemics, and if they have 
never had scarlet fever or whooping-cough, they are not likely to catch it now. 
Then, too, they have passed the age at which consumption and many other diseases 
are developed, and so far, as we have said, they have a decided advantage. But 
on the other hand, old people, and those who have lost their teeth, run some risk 
of not being sufficiently nourished in consequence of swallowing their food too rapidly. 
They are often hurried over their meals, through the thoughtlessness of those around 
them, and since they chew slowly, and secrete saliva slowly, the food remains 
undigested. Their juniors should know this, and, remembering it, should govern 



OLD AOL 419 

themselves accordingly. The story is told of a lady — a kindly British matron—- 
who, on being remonstrated with for spending more hours at table than was 
good for her, replied that if she did not do so she would be a widow in a week, 
and that she habitually ate too much to keep her aged husband in countenance. 

It is of primary importance that, for old people, the meat should always be 
of the best quality, and as soft and tender as possible. When the teeth are 
gone and no artificial substitutes have been provided it should be cut up finely, 
or may even be minced. Vegetables should not be over-soffcened in cooking, and 
there should be sufficient resistance in them to make chewing imperative, so 
as to excite the secretion of the fluids of the mouth, which is so essential for 
proper and easy digestion. Jnere can be no doubt that in the decline of life 
fermented liquors are more advantageous than in early manhood. It is strictly 
in accordance with the teachings of physiology to increase as years grow upon us 
the moderate quantity of stimulant we have been accustomed to take. Elderly 
people are able to do with less sleep than younkers, and need not be 
alarmed at a certain shortening of their night's rest, which is only natural. But 
sometimes this is carried too far, even when the health ..appears to be perfect 
in other respects, and they get worn out with restlessness, and rolling about. 
This inconvenience may often be obviated by taking a little food and stimulant 
the last thing before going to bed. A sandwich and a glass of stout will make an 
excellent night-cap, and will often ensure a refreshing night's rest. Sometimes 
an egg beaten up in a little brandy -and- water or brandy -and-milk will succeed 
equally well Some people like malaga, and others like a glass of burgundy 
or port, warmed, spiced, diluted, and sweetened. Many people take gruel or 
arrowroot every night of their lives, but the custom is not a good one. We 
may be wrong, but we always think they take it because, to use a popular but 
suggestive expression, " it is filling at the price." It undoubtedly contributes to 
length of days to associate as much as possible with young people, and to adopt 
such habits and manners as may attract rather than repel them, to which there 
is too often a temptation in old age. Grandchildren are not to be despised, for the 
best companions are those whose spirits are high and joyous, if we can only induce 
them to rally round us, and infect us with their life. There is nothing more 
conducive to a long life than ease of mind, contentment with the present, and 
a calm confidence in the future. It is not hard work that kills the active, nor 
idleness that kills the man of leisure, be he old or young, but worry and ennui. 

The influence of mental emotions over digestion must not be forgotten. Bread eaten 
in sorrow remains unabsorbed, ; and it is not without reason that even from the 
earliest times, and amongst the most barbarous nations, companionship during meals 
has always been sought. It is not only painful reflections which disturb digestion, 
but any concentrated thought is equally injurious, and injurious in close proportion 
to the intellectual powers of the individual. The cleverer you are the greater the 
necessity for taking your meals in company. To the brain- worker cheerful distrac- 
tion at meal-times is an imperative necessity, the habitual neglect of which entails 
chronic disease and the early failure of the digestive powers. The adjuncts of family 
meals should be made as agreeable as possible. A change of clothes, clean hands. 



420 THE TREATMENT OP DISEASES. 

and courteous manners, should not be reserved for company, but enforced as a daily- 
habit. Table decoration is not to be despised, and the cook should be encouraged to 
make her dishes as attractive as possible. The forms of animals, and, in fact, any- 
thing which makes us remember that the food has been a living animal at all, should 
never be conspicuously displayed, but covered with such vegetable garnish as is 
capable of harmonising with the character of the dish. Many people have a great 
objection to seeing such things as calves' heads on the table on purely artistic grounds. 
Ease of mind and ease of body are requisite for complete digestion. Muscular 
exertion should be avoided immediately before and immediately after all substantial 
meals. The best employment after dinner is light conversation or music, accom- 
panied by such gentle sauntering movements as ^are encouraged by a well- 
ventilated drawing-room. A cigar or cigarette is often a great help to digestion. 
After a night's rest and the long fast which has emptied the digestive 
organs, food should be taken before any of the material business of the day 
is begun. Work done before breakfast is more tiring, and is not done so well as 
after the stomach has been fortified. The hour of rising should regulate the hour of 
breakfast. It is no proof of vigour to forego breakfast without inconvenience, but, 
on the contrary, it is a great point to be able to lay in a good foundation for the 
day's labour. The weak and feeble, as well as those advanced in years, will find it 
a good plan to have a cup of tea, with some dry toast or bread-and-butter, before 
attempting to get up. Many people prefer a tumbler of milk with a table-spoonful 
of brandy or rum in it ; but we should certainly recommend the hot cup of tea by 
preference. In winter it is not a bad plan to have a fire to dress by, especially when 
the process of shaving has to be gone through. 

People as they get older often suffer from torpidity of the bowels, and con- 
stipation is with them a constant source of trouble. The practice of taking aperient 
pills is a bad one, and it is much better to effect the desired object, when possible, 
by a little attention to diet. Many people can ensure an evacuation by taking 
every morning on getting out of bed a tumblerful of cold water. The draught may 
be made more palatable if a few cloves have been placed in a tumbler over night, 
and had boiling water poured on them, so as, in fact, to make a weak clove tea. 
A good way of keeping the bowels in order is to indulge in a little extra fruit, and 
the best time to take it is an hour or so after breakfast. Apples are rather heavy, 
but a nice ripe pear or a couple of oranges will often succeed admirably. Grapes, 
currants, blackberries, and barberries may be indulged in for a change. Many 
people like bananas. Roast apples and stewed prunes are much better suited than 
pastry as a second course in the condition now under consideration. Some people 
like stewed prunes with meat Figs can be eaten either cold or in a pudding. 
Green vegetables should be indulged in freely, and watercresses, dandelion, and 
lettuces may be eaten ad libitum, provided only that they can be obtained fresh. 
Two tea-spoonfuls of salad-oil taken at bed-time will prevent that drying and 
hardening of the contents of the bowels which is so frequently a source of incon- 
venience. When these remedies fail it is a good plan to substitute coffee for tea 
at breakfast, and brown bread for white. Porridge is an excellent breakfast for 
those who like it The ooarselv-ground Scotch oatmeal should be used. "Mix 



OLD ACTL 421 



two table-spoonfuls of it with a small tea-cupful of cold water, till it is of uniform 
consistence. Then pour in a pint of boiling water, and keep boiling and stirring it 
for forty minutes. It is then fit to eat, but may be kept simmering till wanted if 
a little more water be added as the other steams away. It should be served in a 
soup-plate quite hot, and cold milk added to reduce it to an eatable temperature." 
With these means at our disposal no difficulty should be experienced with the 
bowels. 

Of course the fact will be at once recognised that the number of years a man 
happens to have lived in this world is no guide to his real age. Some people are 
still young at sixty ; others are old at forty. We do not all live at the same rate, 
some live slowly and quietly, suffering but little wear and tear ; others live fast, and 
soon find that the pace tells. Nowadays we live faster than we did a century or 
two ago. If one of our ancestors were suddenly resuscitated and made to undergo 
the toil and mental labour we do, he would soon give in. The life of an intelligent 
man, who would keep on a level with his compeers of the present day, is equivalent 
to at least a dozen lives of a former age. What is expected of mere boys in this 
competitive age was not required of wise, full-grown men of old. Take the example 
of a senior wrangler. Even Newton ignored the scope of mathematical science which 
a senior wrangler must now possess, and how hard such men must work and over- 
work themselves is evident from the small number who are ever heard of again, or 
succeed in the real battle of life. They are " played out " before they are thirty, 
and one feels inclined to agree with the common remark that a senior wrangler ia 
generally one of the worst educated men in England. Few of the successful men of 
this or any other age rest upon the laurels gained in their early years, and under the 
exhaustive modern system few or none, after success in examinations, have energy 
enough left to begin the real work of life. Most of them are content with the 
honours they have gained, and sink back breathless with the effort. There can be 
no doubt that at present society is following a course which must inflict irretrievable 
damage upon our children, and those who are to come after them. Health and 
education do not go, as they ought to go, hand in hand. " The whole head is sick, and 
the heart faint ; " for as the frantic passion for over-instruction affects the body it 
reacts upon the mind. The child who has been a victim to excessive education during 
the period of immaturity is never intellectually strong, and is generally feeble in 
physique, in adolescence, and early manhood. In these days there is a strain after 
knowledge, a frenzy of emulation in acquirement, such as the world never saw before. 
The world has produced great men in abundance in every generation, in every sphere 
of activity, in every combination of circumstance. But always, hitherto, the one 
indispensable condition was present, the condition of unfettered development. The 
appearance of the great men of the past in literature, art, and science, was natural, 
because nature in their case was free and untrammelled ; but the appearance of such 
men in similar greatness under the present educational system is well-nigh impossible. 
The theory, or at any rate the practice, of modern education is to supply an unlimited 
quantity of knowledge in early life, when both the mental and the physical powers 
are immature. It is like trying to improve the healthy action of the stomach by a 
system of over-eating. 



422 THE TREATMENT ©F DISEAB1 



Symptoms of over- work and premature old age are often seen in quite young 
children. Children are set to study even before they have learnt to play. Before 
the age of seven a child's work should be principally play, though play judiciously 
guided and varied, as it is under the Kindergarten system, may be made to impart a 
great deal of useful learning, without resort to a book or formal lesson. Too often 
we find that children from the tenderest age are kept at school for six hours a day, 
and have lessons to prepare at night in addition. Only the other day we saw in the 
hospital a little girl, aged thirteen, who was suffering from St. Yitus's, which had 
undoubtedly been brought on by over-work. She was attending a school where she 
was taught "French, physiology, grammar, analysis, British history, writing, 
spelling, arithmetic, freehand drawing, needlework, and maps," besides several other 
subjects of which she had forgotten the names. She was a day scholar, and had lessons 
in the morning from nine till twelve and again in the afternoon from two till half-past 
four. Besides this she had work to do at home. She began again directly after tea, 
and worked up to ten or eleven at night. She had been doing this for over a year, 
and during that time had hardly had a day's holiday. If this is not cruelty, we 
do not know what is. No doubt some of these poor little unfortunates grow up 
precocious, and are thought by their proud and doting parents to be " clever." But 
the results are no longer any matter of doubt. As a recent writer says—" These 
precocious, coached-up children are never well. Their mental excitement keeps up 
a flush, which, like the excitement caused by strong drink in older children, looks 
like health, but has no relation to it Their tongues are furred ; their appetites are 
capricious ; all kinds of strange foods are asked for, and the stomach never seems to 
be in order." If an over-worked child continue to be over-worked, more alarming 
physical symptoms quickly appear. " The frequent flush gives way to an unearthly 
paleness ; the eyes gleam with light at one time and at another are dull, depressed, 
and sad, and are never laughing eyes. The brightness is that of thought on the 
strain, and it often presents a dangerous phenomenon. The muscles are flabby ; the 
sleep is restless, and disturbed with nightmare, or perhaps somnambulism." As the 
victims of over-education grow up to boyhood or girlhood these physical evils are 
complicated by others of a moral or intellectual character. " Clever " boys and girls, 
but especially boys, continue to be over-worked, and in the period of approaching 
and attaining puberty, over- work hurries thousands of unrecognised victims to the 
grave, No farmer would think of over-working a growing horse, and yet parents 
and teachers combine to drive lads and lasses between thirteen and eighteen into an 
endless series of competitive examinations, the severity of which is every day 
increasing. Sometimes a mistake is made in not recognising the natural quality or 
bent of the pupil's mind, and still more frequently irremediable injury is done to his 
spirit in sending him into a competition in which he stands not the ghost of a chance. 
These intellectual gymnastics are a great mistake. Even the successful are deeply to 
be pitied. " The prize system is bad fundamentally. In the matter of health, that 
system stands at the bar guiltiest of the guilty. "We have but to go to a prize distri- 
bution to see in the worn and languid faces of the successful the effects of the system, 
and there we do not see a tithe of the evil ; we have not seen the children before the 
competition, nor do we see them after it, nor between, the competition and the 



OLD AGS. 43$ 



announcement of the awards. If we could see all the changes incident to these 

events, we should see what a mad system it is, and should understand how much 
the dull are to be envied, rather than the successful and the nattered and 
triumphant." With this opinion we cordially agree, and regret that a knowledge of 
these facts is not more widely distributed. The symptoms of premature old age in 
the adult are not difficult of recognition. They are in the main those of exhausted 
nervous pc wer, that is to say, general debility of the body, inability to walk even 
short distances without fatigue, a feeling of languor and unwillingness for exertion 
of any kind. In addition there are well-marked mental symptoms, and generally 
some previously unnoticed peculiarity develops itself in the character of the affected 
person. A man formerly generous and reticient may become intensely selfish and 
garrulous. Without any apparent reason he takes likes and dislikes to those with 
whom he is associated, especially to his best friends and nearest relatives, 
whose motives he invariably insists on misunderstanding. He is subject to uncon- 
trollable fits of moroseness and bad temper. A previously careful man becomes 
unusually liberal, even extravagant. A man who all his life has been remarkable for 
his modesty and retiring disposition puts off all reserve and makes himself intensely 
disagreeable to everybody, or does something that astonishes beyond measure all who 
know him. Not unfrequently in this condition there is an utter inability to fix the 
attention on any one subject. Even in reading the thread of the story or argument 
is lost. The memory becomes strangely defective, and is often so bad that when 
the unfortunate patient leaves the room to go to another to fetch something, he has 
quite forgotten all about it on his arrival there. You may find him, too, on his hands and 
knees searching on the carpet for something he has just dropped ; ask him what he is 
looking for and it is ten to one that he will not remember. Sometimes not only is 
there an entire inability to arrange the ideas in order, but the judgment becomes 
curiously perverted, a serious matter when the subject of this change holds a position 
of trust and responsibility. Sometimes a remarkable indifference to veracity be- 
comes manifest in persons previously noted for their truthfulness, and in others we 
find a craving for strong liquors, which they find it well-nigh impossible to resist. 
Often enough there is an undue excitability of the senses, the hearing for example, 
becomes intensely acute, so that the noise of a door slamming in the street is almost 
unbearable. Then the sight may become strangely impressionable, bright colours are 
intensely disagreeable, scents are odious, and the taste is completely altered. 

There is only one treatment for the condition that we have described, and that 
may be summed up in the one word, " rest." When a man is living too fast, when 
he is suffering from constant worry and anxiety, when he is wearing himself to 
pieces, there is only one thing for him to do, and that is to stop. It is of no use for 
a man to say that it is impossible for him to pull up, for he must, or he will very 
soon find that he will break down completely and entirely. A six weeks' holiday, 
if taken in time, will often set a man on his legs again, and enable him to go on 
with his work for months, or even years ; but should he fail to take Nature's 
warning, she will have her revenge, and he may have to pay dearly for his temerity. 
Sometimes something may be done in the way of obtaining a temporary change of 
employment. For example, the over-worked doctor may get a travelling appointment 



424 THE TREATMENT 07 DISEASES. 

with some rich patient, or he may be able to exchange the worries and anxieties of 
practice for literary work. Rest does not so much mean absolute idleness as change 
of occupation. As adjuncts, bromide of potassium (Pr. 31) or phosphorus (Pr. 53 or 54) 
may prove useful, but the real and only true treatment is rest. If you are pulled 
down from any cause there is nothing like taking a holiday, and there is no surer 
means of warding off that complaint of which we are all so much afraid — " old age." 
It must be understood that it is not work that we condemn, but over-work. We 
should be the last to underrate the importance of real honest work. In fact, a cer- 
tain amount of work is necessary for the maintenance of health. The enervating 
effects of inactivity upon the physical structure and energies of mankind few can 
have failed to observe. Rust is more fatal to metal than wear. A thorough-bred 
racer, if confined in stable or paddock, or a boxer, born of the finest muscular make, 
if permanently incarcerated in gaol, will, after a few years, become quite unable to 
compete with those vastly their inferiors in natural endowments and capabilities. 
This is equally applicable to the temper and intellect of man, which, secluded from 
the scenes of appropriate stimulus and exercise, become relaxed and weakened. 
What would have become of the glorious spirit and powers of Achilles if his days 
had all melted away in the tender, delicate, emasculating inactivity and indulgence 
of the Court of Lycomedes? Work, then, but work in moderation, and work 
judiciously. 

PAIN IN THE MUSCLES, OB MYALGIA. 

This is an affection with which we are all more or less familiar. We commonly 
speak of it as " cramp," " stiffness," " soreness," or " aching." It is the almost 
constant result of any unusual or unusually prolonged muscular exertion. Every 
schoolboy remembers his first ride, and every athlete his first day's training. The 
traveller remembers how stiff and weary he feels after a long day's journey in a 
jolting carriage, and the mountain-climber knows how sore he is after ascending any 
considerable eminence for the first time in the season. It is from pain in the 
muscles that the seaman is suffering when he complains of how his eyes " burn " 
after many an hour's weary look-out for land, especially when the duty has to be 
performed at night. 

It might be thought that this affection must of necessity be confined to men, or 
at all events to them and to those of the fairer sex whose habits and pursuits are 
more or less Amazonian in their character. Such, however, is by no means the case, 
and we do not wonder at it, for the fact is that few people have any idea of the 
amazing amount of work which women of the middle and poorer classes of life have 
often to get through in the course of the day. From the first thing in the morning 
to the last thing at night they are always on their legs, washing, dressing, scouring, 
making the beds, shaking the carpets, sweeping, ironing, sewing, darning, clearing 
up, dusting, looking after babies, &c. <fec. All these acts require muscular exertion, 
and this is sometimes excessive in degree, yet from their very insignificance, and their 
daily occurrence, they are too often completely ignored. It is common enough to 
hear a man say that "the missis is a rare good un, she's always at it," but he would, 
in all probability be considerably surprised to hear that she, in her quiet way, doe» 



PAIN IN THE MUSCLES, OR MYALGIA, 425 

almost as much physical work in the course of the day as he does. When we see 
a woman sewing it very seldom occurs to us that the muscular exertion requisite for 
the performance of the act may, if carried too far, give rise to considerable pain and 
suffering, yet, for all that, the hard-worked sempstress knows well enough what it 
is to stitch, stitch, stitch, till her " eyes ache " with watching the needle, and the 
muscles which move the eyeball are thoroughly weary. Again, pregnant women 
often complain of the pain in the back resulting from the effort to keep about all 
day with the weight of an extra burden to support Many ladies are familiar with 
the severe pain known as a " cutting-out pain," the result of the unusual strain 
thrown upon the muscles of the back in leaning over a table to cut out patterns. 
The amount of work which ladies, in even the upper classes of society, will get 
through in the course of the day and night is really something wonderful, and it is 
no wonder that they occasionally suffer from pain and stiffness in their limbs. 
Not very long ago a well-known physician was called up at three o'clock in the 
morning to go and see a young lady who was suffering from excruciating pains in 
her thighs and the calves of her legs. It was found on inquiry that she had been 
to a ball, and had danced with great spirit for six consecutive hours, the only rest 
which she had allowed herself being at supper. Such cases are not so uncommon as 
might be supposed, although the suffering is seldom sufficient to induce the patient 
to send for her doctor. 

Sometimes this pain in the muscles is produced by acts at first sight so trivial in 
their nature, and in the amount of exertion which they require, that the relation of 
cause and effect is very apt to be overlooked. We often enough talk of " laughing 
till our sides ache" and many people habitually suffer from soreness, pain, and 
tenderness in the muscles of the chest and abdomen after a night spent with an 
irresistibly comic actor, but the true cause is often ignored, and the sufferer not un- 
frequently sends for the doctor under the impression that he has caught a bad cold, 
or that he is going to have an attack of pleurisy. 

We have said that pain in the muscles is commonly the result of over-exertion 
A person who is debilitated as the result of a long illness, or whose health is for any 
reason below par is very apt to suffer in this way, although the absolute amount of 
work done may be very small. A twenty-mile walk may not be over-exertion for a 
man in good physical condition, and he may feel none the worse for it, but, on the 
other hand, a weakly woman may suffer intense pain in the muscles from sitting up 
in bed for half an hour or so to take her meals. 

In some cases attacks of muscular pain have undoubtedly arisen from excessive 
practice at the pianoforte. The performer commonly sits upright on a stool with- 
out the least artificial support, of course, with the exception of the corset in women ; 
both hands are in perpetual motion ; the body is moved from side to side according 
to exigencies of time and tune ; the legs are used to work the pedals, and as singing 
is often combined with the instrumental music, the muscles by which the chest is 
moved are forcibly employed. 

Custom and training will enable a person to undergo without fatigue an amount 
of work which he would otherwise find it impossible to accomplish. The well-tried 
pedestrian can laugh at the stiffness which the sedentary student experiences when 



426 THE TREATMENT OF DISEASES. 

he suddenly throws off his quiet habit for more active physical work. The mason 
and the blacksmith toil with ease for a period quite impossible to the uninitiated ; 
but, set the mason on horseback, and the blacksmith to do duty as a hod-carrier, and 
they will both complain of stiffness, or muscular pain, on the next day. 

As long as the relation between the work to be done and the power to do it 
remains the same, the exertion of the muscles may not be excessive, but whenever 
muscles weakened or reduced in power are obliged to do the same work as when 
they were strong, the exertion they put forth is excessive for them, the severity of 
the exertion being in proportion to their weakness. 

It is astonishing how quickly, and by what apparently trivial circumstances, 
a man of even herculean powers may be " pulled down." A strong cigar or a pipe 
will in a few minutes reduce a person who is unaccustomed to the use of the " weed " 
to a condition of complete prostration Fright will in an instant deprive a person 
of all power of motion, his tongue will cleave to the roof of the mouth, and he may 
be unable to articulate a word or even utter a sound. Most people know how quickly 
a sharp attack of diarrhoea " takes it out of one." A blue-pill and a black draught 
may in a few hours reduce the lion-hearted Richard to the level of the very lowest 
of the Saracen soldiery. 

When one is out of health everything seems a trouble, and every little exertion 
gives rise to pain in the muscles. When we are well we can support the head, 
and keep ourselves erect all day long without fatigue ; but directly we are debili- 
tated in any way we feel the exertion, and are glad to seek the friendly support of 
the sofa or arm-chair. We all know how heavy the eyelids seem when we are tired, 
and how difficult it then is from fatigue of the muscles to keep them open. Difficulties 
seem to increase as we become less able to cope with them. There is an old Spanish 
proverb which says that, " If you carry a lamb all day, it will become a sheep at 
night." It costs us no suffering while we are well to perform the ordinary work of 
the day ; but when illness has reduced our powers, when a refractory stomach has 
refused the necessary supplies of food, or when we have been brought low by acci- 
dents, loss of blood, diarrhoea, hunger, or other cause, we find the exertion excessive, 
and we suffer from pain in the muscles. As long as the school-girl is healthy and 
strong she can sit erect for hours, and at the end of the day feel weary only ; but 
as the influence of sedentary life, mental exertion, deficient appetite and digestion, 
a crowded sleeping apartment and schoolroom begin to be felt, the weariness becomes 
painfulness, and she is no longer fatigued, but is suffering. 

There is scarcely any part of the body which may not be the seat of muscular 
pains, for they are to be met with wherever there are muscles or sinews. Some 
parts are, however, more frequently attacked than others — the trunk more commonly 
than the extremities, the abdominal walls oftener than those of the chest, and the 
legs more constantly than the arms. The pain may be felt between the shoulders, 
at the back of the neck, over the blade-bone, in the back, and in many other regions. 
Women very frequently suffer from a muscular pain under the left breast. It is 
sometimes situated on the right side, and is occasionally met with on both. The 
sufferings it involves are often very severe, and it is not unfrequently supposed by 
the patient to be a symptom of some very serious disease. Pregnant women often 



PAnr xm m mtscles, ob myalgia. 427 

suffer from a muscular pain, referred to a small spot about the size of a aTiffliTig 
just below the breast, commonly the right The pain is pretty constant, slightly 
relieved by the recumbent posture, but increased by lying on the affected side ; it 
may come on during the third month and last to the time of confinement, and from its 
wearing character is very apt to cause great depression, Another common seat of 
muscular pain is in the lower part of the body in front, and it is then sometimes 
erroneously supposed to arise from some disease of the bladder or womb. 

Pain in the back is a very common form of muscular pain It is readily pro- 
duced by a long ride on horseback, by a long stand in a crowd, by digging or 
weeding in a garden, or by working in a position that requires much stooping. It 
is sometimes brought on by railway travelling, or by having to carry a heavy infant 
or other considerable weight for many consecutive hours. It is an accompaniment 
of many diseases, especially of those which are not sufficiently severe to make the 
patient lie up altogether, but are yet bad enough to considerably diminish the 
strength. It is often a cause of infinite trouble to those whose occupations necessi- 
tate the carrying on the head of heavy weights, such as water, stones, baskets of 
fish, fruit, flowers, &c, and is especially common in young men of all classes of 
society, whose health has been lowered by an excessive discharge or other similar cause. 

Muscular pains under the collar-bones and over the front of the chest often 
follow prolonged efforts at vomiting or fits of coughing. In women they are not 
uncommonly produced by sewing, especially when the individual is unaccustomed to 
the work, or when the material consists of some thick, heavy substance, such as 
coarse calico, linen, or canvas. They are often associated with extreme tenderness 
of the breast, and sometimes even with slight swelling. 

There is one form of muscular pain which, from the frequency of its occurrence 
and the ease with which, on a superficial examination, it might be mistaken for 
pleurisy, almost deserves a special notice. It is commonly known as pleurodynia, 
and is an affection of the muscles of the side of the chest Many of us are 
acquainted with it under the name of " stitch in the side," and are aware that it may 
be produced even in perfectly healthy people, by running, or immoderate laughing, 
coughing, or sneezing. It is very common in delicate women, and even in men 
whose health has been reduced by an attack of illness or other similar cause. The 
pain is often confined to the left side. It is always increased by taking a deep 
breath, or by any movement which stretches the muscles. Before the introduction 
of the clinical thermometer it was frequently by no means an easy matter to dis- 
tinguish between pleurisy and pleurodynia or false pleurisy. Nowadays, in the 
majority of cases little or no difficulty is experienced in making the diagnosis. 
Pleurisy is attended with fever, whilst pleurodynia is a non-febrile disease. If we 
take the temperature and find that it is not at all elevated, we may feel assured 
that it is not pleurisy from which the patient is suffering ; but if, on the other hand, 
the temperature is distinctly raised, we are certain that we have to do with some- 
thing more than mere muscular pain. Of course, the patient may be suffering from 
a cold, and this may be sufficient to cause the elevation of temperature, but the 
exercise of a little judgment usually suffices to eliminate this or any similar source 
of error. 



42S THE TREATMENT OP DISEASES. 

Muscular pains are not unfrequently mistaken for symptoms of some disease 
of serious import, but there is no real difficulty in recognising the true nature 
of the case. The pain is usually spoken of as wearing, aching, burning, or 
" hot," but is occasionally referred to as a " weakness," or " soreness." In 
those who have much bodily fatigue for six days in the week, and a perfect 
rest on Sunday, the pains are always better if not absent on Monday morning, 
and very bad on Friday and Saturday. As a general rule muscular pains are 
absent in the morning, begin about noon, and increase in severity up to bed-time. 
They commonly cease entirely when the sufferer lies down in bed, but in bad 
cases they are only renewed by the recumbent posture. The pains are often 
attended with exquisite tenderness of the skin, so that even the contact of the 
clothes may be almost unbearable. They are usually traceable to over-work 
of some kind or other, although the circumstances which suffice to produce them 
are often apparently very trivial in their nature. 

Having recognised the nature of the complaint, we must proceed to treat 
it. It is obvious that a disease which has been produced by over-exertion will 
be most benefited by rest — rest of the whole body, and more especially of 
the affected part. It is easy enough to recommend rest, but we are perfectly 
aware that in many cases it will be found difficult to carry out our directions. 
A woman very frequently cannot take sufficient rest, for the household duties 
fall upon her, and, as she says, "If I don't look after things, everything goes 
wrong." You tell a man to rest, and he says — " Rest ! I only wish I could. 
I haven't had a holiday for years. If I don't work, who's to keep the wolf 
from the door ? " There are a good many people who cannot rest, but there are 
a good many people who will not rest Many women, for instance, are naturally 
too anxious, active, we might even say too fidgety, to take anything like a 
real rest. Men, commonly enough, recognise the fact that exhaustion, consequent 
upon continuous tension, invariably ends sooner or later in restlessness and 
irritability, but they too often neglect the great vital law of change, which 
runs through the whole universe, and impels the weary to cease from labour. 
Strangely enough the well-to-do are often the greatest offenders in this respect It ia 
the old story of much would have more, and thus we find the man who has a 
lucrative business, and who is making money fast, is the one most difficult to 
induce to take the urgently-needed rest. His excuses are innumerable. In vain 
it is pointed out to him that for his own sake, and for the sake of his family, 
rest is absolutely necessary. Ambition or the love of wealth leads him on, 
and he continues the battle until at length a crisis arrives, and then that cessation 
from work which might have been enjoyed at a convenient season and for a 
suitable period, is enforced, most probably at a very inconvenient time, upon a 
bed of pain and amidst sorrowing faces. Rest, to be of much service, must be 
thorough rest — rest, mental and physical. It is of but little advantage for a 
worn-down mother to go to the sea-side for the benefit of her health if she 
has to take all her little ones with her ; or for an author to resort to the lake 
district with his pens, ink, and paper in undiminished array. Equally useless 
is it for the jaded belle to change the ball-rooms, theatres, concerts, and operas 



PAIN IN THE MUSCLES, OB MYALGIA. 429 

of the town for the assemblies, dinner-parties, and picnics of the country. 
Rest is often useless because it is insufficient Rest in an arm-chair, or on the 
sofa, may do good, but it is usually inferior to rest in or on the bed. For a 
delicate woman to get much benefit from rest, or to obtain relief from muscular 
pains, she should retire to her bedroom at two o'clock every day, and lie 
on her back for a good hour or more with no other companion than a readable 
book. If there is much constitutional debility another rest may be required 
about seven in the evening. 

Where rest of the whole body is unattainable, it may perhaps be possible to rest 
the affected part Any plan of treatment by which we rest, and at the same time 
support, the painful muscles will prove advantageous. We all know what relief a 
well-made corset or waist-belt will sometimes afford, when the pain or weakness 
affects the chest or abdomen, or the muscles of the back. 

The fact that " stays " afford a considerable amount of artificial support to the 
body is easily shown by the consideration of a few simple facts. Women can, as a 
rule, sit upright considerably longer than men, she retaining her graceful position 
long after he has taken to lolling back in his arm-chair, or to exhibiting the soles of 
his boots on the sofa. Then again it is well known that ladies who have once 
accustomed themselves to the use of stays have the greatest difficulty in dispensing 
with their support, and that spasm or cramp is not unfrequently experienced in some 
cf the erect-keeping muscles when they are laid asida A person, therefore, without 
any artificial support is more obnoxious to muscular pain in the trunk than one who 
does not attempt to keep the body upright without assistance. Whilst recommend- 
ing the use of stays for the relief of muscular pains about the body it must be 
distinctly understood that we are not advocating or defending the practice of tight 
lacing. 

In addition to the use of stays, or in cases in which they fail to give the requisite 
relief, a good stout plaster applied well over the seat of pain and its immediate 
neighbourhood may prove more successful. It is necessary that the plaster, to do 
any good, should be large, and that it should be evenly applied. In some cases 
where a single plaster has proved useless, two or three applied one on the top of 
another have effected a speedy cure. 

The importance of affording artificial assistance to parts that are subjected to any 
considerable strain is very generally recognised. We often see navvies who have to 
wheel heavy barrow-loads of earth, place a tight strap round the wrist, and there can 
be no doubt that they derive considerable help from this simple expedient. In like 
manner washerwomen, who have to do much wringing of clothes, apply a piece of 
ribbon to the same place and for the same purpose. Labourers who have much 
standing-work employ a belt, and the pedestrian not unfrequently ties a handkerchief 
tightly round his waist to prevent "stitch in the side." Swimmers sometimes use a 
tight garter round the calf with the view of warding off cramp. 

For effecting a permanent cure, in addition to the local measures, steps must be 
taken to improve the general health. The benefit which may be derived from 
a judicious change of air and scene cannot be over estimated. It is a commonly- 
received opinion, and in the main a correct one, that the change, to be of service, 



430 THE TREATMENT OF DISEASES. 

must be from the bad air of town to the purer air of the country or the sea-side, but 
such is not always the case, for experience shows that a change from the country to 
a comparatively unhealthy town may do good. It is probable that in this case the 
benefit is derived rather from the absence of excessive mental or bodily labour,and in 
the presence of pleasant associations and companions, than from the mere change of 
air. Although we have strongly advocated the employment of rest in the treatment 
of muscular pains, we do not mean to imply that no exercise at all should be taken 
On the contrary, we believe that moderate exercise in the open air will, in the 
majority of cases, be productive of much benefit by improving the appetite and pro- 
moting the circulation. When walking is too much for the strength, gentle carriage 
exercise might prove of benefit Respecting the diet, all we need say is that the 
patient should live generously, and that stimulants may be used in moderation. 
When recovery is retarded by ansemia, indigestion, or constipation, the appropriate 
remedies should be applied, and these evils remedied with as little delay as possible. 
In weakly people purgatives are to be employed with considerable caution. People 
suffering from muscular pains are not unfrequently supposed to have congestion of 
the liver, and are consequently purged unmercifully, the only result being that the 
general tone of the whole system is lowered, and the pains are consequently in- 
creased. There is a case recorded of a man who, under the impression that his 
muscular pains were the premonitory symptoms of apoplexy, took purgatives to such 
an extent that he stated he had gone to the closet six times before breakfast, and 
twenty times during the day. and that the average of his visits was about fifteen 
times a day for at least three months. His method of treatment had materially 
increased the severity of the pains, and had reduced him to such a state of weakness 
that he had often had to rest on the bed while dressing, and had been unable to 
get up-stairs without assistance after his day's work was over. He rapidly recovered 
his normal condition of health on discontinuing the use of his purgatives. In the 
majority of cases of muscular weakness in which the bowels are confined a little 
brimstone and treacle, or the more elegant confection of sulphur or confection of 
sulphur and senna (Pr. 59) will effect all that is necessary. For those who do not 
like purgatives the following device may be adopted. A strip of coarse linen, about 
a foot broad, and long enough to go three times round the body, is wetted at one end 
sufficiently to admit of the damped part going round the body, the dry part of the 
bandage covering that which is wet and excluding the air ; an attendant stands still, 
holding the dry end, whilst the patient applies the wet cloth and rolls himself up 
tightly and ties the strings to keep all snug. The bandage must be put on under 
the ribs so that the play of the lungs be not affected. It is worn night and day, 
and only removed to be re-damped, in the morning on getting up, at midday, in the 
evening, and perhaps again at night. This is an excellent plan, and nearly always 
keeps the bowels perfectly regular. 

What should be our immediate treatment when a person is suffering from acute 
muscular pain ? The patient should go to bed, and the affected part should be kept 
at rest by the application of a plaster or good strong bandage. An injection of mor- 
phia given under the skin, or either twenty drops of laudanum, or twenty grains of 
chloral in a little water, will usually produce sleep, and ease _ the pain. A mixture 



PAIN IN THE MUSCLES, OR MYALGIA. 431 

of oil and laudanum well rubbed into the part often proves more successful than any 
other mode of treatment. The frequent application of hot poultices may do good, 
but they are, as a rule, inferior to the methods we have already mentioned In 
chronic cases, freezing the part by means of the ether spray may be tried ; some- 
times the pain is removed by a single application. The use of iodine ointment 
is indicated in obstinate cases where there is tenderness of the muscles, but the skin 
can be pinched without causing any unusual pain. It should be remembered that 
this is a mild application, and that it should therefore be rubbed into the part two 
or three times a day. Chloride of ammonium, in twenty-grain doses, dissolved in 
water and mixed with an equal quantity of milk, often does good. 

The stiffness and aching of the muscles which commonly follow an unusually 
long walk may in the majority of cases be prevented by at once wrapping oneself in 
a dripping wet sheet, and then getting a thoroughly good rub down. When the 
stiffness has already set in it may be removed by taking a drop of tincture of arnica 
every ten minutes for the first hour, and subsequently hourly, in a little water. 

Sufferers from myalgia often derive great benefit from a temporary residence in a 
hydropathic establishment. This mode of treatment is especially to be recommended 
in the case of the man of pleasure accustomed to lead an irregular, luxurious, or 
indolent life. The system is full of enjoyment, and the simple diet of the water- 
cure patient is relished with a gusto unknown to the pampered slave of calipash and 
calipee — to those comfortable gourmets who begin dinner with soup, fish, and pate, 
washed down with two or three glasses of sherry. The post-prandial lightness of 
spirits more than compensates for any amount of abstinence. 

In pleurodynia the importance of rest of the affected part is as great as in any 
other form of muscular pain. There are, however, certain accessory modes of treat- 
ment, which, in addition to those which we have mentioned when speaking of mus- 
cular pain generally, may be employed with advantage. Thus, in obstinate cases, a 
mixture of chloral and camphor may be used as a local application. When equal 
parts of these two substances are pounded up in a mortar they form a syrupy liquid 
which, when painted on the painful part, or gently rubbed in, often affords speedy 
relief. A blister applied over the seat of the pain often does good, although from 
its weakening effect on the patient it may increase the pain for a day or two. It is 
just possible that the blister makes the part so painful that the patient carefully 
abstains from using his muscles, and thus, by giving them a rest, derives benefit. 
Belladonna liniment often affords marked relief in pleurodynia. It should be rubbed 
over the tender and painful part several times a day, according to the severity of the 
pain. Sometimes a belladonna plaster, from the support which it affords, succeeds 
where the liniment has failed. When pleurodynia is associated with some derange- 
ment of the womb, actaea racemosa is the appropriate remedy. It is especially 
indicated in pain under the left breast occurring in women. Small doses taken 
frequently of a tincture prepared from the common buttercup {Ranunculus bulbosus) 
have been know to succeed in cases of pleurodynia where other remedies have been 
tried in vain. 



432 THE TREATMENT OF DISEASES. 



PALPITATIOH. 

As a rule, we are not sensible of the beating of our hearts, but when the 
pulsations become inordinately forcible they make themselves felt, and the sensation 
is in many cases a most troublesome and distressing one. Palpitation implies 
increased force, or increased frequency, or an increase both in force and in 
frequency, of the contractions of the heart. The pulsations are sometimes 
tumultuous also, and irregular as well as unduly forcible and frequent, but this is 
not necessarily the case. The irregularity in the heart's action may be experienced 
not only by the patient himself, but may be obvious to others. Sometimes a few 
rapid and feeble pulsations occur at uncertain intervals, and are followed by others 
that are fuller and slower. Sometimes one or more beats are left out, the next beat, 
as if to make up for the pause, being unusually strong. The intermissions may be 
unperceived by the patient himself; but often they are attended with a singularly 
disagreeable fluttering or trembling sensation in the breast, There may be a variety 
of attendant symptoms occurring singly or in groups, the most prominent being a 
sensation of choking, a feeling as if the heart were jumping into the throat, and the 
eyes bursting from the sockets, pain over the region of the heart, faintness with 
actual loss of sensibility or partial unconsciousness. The pain rarely amounts to 
more than a sense of dull aching soreness, but in exceptional cases sharp twinges 
occurring in paroxysms may be experienced. Shortness of breath rarely occurs to 
any notable extent, but it does sometimes, giving the patient the appearance of a 
person out of breath with running, singing in the ears, giddiness, and confused 
vision, headache, a hot head and flushed face, with clammy coldness of the hands 
and feet, may be added to the list of disturbances. In rare cases the eyeballs seem 
to enlarge and protrude to an unnatural extent from the orbits, and this may be 
accompanied by enlargement of the throat. In some instances palpitation is more 
or less permanent, but in the majority of the cases it comes on in paroxysios lasting 
for an hour or two, or perhaps only for a few minutes, and then passing off again. 
In young persons of a delicate constitution it often occurs, in a slight degree, nightly ; 
so tha,t the patient on going to bed passes many hours sleeplessly, not only feeling 
his heart beat, but hearing it. His subsequent sleep is unrefreshing, and he awakes 
in the morning more tired and jaded than when he went to bed. A fit of palpitation 
often terminates in sleep, and in the case of hysterical women, a copious discharge of 
watery urine may occur at the time of release. The time during which a patient 
remains subject to these attacks varies infinitely, as does the duration of the intervals 
of freedom. In some cases, as, for instance, in young women suffering from 
" whites," the palpitation is constant, the pulse beating for many days at 150 or 
180 strokes in the minute. In very severe cases the pulse has a mere vibratory 
motion, and cannot be counted, whilst its rhythm is extremely irregular. 

The subjects of palpitation are usually of the nervous type, persons in whom the 
nervous element predominates, and who are what is called emotional or susceptible. 
Thus the nervous constitution of the female sex renders women more liable to it 
than men. Further, temporary causes affecting the emotional nature increase this 
susceptibility, as, for example, sudden surprise, excitement, anxiety^ or mental shock. 



palpitation. 433 



Certain periods, as the commencement of the menstrual flow, and a short time before 
it, render females periodically liable to it. It often comes on after excessive indul- 
gence in tea or tobacco. It is common in the subjects of Blight's disease, and in 
those debilitated by any chronic illness. Youth, too, is more subject to palpitation 
than adult life. It rarely occurs in those under fourteen, except as the result of 
some sudden start or shock ; but it is frequently met with in middle-aged adults, in 
women chiefly, but also in nervous men. The more the nervous system in men 
approaches the feminine type, the more likely are they to suffer from palpitation. 
There is, however, a great diversity in this respect — some women seem as little likely 
to suffer from palpitation as the majority of men do to become pregnant. 

Palpitation of the heart often depends on a disordered condition of the stomach ; 
in fact, it is more frequently due to that cause than to any other. Palpitation may 
occur as a symptom of stomach derangement even when indigestion causes no other 
inconvenience, We have already related a case in which persistent palpitation re- 
sulted from excessive indulgence k tea (see Diseases op the Heart). The 
active principle of tea — theine — is a powerful neurotic agent, and when indulged in 
to excess has a very decided action upon the heart, rendering it irritable, excited, 
and irregular in its action. In such cases the withdrawal of the tea is absolutely 
essential to successful treatment. Regarded chemically, the composition of coffee or 
cocoa is closely allied to that of tea, and it is not easy to believe that the symptoms 
produced by excessive indulgence in tea are relieved by substituting for it those of 
allied vegetable products, but so it is. It is said that tea contains, in addition to its 
principle, theine, a volatile intoxicating oil, and it may be the presence of this agent 
which makes the difference. We conclude that palpitation is due merely to stomach 
disorder when it occurs occasionally only, when the action of the heart is perfectly- 
regular in the intervals, and when there are no other symptoms of heart disease. 

In the following table the more prominent characters of the palpitation 
depending on organic disease of the heart are contrasted with those of palpitation 
arising from other causes : — - 
Palpitation depending on Disease of the Heart. Palpitation arising from other causes. 

1. More common in men than in women. 1. More common in women than in men. 

2. Usually comes on slowly and gradually. 2. Usually sets in suddenly. 

3. Constant, though more marked at one time 3. Not constant, having perfect intermissions, 

than another. 

4. Often not much complained of by the patient, 4. Usually much complained of by the patient ; 

occasionally attended by severe pain ex- readily induced, oy mental emotion; and 

tending to the should ers. frequently accompanied by pain in the left 

side. 

6. Beat against the chest usually stronger than 5. Beat neither heaving nor prolonged ; often 
natural ; sometimes remarkably increased, abrupt, or knocking, and accompanied by 

heaving and prolonged ; at others irregular fluttering sensation at the pit of the 

and unequal. stomach. 

6. lips and cheeks often blue ; countenance 6. lips and cheeks never livid ; countenance 
congested ; dropsy of the lower extremities often pale ; dropsy absent, except in ex- 

common, treme cases. 

f. Palpitation increased by stimulants and 7. Palpitation increased by sedentary occupa- 
tenics, but relieved by rest. tions, relieved by moderate exercise, and 



by stimulants and tonics. 



434 THE TREATMEUT Of DISEASE 

As a rale, patients with heart disease complain but little of palpitation, whilst 
those with digestive derangements often regard it as the essence of their malady. 
That palpitation is in the majority of cases merely functional is evident from 
the number of young persons who suffer from it, and who afterwards attain a 
hale old age. In young people especially, every passion and every affection acts 
on the heart and changes its healthy beat, and over-exertion, or any little 
error in diet, may produce the same result. In some instances palpitation arises 
from prolonged mental application and over-work, as in the case of literary men, 
barristers, and others whose pursuits are psychical rather than physical. Occa- 
sionally palpitation is met with as a symptom of retrocedent gout — the pain 
in the joints suddenly subsides, and then the sufferer complains of his heart. 

And now as to the future of these cases. Do people get cured of palpitation, 
or do they die of it? Nine times out of ten they recover completely. It is 
very essential to bear in mind that palpitation is not only not invariably associated 
with grave disease, but that it is often a mere nervous abnormality of little or 
no importanca This is also true of intermittency of the heart's action. A recent 
writer says : " On mere intermittency of the heart alone, no practitioner is justified 
in giving an opinion as to the existence of heart disease. The suffering and 
misery entailed by hasty medical opinions as to the existence of heart disease 
of a grave character, and its proneness to sudden death, is something fearful to 
contemplate. I know well a hale north - country yeoman of unusually fine 
physique, whose peace of mind, years ago, was ruined by a rash medical opinion, 
formed most unjustifiably, and so strong was the impression then made, that no 
amount of assurance of his health can free him from the terrible bondage of 
this idea." Palpitation of violent character, such as obtrudes itself forcibly 
on the patient's attention, is more decidedly the characteristic of some nervous 
affection than of organic disease of the heart In heart disease, palpitation is 
often to be regarded almost as a good sign, affording evidence as it does that the 
heart has still strength to palpitate. Before doing anything in the way of 
treatment it is very important to make sure of the diagnosis. If after reading 
our description you have any doubt whether your palpitation is due to heart 
disease or not, you had better go to a doctor and get him to decide for you. 
It is of no use trying to treat yourself if you are not sure what you are 
suffering from. If you at any time in your life have had rheumatic fever, and 
suffer from palpitation, we should advise you to get your chest examined. 

The treatment of nervous palpitation is not a very difficult matter. When an 
attack comes on the patient should be made to lie flat on his back, the neck and 
chest being bared, and a liberal allowance of fresh air insisted on. A little sal volatile 
may be given in a wine-glassful of water, or a bottle of eau de Cologne may be held 
to the nose to smelL It is important to avoid all appearance of alarm, and to avoid 
exuberant sympathy. When the palpitation has been induced by a sudden effort, 
rest, quiet, and the administration of a little stimulant, with the addition of fifteen 
drops of either tincture of belladonna or digitalis, will be found useful. Cold 
brandy-and- water can always be obtained in an emergency, and is an excellent 
remedy for occasional use. When the attack is over, treatment must be directed to 



PALPITATION. 435 



the improvement of the general health. When the palpitation is due to a finely- 
Btrung and over-susceptible nervous temperament, we cannot hope that medicine 
will prove of much avail, but quiet, mental and bodily, and avoidance of all exciting 
pursuits, are indicated, whilst any temporary derangement of the bowels and stomach 
Bhould be seen to without delay. When the occupations are chiefly sedentary, out- 
door exercise, with plenty of fresh air, should be tried. Cold or tepid baths are of 
essential service. As has been very truly said, " the excitement of modern fiction 
is not without an effect on the emotional nature of its votaries, who become 
as abandoned to this form of intemperance as others are to the use or abuse of 
other stimulants." The enthralling plot which the victim to novel-reading demands 
is allied to the cry for brandy of the toper ; slighter stimulants are inefficient and 
powerless. The desirability of removal from the circulating library is obvious, and 
exercise, other interests and occupations, and rational mental pabulum are necessary. 
When there is more than ordinary disturbance of the nervous system, the administra- 
tion of bromide of potassium (Pr. 31) may prove useful Disturbed rest is better 
met by early rising, active exercise, and light suppers, than by opiates or other 
narcotics, or even by morning slumber. When the liver is sluggish, nothing acts 
better than a blue-pill and black draught. When there is obvious derangement of 
digestion, the gentian and soda mixture (Pr. 14) taken half an hour before meals 
answers admirably. Attention must of course be paid to diet, mutton and beef 
being taken in preference to pork and veaL In some cases nothing agrees so well 
as boiled mutton. Pastry is seldom admissible, and the same may be said of cheese, 
nuts, and many other articles of diet that are ordinarily reputed to be indigestible. 
For flatulence nothing succeeds better than three drops of oil of cajeput taken on a 
piece of sugar when the wind is troublesome. 

Of the specific remedies for palpitation, digitalis is one of the best. Two table- 
spoonfuls of the perchloride of iron mixtures (Pr. 1 or 2) may be taken three times a day 
for a week, with the addition of ten drops of tincture of digitalis to each dose. The 
infusion of digitalis often proves more effective than the tincture. A drachm may 
be taken twice a day in the iron mixture, or, better still, alone. Tincture of aconite 
often proves useful ; it should be given in from one to three-drop doses in water three 
times a day. It will succeed admirably if added to the iron (Pr. 1 or 2) or gentiaD 
mixture (Pr. 14). Five-drop doses of tincture of belladonna in water three times 
a day sometimes succeed admirably. The belladonna plaster applied over the region 
of the heart is a capital remedy. It should not be smaller than six inches by four. 
We have ordered it in hundreds of cases with the greatest success. To make a 
plaster adhere firmly, first wash the part with soap and warm water, then dry it 
thoroughly with a soft toweL After waiting an hour, warm the plaster before the 
fire and apply it smoothly. A plaster with creases in it is most uncomfortable, and 
is worse than useless. If properly put on, a good plaster will last a month or more. 
It matters not whether the palpitation be due to heart disease or the functional 
derangement of the stomach, it will do good. It should be kept on till it comes off 
by itself, or until it gets wrinkled and uncomfortable, when it may be taken off. Its 
only possible disadvantage is that it sometimes produces a little eruption of pimples, 
or a rash not unlike that of scarlet fever. In that case the plaster will hav* to 



436 



THE TREATMENT OF DISEASES. 



be taken off Should the plaster cause this irritation of the skin, it may be punched 
with holes at regular intervals so as to admit of the escape of the retained per- 
spiration. These porous plasters are often very useful. We can warmly recommend 
the belladonna plaster in the treatment of palpitation. Its application does not, of 
course, in any way limit the choice of internal remedies. Mustard poultices applied 
over the region of the heart often help to regulate its action ; they lessen the feeling 
of distress, and cannot possibly do any harm, even if they do no good. When 
there is any suspicion of gout, colchicum must be given. Tincture of musk and 
caffeine are remedies that occasionally prove useful in palpitation. 

As accessory measures, abstinence from tea and tobacco is very essential. The 
effect of tobacco is to render the heart's action quicker, its beat feebler, and to 
promote a liability to palpitation. There is a distinct functional derangement of the 
heart which is recognised and known as " smoker's heart." In many instances this 
condition arises from great indulgence in strong tobacco, and frequently the substi- 
tution of a lighter form of tobacco in moderation is sufficient to afford relief without 
the abandonment of the favourite habit. We recently met with a man whose 
palpitation had for years resisted treatment, simply because he consumed three or 
four cigars regularly every day of his life. Many of the metropolis poor — the women 
especially — live almost exclusively on weak tea and bread-and-butter. It is hardly 
to be wondered at that they suffer from palpitation, and form so large a contingent 
of our hospital out-patients. The great thing is to get them to substitute milk or cocoa 
for tea. Soberness in the use of alcoholic stimulants is important. It is really 
wonderful what a quantity of drink many people consume in the course of the day. 
Only a week or two ago a patient told us that his usual allowance was four or five 
pots of beer, with a " go or two " of rum or rum-and-milk, in the morning, to " pull 
himself together." He added that of course that did not include a glass or two if 
he met a friend, " which didn't count." He expressed considerable surprise on being 
advised to reduce the quantity, and said that he always considered himself " a very 
sober man." He added, by way of explanation, that he was a barman, and was 
" always in it ; " and that, as it didn't cost him anything, he didn't see how it could 
do him any harm. This is by no means an exceptional case ; and when a man 
assures you that he is not taking too much, it is desirable to obtain from him some 
idea of what he considers to be " too much." The free use of wine and spirits in 
the intervals of the attacks of palpitation not only renders the patient more subject 
to them, but deprives him of one of his chief aids during their occurrence. There is 
no occasion to abstain altogether from the use of alcohol — a pint of beer a day, or 
three glasses of sherry or port, can do no one any harm. Experience alone will 
teach the sufferer what kind of alcohol may be taken with least discomfort. People 
subject to palpitation should not hurry themselves. Take a rest going up-stairs, for 
example ; never get excited, and rather lose a train than hurry to catch it. 



PARALYSIS. 

By paralysis, or palsy, is meant impairment or loss of power or sensation in some 
part of the body. Sometimes only one side is affected, and then it is technically 



PARALYSIS. 437 



called hemiplegiay at others the loss of power is confined to the legs, and then we say 
it is a case of paraplegia. Then, again, the paralysis may be local, only a small 
portion of the body, as a limb, a foot, or the face, being involved. In many instances 
the affection is due to brain disease, and immediately follows a shock. Not unfre- 
quently the brain is unaffected, the disease being in the spinal cord, or spinal marrow, 
as it is called. Sometimes even it is the nerve itself which is at fault. 

That variety of paralysis which we have called hemiplegia is the most common 
form of palsy. It usually comes on suddenly, and is spoken of as a paralytic stroke. 
Almost invariably both arm and leg are paralysed, and the left side suffers more 
frequently than the right. The loss of power is very striking. The patient may 
will the motion of his leg or his arm, but neither of them any longer obeys the act 
of volition ; if they are lifted by a bystander, and then let go, they drop down like 
logs of wood. This is a condition very painful to witness, for the powerful man, full 
of health and strength, is in a moment reduced to the condition of helplessness of a 
little child. One side is for the time being dead. "When only one limb suffers it is 
usually the arm. Often enough this condition is accompanied by some loss of power 
over the movements of the face. Sometimes the mental faculties remain intact, but 
very often the memory becomes weakened, and there is a peculiar tendency to shed 
tears and to become distressed by slight causes. In paralysis of the right side there 
often co-exists that peculiar loss of the faculty of language which we have described 
under the title of Aphasia. In hemiplegia from disease of the brain, although the 
sufferer cannot, by his own will, move the palsied limb, yet the irritation of the sole 
of the foot will often excite active movements, the involuntary action causing no 
little astonishment to the patient. Supposing recovery to take place, the symptoms 
of amendment are usually first noticed in the leg. Besides the palsy there is 
mostly loss of sensation also, but this is by no means so constant a symptom as the 
paralysis. "When the sensibility is lost or blunted it is so, commonly in the same parts 
that are affected with paralysis. But sometimes there is loss of sensation and no 
palsy, and, more strange still, there has been sometimes loss of feeling on one side 
and loss of the power of motion on the other. It must be remembered that these 
palsied parts do not resist the influence of cold and heat so well as the sound parts. 
They readily get chilled if exposed to even a very moderate degree of cold. One 
has always to be careful in applying hot-water bottles or hot bricks to the feet of the 
paralysed, for the parts may get blistered or scalded without the patient experiencing 
any pain. In this affection the attendance of a doctor is necessary. As a rule, good 
feeding, with the administration of tonics, is to be enjoined. 

Paraplegia, or paralysis of the lower half of the body, usually arises from some 
disease of the spinal cord. It most frequently commences slowly and insidiously 
with weakness and numbness of the feet and legs, or with tingling and a creeping 
sensation in the parts, unattended with pain. By degrees the weakness increases 
until there is complete loss of sensibility and motion of the lower extremities, with 
perhaps some affection of the bladder or bowels. Although the power of moving is 
completely lost in the lower limbs, the patient is not uncommonly rendered sleepless 
at night by painful spasmodic twinges and startings in the parts. Paraplegia may 
be the result of some injury to the spinal cord, or it may proceed from the pressure 



458 THE TREATMENT O* DISEASES. 



of a tumour or othe- causes. Sometimes it follows the immersion of the lower part 
of the body for some time in cold, water. In one case the patient had been in the 
habit of wading for hours together in a river while fly-fishing. Much good may 
often be done by medicinal treatment in these cases. The remedy to give is extract 
of physostigma. It is made into little pills, each containing a thirty-second of a 
grain, and one of these is taken every three hours during the day-time, and also at 
night if awake. In three or four cases we have seen considerable benefit derived 
from the adoption of this mode of treatment. The sooner the physostigma is taken, 
the greater is the likelihood of its doing good. In old-standing cases the treatment 
may have to be persisted in for some weeks, or even months. These patients require 
the greatest care and attention, and it is extremely difficult to keep them clean and 
dry. The great thing is to avoid bed-sores. The parts on which the pressure is 
greatest should be examined almost daily to make sure that there are no signs of 
redness. The skin may be hardened by the occasional application of a little alcohol 
in the form of brandy or eau de Cologne, rubbed in with the palm of the hand. A 
mixture of oxide of zinc and starch, in equal parts, forms an excellent dusting powder. 
One of the best preventives of bed-sores is glycerine or glycerine cream. The parts 
exposed to pressure should be washed morning and evening with tepid water, 
dabbed quite dry with a soft towel, and then gently rubbed over with a little of the 
glycerine or glycerine cream. A draw-sheet, made of linen, and sufficiently large to 
be firmly tucked in at both sides of the bed, will prevent the bedclothes from getting 
soiled. When people have of necessity to pass the whole of their time in the hori- 
zontal posture, it is a capital plan to have two beds placed side by side, and to move 
them occasionally from one to the other. The question of getting a water-bed is in 
many cases well worth considering. 

Locomotor ataxy is a disease closely allied to, though not identical with, 
paraphlegia. There is loss of control over the movements of the legs, but there is 
no actual paralysis. When the patient attempts to walk, instead of the leg 
dragging after him as it does in true paralysis, it is suddenly jerked out in a most 
peculiar manner, just as if it were trying to dance a "break-down" by itself. The 
patient can move the limb, but not in the way he wishes. The power of guiding 
the muscles aright is quite gone. It is not a common disease, but we recently had a 
case of this description under our care, and succeeded in doing him some good. He 
was a tall, thin, wiry-looking man, the foreman in a large warehouse in the city. 
He had always been accustomed to lead an active life, and could, as he said, "walk, 
run, or jump with anybody." He lived five miles from his work, and " did the 
journey, twice a day, in and out, under the hour." After a time he noticed a feeling 
of uncertainty in his walk, and " a little giving way in his knees ; " in fact, to use 
his own expression, he was " like a horse that had been hamstrung." Soon he felt 
that he could not run so well, and he gave up his morning and evening walk, taking 
the omnibus to and from his work. In a little while he felt afraid*to jump on the 
omnibus whilst it was in motion, and took to hailing it so that it might stop for him. 
As time went on he felt afraid to get on the roof or knifeboard, and went inside. 
He next noticed that he staggered a little in his walk, and suddenly received notice 
of dismissal from his employers without any reason being assigned. He was at the 



PARALYSES, 439 



time quite unable to account for this, but on consideration baa no doubt be lost bis 
place in consequence of bis staggering haying been attributed to the effects of drink. 
For two years he endeavoured to obtain employment, but unsuccessfully, and 
being in trouble and distress, paid very little attention to the condition of his health 
or the progress of his complaint. At the expiration of that time his powers of 
walking were found to be greatly affected. On attempting to take a step, the leg 
was thrown up in the air, and then brought down violently, the heels first coming 
in contact with the ground. He could walk for a short distance, but was obliged 
to take every opportunity of steadying himself by the table and other articles of 
furniture about the room. His greatest difficulty in locomotion was in crossing 
the road, and going round corners. Stepping on the curbstone was always a difficult 
and delicate operation. He would ofben walk in the road until he came to a 
lamp-post by which he could assist himself on to the pavement. He was quite 
unable to stand alone in the dark, and merely turning out the gas would cause him 
to fall almost as if he were shot. There was no true paralysis, for when the patient 
was in bed be could move his legs in any direction. He suffered greatly from pains 
in his limbs, which he described as being " sharp, rheumatic, spasmodic, like 
toothache." He derived considerable benefit from taking physostigma. He had 
some pills given him, each containing a thirty-second of a grain of extract of 
physostigma, and of these he took one, six or eight times a day, for three or four 
months. At the end of that time he could walk very much better, and could cross 
the street, and step from the road on to the pavement with comparative ease. At 
times he could walk almost as well as ever, and there was distinct improvement in 
other respects. The physostigma did him a great deal of good, in spite of the fact 
that from domestic and other reasons he was very unfavourably situated for carrying 
out systematically any plan of treatment 

Facial paralysis is a variety of palsy in which only the muscles of the face are 
affected. It most commonly arises from cold, as when a person is exposed to a 
draught in driving or in a railway carriage, but it sometimes arises from rheumatism, 
and other causes. The appearance presented by a patient affected with facial palsy 
is peculiar and very striking. He cannot knit the forehead, neither can he raise 
the eyebrows or draw them together. The eye remains open, as the power of 
closing the lids is lost, and their blinking movement no longer exists. From one- 
half of the countenance all power of expression is gone ; the features are blank, still, 
and unmeaning ; the eyelids apart and motionless. The other half retains its 
natural cast, except that in some cases the angle of the mouth on that side seems a 
little awry. The patient cannot laugh, or weep, or frown, or express any feeling or 
emotion with one side of his face, while the features of the other may be in full 
play. Further, the patient cannot whistle, for he is unable to purse up his mouth 
for that purpose, and for the same reason he can neither spit nor distend his 
cheeks with air, or blow wind from the mouth. In mastication portions of food 
are apt to collect between the cheeks and gums, as the support of the lips and 
cheek necessary for its proper performance is lost. The saliva and fluids fre- 
quently trickle from the mouth. At the same time it must be remembered that 
this particular form of palsy is much less serious than the other forms we have 



440 THE TREATMENT OF DISEASES. 

been considering, for if unaccompanied by palsy of the limbs there is really no cause 
for anxiety. It is often supposed that the patient has had a stroke, and is in im- 
minent danger ; but such is not the case. Sometimes the loss of power over the 
movements of the face is accompanied by loss of sensation in the corresponding 
part Usually, sight is unimpaired and the tongue is unaffected, but the articulation 
of some words formed by the lips may be difficult Facial palsy may have a dura- 
tion of from ten days to as many weeks; perhaps three or four weeks may be regarded 
as the ordinary duration. Cases arising from cold or rheumatism nearly always do 
well. Now as to the treatment. Hot fomentations are useful at an early period of 
the complaint. Later warm douches, shampooing, and galvanism may be resorted 
to. When there is any suspicion of a syphilitic taint, iodide of potassium may be 
used with advantage (Pr. 32). Should a rheumatic or gouty habit be found in con- 
nection with the palsy, colchicum (Pr. 33) or perhaps lemon-juice might exert a 
beneficial influenca Iron (Prs. 1 — 7) is likely to be useful when an anaemic condition 
of the system exists. 

Hysterical paralysis has already received some attention at our hands (see 
Hysteria). In hysterical hemiplegia the patient drags the palsied leg along the floor 
with a sweeping motion, as if it were dead, without endeavouring to lift it, and 
without that swinging-round movement of the limb observable in those whose 
paralysis is dependent on disease of the brain. Hysterical paralysis occurs almost 
exclusively in women, and it is sometimes directly traceable to fright, over-excite- 
ment, loss of blood, deficient nourishment, or some other circumstance tending to 
depress the general health. There are almost invariably other symptoms of hysteria 
present, whilst the menstrual functions are often performed in an irregular manner. 
The treatment must be that of hysteria, and not of paralysis. 

Shaking palsy, wasting palsy, and the paralysis arising from lead-poisoning are of 
such importance as to merit a separate and more detailed consideration. 



PILES, OB HEMORRHOIDS. 

The terminal portion of the bowel — the rectum — is subject to derangements as 
numerous and varied as any organ of the body, although for obvious reasons we 
ordinarily hear very little about them. These complaints not only cause intense 
suffering, but give rise to an amount of depression and anxiety quite out of 
proportion to their gravity. They usually spring from habits prejudicial to health, 
being either engendered by sedentary pursuits or the result of over-indulgence in 
the luxuries of civilised life. 

Piles, or hsemorrhoids, occur both in men and women, and are usually not met 
with until middle age. Amongst circumstances favouring their formation may be 
mentioned pregnancy, habitual constipation, the frequent use of powerful purgatives, 
straining at stool, rich living, insufficient exercise, hereditary tendency, and a long 
residence in tropical climates. They are much more prevalent in the upper classes 
of society than amongst the labouring population. The latter live plainly, take 
plenty of exercise in the open air, and seldom suffer from constipation. 

We shall discuss this complaint chiefly from a medical point of view, 01 



FILES, OS EJOtOEEHOIBS. 4il 



surgical operations, the use of the knife, the ligature, and acid, we have nothing to 
say. They are in many cases of inestimable value, bnt it is undesirable to submit 
to any operative procedure until it has been clearly demonstrated that medicinal 
treatment has failed. 

There are many valuable remedies for piles, some of which ought, in every 
instance, to afford relief. For bleeding piles nothing equals the tincture of 
hamamelis virginica. It is almost a specific, and many doctors who have used it 
extensively say they have never known it faiL It is to be used in those cases, and 
in those cases only, in which the piles bleed. Its use is especially indicated when 
there are, in addition to bleeding piles, enlarged or varicose veins of the legs. A 
tea-spoonful of the tincture of hamamelis is to be put in an eight-ounce bottle of 
water, and of this three tea-spoonfuls are to be taken every three hours. It is not 
to be given with any flavouring agent, or with any other medicine. In addition to 
taking the hamamelis it is necessary to apply it locally. A hamamelis lotion is made 
by adding two tea-spoonfuls of the tincture to half a pint of water, and when the 
piles are external this is to be applied to the part by means of two or three folds of 
linen covered with oiled silk, and renewed several times daily. When the piles are 
internal some of the lotion is to be injected with a syringe or injection apparatus 
into the back passage two or three times a day. We can almost guarantee that in 
the cases we have indicated hamamelis will effect a cure. The best and cheapest 
way is to buy a couple of ounces of tincture of hamamelis virginica from the 
chemist, and make your own lotion. Mind you get the strong tincture, and not 
any weaker preparation or dilution. All you have to do is to put two tea-spoonfuls 
into half a pint of water, shake it up, and it is ready for use. Many chemists keep 
an ointment or cerate of hamamelis, which for external piles is more convenient to 
use than the lotion. It should be applied to the parts after the morning bath, and 
again after each motion. If you have bleeding piles you may get rid of them 
almost to a certainty by using hamamelis as we have directed. We recently cured 
with this drug a gentleman who had suffered from haemorrhoids for over thirty 
years. He had been an officer in the army, and his complaint was attributable to 
excessive riding. He was for ten years in India and China, and since his return 
had lost blood almost daily. He had been operated on twice without any permanent 
benefit, and had quite given up all hope of obtaining relief. He used the 
hamamelis lotion every morning after his bath, and also after every motion, and in 
less than a week the bleeding had ceased. 

Hydrastis canadensis is another remedy which enjoys a high reputation in the 
treatment of piles. Internal piles, which cause great prostration of strength, and 
are accompanied by various dyspeptic symptoms, giving rise to considerable pain 
during defecation, and frequent attacks of bleeding with a little discharge of mucus 
or matter, are cured, or at all events materially relieved, by the use of hydrastis. 
A lotion is made by adding a tea-spoonful of the tincture of hydrastis to half a pint 
of water, and some of this is injected into the back passage night and morning. In 
addition five drops of tincture of hydrastis are to be taken in a wine-glassful of 
water three times a day. In the case of external piles hydrastis is often of 
great value, the lotion being used three or four times a day, just in the same way 



442 THE TREATMENT OP DISEASES. 

as the hamamelia lotion ; or the drug may be applied in the form of a cerate or 

ointment. 

A tincture made from horse-chestnut (JEsculus hippocastanum) is used for some 
kinds of piles. When the piles are due to congestion of the liver it will usually be 
found to be inferior to nux vomica or sulphur, of which we shall speak presently. 
When the piles are associated with enlarged veins in the legs, and bleed much, 
hamamelis is a better remedy. But when the only associated symptom or appreciable 
cause is a confined condition of the bowels, sesculus is the drug to be employed. 
The dose is three drops of the tincture in a little water every three hours, and a 
lotion or injection may be made by adding two tea-spoonfuls to half a pint of water. 

Nux vomica is useful for piles which do not bleed, especially when the patient 
also suffers from dyspepsia, congestion of the Liver, and confined bowels. From five 
to ten drops of the tincture of nux vomica may be taken in a tumblerful of cold 
water twice a day, half an hour before breakfast and dinner. It usually acts as a 
laxative, and will often overcome the most obstinate constipation. 

In ordinary simple cases of piles it is a good plan to keep the bowels moderately 
relaxed by occasionally taking a tea-spoonful of some electuary, such as confection of 
sulphur or confection of senna. We have already given a formula for a confection 
containing both sulphur and senna (Pr. 59), and this usually answers admirably. 
The old-fashioned sulphur and treacle is as good as anything. These laxatives 
should not be employed when any of the specific remedies for piles, such as hama- 
melis, hydrastis, or horse-chesnut, are being administered. As a local application the 
ointment of galls and opium is extremely useful, and often affords great comfort 
to the sufferer. 

When piles become inflamed, the best remedy is tincture of aconite, a drop in a 
tea-spoonful of water every ten minutes for the first hour, and subsequently hourly 
until the pain subsides. For the excessive pain often associated with piles an 
aconite lotion may be employed in addition to its internal administration, The lotion 
Is made by adding two tea-spoonfuls of the tincture of aconite to half a pint of 
water. 

Sufferers from piles would do well to use what is called medicated paper or curl 
paper. It can be procured in packets at any chemist's. When the piles are very 
painful it may be necessary to use a piece of sponge dipped in cold water. It is 
said, but with what truth we know not, that the printer's ink in newspapers is 
injurious, and by the irritation it causes favours the development of piles. 

Many people who think they have piles are in reality suffering from fissure. A 
fissure is a small chap, crack, or ulcer situated just within the anus, or orifice of the 
boweL It occurs most commonly in women, and especially in those of a weakly 
constitution. The sufferer complains of pain, usually of a severe burning character, 
on the passage of a motion, especially if a hard one ; occasionally it occurs at the 
time of defecation, but more frequently it commences a few minutes afterwards, and 
it may continue for two, four, or even eight hours. This pain is very severe, and 
peculiarly wearing and burning. It L_jy extend all round the hips and even down 
the thighs. Sometimes it gives rise to irritability of the bladder, or even to symp- 
toms similar to those resulting from derangement of the womb Often enough there 



PILES, OS HJEMORRHOraa, 443 



is a good deal of constitutional irritation, the nervous system generally being 
deranged in, as we say, sympathy with the local irritation. The pain produced by 
an evacuation is sometimes so severe that the patient avoids defecation as long as 
possible, and even abstains from food with the view of lessening the necessity for 
the frequency of the act. If you have reason to suppose that you are suffering from 
fissure and not piles, we advise you to consult your doctor at once. We give this 
advice, not because the complaint is a dangerous one, but because it is so situated 
that it would be well-nigh impossible for you to make an application at all satisfac- 
torily without some assistance. It is of little or no use applying to a non-medical 
friend to help you, for the fissure is so small that it would probably escape the 
notice of one untrained in the investigation of such matters. On consulting your 
doctor you will, of course, say at once that you have reason to suspect that you have 
fissure of the anus. There is often a great deal of mock modesty about these 
matters, and the doctor often obtains the required information only after a con- 
siderable amount of beating about the bush. You will find that it will simplify 
matters if you say at once what it is you think you are suffering from. 

Fistula of the anus is another complaint we have known mistaken for piles. It 
usually forms as the result of an abscess, running up by the side of the gut Some- 
times it follows kicks, blows, or bruises on the lower part of the body. Here, again, 
little or nothing can be done without the assistance of a medical man. The mere 
fact of its position renders it almost impossible to treat it without extraneous help. 

Before leaving the subject of piles, we will say a word or two about diet and 
other accessory measures. When the complaint occurs in debilitated persons, benefit 
will be derived from a tonic and nutritious plan of treatment In the great majority 
of instances, however, more particularly when occurring about the middle period of 
life, piles are connected with a plethoric state of the system, and then we recommend 
abstinence from coffee, peppers, spices, and all stimulating and highly-seasoned food. 
In these cases, too, beer, wine, and spirits must be taken in the very strictest mode- 
ration. The best drink — at all events for the summer months — is a light claret 
A liberal supply of well-cooked vegetables, and plenty of ripe, wholesome fruit, is 
enjoined. Sedentary habits, and the habitual use of soft cushions and feather beds, 
undoubtedly favour the formation of piles, and do much to retard the progress of 
a cure. The pain attending piles which do not bleed may often be relieved by 
washing the parts with cold or tepid water. In an attack of bleeding piles, it is a 
good plan, in addition to bathing the part, to drink a tumblerful of cold water, and 
then to He down for an hour or two. The horizontal posture is conducive to recovery. 
In many cases of piles, great relief follows an occasional injection of about a pint of 
water into the lower bowel It acts beneficially by constricting the blood-vessels, 
and it also gives tone to the relaxed tissues, and softens the motions before evacuation. 
When piles are very painful, the unfortunate sufferer may obtain relief by sitting 
over the steam of hot water. When the attack is a very severe one, he may have 
to keep his bed, or recline for the greater part of the day on a couch. People 
troubled with piles often find it a good plan to acquire the habit of going to stool at 
night, immediately before retiring to rest, instead of in the morning, so as to obtain 
the benefit of a long rest in the horizontal position after each motion. 



444 THE TREATMENT OF diseases 



PLEURISY. 

Pleurisy ia a complaint essentially unsuited for domestic treatment, and the 
object of this article is not to teach people how to cure themselves, but to place 
before them certain facts that will enable them to recognise the disease when 
preseni, and to indicate the necessity for obtaining medical assistance. 

By pleurisy we mean inflammation of the pleura, or membrane covering the 
lung. 

The most frequent causes of pleurisy are exposure to cold and wet, sitting or 
sleeping in wet clothes, <fec. Two cases that recently came under our notice will 
afford examples of its mode of production. The first is that of a young man, who 
went to a crowded theatre on Boxing night, and what with the heat and crowd 
and excitement, got drenched with perspiration. At the conclusion of the per- 
formance he stopped talking to some friends at the corner of the street, until he was 
thoroughly cold, and, to use his own expression, " all of a shiver." He went into a 
public-house and had some hot brandy-and-water, but was unable to shake off 
the feeling of chilliness, and the next day he was laid up with a sharp attack of 
pleurisy. The other patient was a clown and gymnast in a travelling circus. One 
night when in the country his " tights " were not sent home from the wash until the 
last moment, and he found they were quite damp. It was almost time for him to 
appear, and he had no chance of airing them before putting them on. He went 
through his performance, but felt cold and chilly from his wet garments, and the 
result was that he, too, got pleurisy, which finally left him so weak and short of 
breath that he was hardly able to walk across the room, much less to amuse the 
public. Sometimes inflammation of the pleura occurs as the direct result of a blow 
or fall on the chest, and sometimes it is excited by the irritation caused by the 
splintered ends of a broken rib. There is reason to think that extreme muscular 
over-exertion, or prolonged public speaking, may produce pleurisy, even in pre- 
viously healthy persons, but these cases must be rare. Not unfrequently pleurisy 
occurs as the result of some constitutional affection, as, for example, scarlatina, 
typhoid fever, or Bright's disease. When it occurs " primarily," that is, as the sole 
complaint, it usually attacks one side only, but when it is secondary to some other 
disease, it is commonly bilateral, both sides of the chest being involved. 

The outset of pleurisy is in most cases marked by sharp, stabbing pains, com- 
monly in the side or beneath one of the breasts, preceded or accompanied by shivering 
or a feeling of chilliness. These two signs, the stitch in the side and the shivering, 
are in themselves sufficient to make us suspect pleurisy ; and should there be, in 
addition, distinct elevation of the temperature as tested by the thermometer, our 
suspicion will be considerably heightened. The pain is usually aggravated by taking 
a deep breath, by coughing, by lying on the affected side, and by pressure. The 
skin is hot and dry, the cheeks are flushed, the pulse is full and quick, there is 
anxiety with considerable restlessness, and the urine is rather scanty and high- 
coloured. The breathing, at the outset especially, and while there is still pain, is 
considerably embarrassed, the movements of inspiration in particular being short, 
hurried, and often interrupted or jerking. The temperature of the body gradually 



PLEURISY, 445 



rises to perhaps 103° F., but this elevation is not persistent, and it quickly falls 
again. Disturbances of the digestive organs, headache, and other symptoms asso- 
ciated with the condition of fever are present more or less. Cough is another of the 
ordinary symptoms, but it does not occur in paroxysms ; it is small, half-suppressed, 
ineffectual, and is dry, or accompanied by very little expectoration. If much frothy 
mucus should be expectorated, it is a sign that there is also bronchitis ; or if rusk 
coloured sputa be brought up, it is an indication that the complaint is complicated 
with inflammation of the lungs. 

The symptoms we have enumerated may be regarded as those of a pretty sharp 
attack occurring in an adult Sometimes, however, pleurisy may come on with 
scarcely a single noticeable symptom to arrest attention, at all events in the early 
stage of the malady. The pain may be vague or fugitive at first, and not become 
fixed and permanent for a day or two. In that case it may be mistaken for simple 
rheumatic pain, for muscular soreness, for pleurodynia, or for what is thought to be 
merely a nervous pain. In children especially, the febrile symptoms are often incon- 
siderable, and the cough is not likely to attract much attention in slight cases. 

"We have said that by the pleura we mean the investing membrane or covering 
of the lung, but we ought perhaps to have explained that it is in reality a double 
bag, consisting of two parts, one of which covers the lung, and the other lines the 
cavity of the chest on the same side. Ordinarily there is no true cavity between these 
two layers, one bag being in contact with the other, and gently gliding over it with 
every movement of the chest and lung. Now, in pleurisy the adjacent surfaces of 
the pleura' get roughened as the result of the inflammation, giving rise to " friction," 
a rubbing or grating noise, which may be heard by the physician when he listens 
to the chest with the stethoscope. The inflammation may subside, leaving the pleura 
uninjured, or the two layers may become more or less adherent, the patient being 
left with permanent shortness of breath, little or much as the case may be. Not 
unfrequently the inflammation results in what may be called dropsy of the chest, 
a clear fluid being poured out between the two bags, so as to surround the lung on 
the affected side. When the fluid is considerable in quantity — and sometimes it 
amounts to several pints — it compresses the lung, so that it cannot expand properly 
during respiration. The physician detects the presence of fluid in the chest by 
means that are simple enough to him, although they may appear somewhat com- 
plicated to those who have not had experience in such modes of investigation. In 
the first place he looks carefully at the chest, to see if one side is larger than the 
other, for it is obvious that if much fluid be present it will cause the chest on that 
side to bulge out. Should the bulging be not very distinct, he may measure the 
two sides with a tape, with the view of detecting the enlargement ; but the practical 
physician, as a rule, trusts rather to his eye and hand than to actual measurement. 
It should be remembered that in many healthy people the right side of the chest is 
somewhat larger than the left, from the greater development of the muscles. Then 
the next thing the doctor does is to place the palm of his hand on the chest, first on 
one side, and then on the other, making the patient speak at the same time. On 
the sound side he feels a vibrating movement, just as you do when you place your 
hand on your own healthy chest, and say, for example, " ninety-nine " in a fairly 



446 THE TREATMENT OF DISEASES. 

loud voice. On the side on which there is effusion nothing of the kind is felt, for the 
fluid fails to conduct the vibration to the chest-walL Then the doctor percusses 
the chest ; in other words, taps it with the tips of his fingers, interposing perhaps 
one or two fingers of the other hand, to prevent the patient from being hurt. On 
the healthy side the blow gives out a clear sound, just as you get when you tap 
with your finger on the upper part of your bared chest. When there is fluid 
present, the note given out is a dull one, similar to that you obtain when you 
strike your thigh in the same way. Often enough the fluid is only sufficient to 
half or a quarter fill the chest on one side, and then the dulness on percussion will 
obviously be only at the lower part of the lung. Finally, the doctor listens to the 
chest with his stethoscope, and hears the air entering the lung on the healthy side, 
but little or nothing where the fluid is. We have described these different modes 
of examining the chest, not that you may practise them yourself, but rather to 
impress upon you the necessity for having the chest thoroughly examined in any 
case in which there is the slightest suspicion of lung disease. Many people put 
absurd difficulties in the way of the doctor, and he is sometimes — wrongly, we are 
sure — afraid to push his point, for fear of offending his patient. Remember that 
in any case of suspected lung mischief it is impossible for the doctor to do you 
justice unless he has an opportunity of thoroughly examining your chest ; and 
remember, too, that often enough he will require to make several examinations 
before giving a positive opinion. Many people seem to think that a physician can 
find out what is the matter with them by listening through their clothes, but it 
cannot be done. You might as well ask him to listen through a brick wall. 

The amount of effusion may to some extent be estimated by the shortness of 
breath, but the best test is the extent of dulness on percussion. In some cases the 
whole of one side of the chest becomes filled with matter, and this is most likely to 
arise in weakly constitutions, or when the inflammation has resulted from injury. 

The disease with which pleurisy is most likely to be confounded is inflamma- 
tion of the lungs. In both affections there are fever, cough, and shortness of breath. 
In pleurisy, however, the temperature is rarely very high at first, whilst in inflam- 
mation of the lungs it may reach 103° or 104° within the first twenty-four hours. 
The feeling of shortness of breath is usually much more distinct in pleurisy than 
in inflammation of the lungs. The cough in pleurisy is short and hacking, but 
attended with no expectoration, or with only the discharge of a little mucus ; 
whereas, when the lungs are inflamed, the expectoration which is present in almost 
all cases soon becomes rusty in colour, and very thick and tenacious. Sharp, stitch- 
like pain in the side is a very frequent characteristic of pleurisy ; whereas, in in- 
flammation of the lungs there is commonly no pain, or it is of a duller and more 
diffused character. It must not be forgotten that the two affections — pleurisy and 
inflammation of the lungs — may coexist. Should a difficulty be experienced in 
making the diagnosis, it is not a matter of any very great moment, for in either 
case the attendance of a doctor is absolutely necessary. 

There is no difficulty in distinguishing between pleurisy and a purely muscular 
pain. In the former case there is distinct elevation of temperature, in the latter 
there is none. A simple thermometrical observation will settle the question. 



FLETTRISY. 447 

Cases of simple pleurisy without effusion usually terminate favourably, and the 
danger to life is small. When effusion has occurred, and there is fluid in the chest, 
the prognosis is far less favourable, and the danger may to some extent be estimated 
by the occurrence of attacks of shortness of breath. Secondary pleurisy is always 
more dangerous than primary. 

Now as to the treatment of pleurisy. Practically it may be summed up in these 
words : " Put the patient to bed and send for the doctor." But as medical 5 
assistance is not always forthcoming at a moment's notice, there are other measures 
that may be adopted pending its arrival. A light diet of gruel, arrowroot, beef-tea, 
and broth, with occasional sips of cold water to allay thirst, will be found beneficial. 
When there is effusion some doctors consider that little or no fluid should be given, 
and cases have recently been published which seem to bear out this view. It is 
important to avoid draughts, but if in bed the patient may be allowed to assume any 
position that is to him most comfortable. Linseed-meal poultices, or flannels wrung 
out of hot water and applied to the chest, often give relief. A flannel bandage 
attached round the chest will moderate the pain by restraining the movement of the 
ribs. Strapping the chest on the affected side, as one would do for broken ribs, 
often affords immediate relief, and the most favourable results have in many cases 
followed this procedure. Ordinary sticking-plaster may be used, and if spread on 
some thick material so much the better. It should be cut into strips from three to 
four inches wide, and sufficiently long to extend from the spine behind to the middle 
line in front These strips should be warmed before being applied, either by 
holding them in front of a fire for a few seconds, or what is better, by drawing their 
backs over a large jug of hot water. Some people dip them bodily into hot water, 
but this is not a good plan, for the patient is very apt to catch cold after it. The 
strips should not be applied horizontally, but somewhat obliquely, the alternate 
layers running in opposite directions. It is best to make the application from below 
upwards, and the patient should be directed to expire deeply as each strip is being 
put on. Each layer should overlap the preceding by about a third of its breadth. 
Finally, it is often desirable to apply over the whole two or three strips horizontally, 
bo as to form a superficial layer, and one or two may also be passed from behind 
forwards over the shoulder, these being kept down by another fixed round the side 
across their ends. It is of course necessary to make this application only on the 
affected side. When this plan is not adopted the chest may be well painted with 
iodine liniment. When the pain is agonising, and resists other and simpler 
treatment, it is quite justifiable to give a hypodermic injection of morphia — say two 
drops of the pharmacopceial solution. 

There are two drugs which may be advantageously administered internally, and 
these are aconite and bryony. Aconite is most useful in quite the early stage of the 
complaint. A drop of the tincture should be given in a tea-spoonful of water every 
ten minutes for the first hour, and subsequently hourly, or Pr. 38 may be used. After 
two or three doses the skin becomes moist, contrasting favourably with the hot dry 
skin, urgent thirst, quick pulse, and general suspension of the secretory functions which 
previously existed. Bryony is especially indicated when there are stinging, shooting, 
or burning pains in the side, aggravated by breathing or movement ; painful dry cough, 



448 THE TREATMENT OF DISEASES. 

or cough with expectoration of glairy sputa ; laboured, short, and rapid respirations ; 
weariness, disposition to retain the recumbent posture, irritability, and restlessness. 
A dose of Pr. 49 may be given every two hours, either alone or alternately with 
aconite. A recent writer says :— "In pleurisy, bryony is an exceedingly valuable drug; 
it is usually in the second stage, in which general pyrexia (fever) has diminished or 
disappeared, but exudation continues, that the best effects of the remedy are seen. 
It is just in those cases in which aconite is so effectively employed in the earlier 
feverish stage that bryony afterwards proves most useful ; it limits the extent of 
serous effusion, and actively helps its removal by absorption." 

Iodide of potassium is a drug frequently given in the treatment of pleuritic 
effusion, with the view of aiding the absorption of fluid, but it is very doubtful 
whether it has any such effect. By many it is considered that the tincture of 
perchloride of iron, given in fifteen-drop doses in a tea-spoonful of water three times 
a day, is a more efficacious remedy. It forms an admirable tonic and restorative in 
the anaemia which often follows an attack of pleurisy. 

In many cases of pleurisy with effusion it becomes necessary to resort to the 
operation of tapping the chest. This plan of treatment has inaugurated a new era 
in the management of these cases, and many lives are now saved which formerly 
would have been inevitably sacrificed. When carefully performed by means of an 
instrument called the aspirator, it is not only devoid of danger, but is practically 
painless. 

PYROSIS, OR WATERBRASH. ■ 

"We have already had occasion to refer to this complaint as a symptom of 
dyspepsia. It is characterised by a burning sensation at the pit of the stomach, 
followed by the vomiting or rather the eructation of a thin watery fluid resembling 
saliva, sometimes sourish, but usually insipid and tasteless, and often described by 
the sufferers as being cold. It is stated that it sometimes occurs without any other 
evidence of dyspepsia, but such is not often the case. It is, however, often a 
symptom of some of the more serious diseases of the stomach. It is a disorder far 
more common in the lower ranks of society than in the upper, and among women 
than men. It is of common occurrence in Scotland, and is there ascribed to the 
large employment of oatmeal as an article of diet. It is said to be even 
more prevalent in Lapland, and is not at all uncommon in "Wales, and in various 
parts of England where the diet is chiefly vegetable. The paroxysms usually come 
on in the morning and forenoon, when the stomach is empty. The first symptom is 
usually a pain at the pit of the stomach, often very severe, and increased on assuming 
the erect posture. The sufferer usually obtains relief by bending the body fore- 
wards. The pain continues for some time, and is then followed by the eructation of 
a thin watery fluid in considerable quantities. A case is recorded in which no less 
than three pints of this tasteless fluid were brought up every day. It has been sup- 
posed that when the fluid is tasteless and insipid it is formed in the mouth or 
throat, and does not come from the stomach at all. When, however, the fluid is 
acid, it may be taken for granted that at ail events some of it comes from the 
stomach. 



FTROfllS, OK WATMKBUASH. 44# 



Next as to the treatment It need hardly be said that when tke disorder has 
arisen from the use of innutritions or unwholesome food, the adoptiom of a more 
generous and varied diet, including a sufficient proportion of meat, is essential 
Many of the rules we have laid down regarding the diet of dyspeptics are applicable 
to the treatment of this complaint. In obstinate cases the most brilliant results 
have followed this prescription : — " When the patient is hungry, let him eat butter- 
milk, and when he is thirsty, let him drink buttermilk. " Fresh milk is not bo well 
borne, as it curdles in the stomach. 

There are several medicinal preparations which are useful in the treatment of 
waterbrasL The compound kino powder of the Pharmacopoeia is an admirable 
remedy. It should be taken in twenty-grain doses three times a day. The only ob- 
jection to its use is that it contains opium, which has a tendency to confine the 
bowels. This difficulty may, however, be readily overcome by administering with it 
some simple purgative, as the watery extract of aloes, confection of sulphur and senna 
(Pr. 59), or the compound colocynth pill (Pr. 60). Bismuth (Pr. 18) usually succeeds 
admirably. If the ordinary dose should fail, thirty grains of carbonate of bismuth 
should be taken three times a day in a little water half an hour before meals. When 
the fluid which regurgitates into the mouth is distinctly sour or acid, nothing 
suceeds like dilute hydrochloric or nitric acid given before food. From twenty to 
thirty drops of either taken in a wine-glassful of water half an hour before each 
meal will, in these cases, usually effect a cure. When the fluid of pyrosis has an 
alkaline reaction, and i3 accompanied by much distress and nausea, and the vomiting 
of the just-eaten food, the acid should be given in the same dose, but just after food 
In some cases mix vomica (Pr. 44) or pulsatilla (Pr. 43) has been known to prove 
usefuL 

In connection with the subject of pyrosis we may mention that rumination occa- 
sionally occurs in the human being. One of the most remarkable cases on record is 
that of a carpenter's apprentice. Although a sharp and intelligent young man, he 
was a " slow eater." In the struggle for existence, he found himself at a consider- 
able disadvantage, for only a few minutes were allowed for meals by an exacting 
and ubiquitous taskmaster. It was obvious that he must either go with insufficient 
food, or swallow it whole and nm the risk of suffocation. Having a natural dislike 
to hunger, he selected the latter course, and in process of time acquired the art of 
swallowing his food in wholesale pieces, and without any attempt at mastication. 
Having finished his meal, he usually repaired to the workship, and no sooner com- 
menced handling the implements of his craft than the regurgitation of the food com- 
menced As a rule, in ten or fifteen minutes after the meal was swallowed it was 
returned in mouthfuls, at intervals of from five to ten minutes, to be masticated and 
again swallowed until the whole contents of the stomach had been similarly served, 
when the abnormal process ceased. This regurgitation was first noticed about the 
age of fifteen, soon after this jolly young carpenter entered on his apprenticeship. 
For the succeeding fifteen years he invariably returned to his mouth all his food, or 
nearly all, until at length, as time rolled on, and as fortune and circumstances im- 
proved, he had more leisure for his meals, and more time for what may be called 
primary mastication, and then this striking, novel, and supplementary process of 
29 



450 THE TREATMENT OP DISEASES. 

nature became modified, and gave way in great part to the more usual, less compli- 
cated process of preparing the food off-hand for admixture with the gastric juice, 
and for the processes of digestion and assimilation. 

QUINSY — INFLAMMATORY SORE THROAT, OR TONSILLITIS. 

This complaint consists essentially of inflammation of the tonsils and adjacent 
parts. 

It is said to occur most commonly among young people, but it is frequently 
enough met with in middle-aged adults. Some individuals appear to have naturally 
a strong predisposition to this disease, and in them the attacks are usually more or 
less periodical, recurring at particular seasons, commonly during the variable weather 
of spring and autumn. The exciting cause is usually exposure to cold or damp, or 
both combined. At some seasons it is so prevalent that it might almost be said to 
be epidemic. At one time it was supposed to be contagious, but there is not the 
slightest evidence to show that such is the case. One attack usually predisposes to 
another. 

The symptoms vary very much in different cases, according to the extent of the 
disease and the parts involved In all but very mild attacks the invasion of the 
complaint is marked by a general feeling of malaise, by headache, and aching pains 
in the limbs, and a sense of chilliness, or even distinct rigors. The constitutional 
symptoms are usually severe, the temperature rising to 102° Fahr., and the pulse 
reaching 120 beats in the minute, or even more. The skin is moist, the tongue is 
covered with a thick yellowish creamy fur, and there is often headache. The bowels 
are confined, and there is generally much restlessness, particularly at night. 

The local symptoms keep pace with the constitutional disturbance. At first a 
little dryness or uneasiness in the throat is experienced, but this gradually increases 
until it amounts to severe pain. Swallowing soon becomes very dim cult and 
extremely painful, the pain shooting up towards the ears. There is considerable 
tenderness behind the jaws, and on this account some difficulty may be experienced 
in opening the mouth. The glands of the neck become enlarged and hardened, and 
very frequently the whole neck itself is stiff and swollen. Later on swallowing 
becomes still more difficult, fluids return through the nose, and the throat feels as if 
it were completely blocked up. The speech is altered, and is not uncommonly thick, 
guttural, and inarticulate. There is often more or less deafness on one or both sides, 
particularly if the tonsils are much enlarged. In some instances there may be a 
sense of suffocation on lying down, but in adults this is not common. 

If the tongue be depressed with the handle of the spoon so that the back of the 
throat may be examined, it will be found to be redder than natural, and the tonsils, 
greatly enlarged, will be seen projecting, perhaps to such an extent as almost to 
meet in the middle line. 

In mild cases the inflammation may gradually subside, but far more frequently 
it runs on to the formation of matter. After a few days a pale yellowish spot is 
seen on the surface of the tonsil, indicating the point at which the matter tends to 
escape. The abscess usually bursts during some effort made by the patient to 



QUINSY — INFLAMMATORY SORK THROAT, OR TORBTLLTim 451 

coughing, swallowing, or clearing his throat. The matter discharged has usually a 
fetid odour, and a disagreeable taste. Sometimes this circumstance alone indicates 
to the patient what has happened, for the quantity of matter may be so small as 
readily to escape notice. The relief which ensue* on the bursting of the abscess is 
very striking. The pain almost at once subsides, and the difficulty in swallowing is 
in a great measure removed. Although both tonsils may be affected, usually matter 
forms in only one of them. 

Quinsy is a very disagreeable complaint, but fortunately it is attended with 
little or no danger. Common as it is, death from this cause is almost unknown. 
The duration of an attack is usually some five or six days, but occasionally it will 
keep the patient in bed, or at all events in the house, for ten days or longer. 

Next, as to the treatment of quinsy, the remedy par excellence is aconite. It 
should be given in half -drop or drop doses of the tincture in a little water every ten 
minutes or quarter of an hour for two hours, and afterwards hourly. If there is 
much prostration, with weak and feeble pulse, a smaller dose should be given. The 
medicine may be conveniently administered in the form of the aconite mixture 
(Pr. 38), every tea-spoonful of which is equivalent to about a drop of the tincture. 
Aconite, if given in the early stages of quinsy, acts like a charm. The dry, hot, 
burning skin becomes in a few hours comfortably moist, and in a little while longer 
is bathed in a profuse perspiration, the sweat not uncommonly standing on the face 
and chest in large drops. With the sweating comes speedy relief from many of the 
most distressing sensations, as restlessness, chilliness, heat and dryness of the skin, 
aching pains and stiffness. At the same time the quickened pulse becomes far less 
frequent, and in a period varying from twenty-four to forty-eight hours both pulse 
and temperature regain their natural state. If caught at the commencement, 
a quinsy or acute sore throat seldom fails to quickly yield to this treatment. The 
sweating may continue for a few days after the decline of the fever. If administered 
sufficiently early, the beneficial effects on the local symptoms are very striking. 
The large, livid, red-glazed, dry tonsils within twenty -four hours present an appear- 
ance indicating that the acute stage of inflammation has subsided. Just at this 
point a strong astringent, such as glycerine of tannin, applied well to the inside of 
the throat by means of a brush, will quickly remove most of the remaining unhealthy 
appearances, and also any pain that may still be lingering. 

There are several different forms of sore throat, but it is only in those cases in 
which the patient is feverish that aconite does good. In the ordinary relaxed sore 
throat its administration is useless. Directly you get a Bore throat, pull out your 
thermometer and take your temperature. If you find it elevated, you know that 
your remedy is aconite ; if you find that it is normal, you know that aconite will do 
no good. In the treatment of inflammation, and more especially of inflammation of 
the throat, the thermometer and the aconite bottle should go hand in hand. 

Belladonna is a useful remedy in quinsy. It is chiefly indicated when there are 
bright redness and rawness of the affected parts, with flushed face, glistening of the 
eyes, headache, and pain and difficulty in swallowing. The tincture of belladonna 
should be given in the same way and in the same doses as the tincture of aconite. 
The belladonna mixture may be used (Pr. 39). We prefer, as a rule, not giving this 



452 THE TREATMENT OF DISEASES. 

remedy until the patient has taken aconite for some twenty-four hours or more. In 
many cases, however, the two remedies may be associated ; they are not to be mixed, 
and they are not to be given together, but alternately — a dose of aconite one hour, a 
dose of belladonna the next, then again the aconite, and so on. 

In certain conditions of quinsy the influence of grey powder is most marked. 
Pr. 71 may be employed, a powder to be taken every two or three hours. It is 
especially indicated when the tonsils are so enlarged as almost to meet ; when the 
difficulty in swallowing is almost insuperable, and when the obstruction to breathing 
is so great that the patient seems to be in danger of suffocation. In these cases 
it acts like a charm, the swelling quickly subsides, and in a few hours the 
crisis is passed. Even when matter has formed, its maturation and evacuation 
are facilitated. 

Grey powder is not usually required quite at the commencement of the attacks. 
In many cases our treatment of quinsy runs as follows : first a course of 
aconite, then one of belladonna, and finally one of grey powder. The indications 
for each of these remedies should be carefully considered 

Another good medicine, when matter has distinctly formed, is sulphide of 
calcium. It should be given in the form of the pilules (Pr. 68), one every 
quarter of an hour for the first hour, and then hourly for five or six hours. 

Carbonate of baryta in small doses has been highly recommended in the 
treatment of quinsy. It must be given early, before matter has formed, and it 
is essential to give it frequently. 

Guaiacum is a capital remedy for tonsillitis. Send to your chemist for a 
naif-pint bottle of guaiacum mixture, and take three table-spoonfuls every four 
hours. It is distinctly nasty, but you must not mind that. It is essential to 
take the full quantity, for small doses do hardly any good. In the case of 
children, who have frequently very decided opinions as to the inadvisability of 
taking nasty medicines, it may be better to give small doses of the aconite 
mixture, which is perfectly tasteless. It has been said that guaiacum proves of 
service only in "rheumatic" sore throat. This is not the case, for it answers 
admirably in ordinary quinsy. 

Next as to the general treatment, and the accessory measures to be employed. 
The first thing is to go to bed — there's no help for it, and there's not a bit of 
good your trying to keep about, you'll only make yourself worse, and, perhaps, 
be laid up for a fortnight. You must go off to bed at once. No, presently 
won't do, every hour is of importance. You must have a hot-water bottle in 
the bed, and the fire must be lighted. Put the kettle on the hob, so that the 
steam may escape into the room and keep the air moist. You must have 
the window open for a good inch at the top, or the room will get abominably 
stuffy, and that's the worst thing in the world for a sore throat. Shall you 
send for a doctor? No, you'll get on very well if you will only keep your 
wits about you. Where's your tincture of aconite bottle? Haven't you got 
any? Then you ought to have. Send to the chemist's for it without a 
moment's delay. No, don't go yourself; you are not to go out on any account 
And just say, if you please, that you will feel obliged if the chemist will let 



RELAXED SORE THROAT. 453 



you have it at once, as it is a matter of importanca Says he will send it 
round by-and-by, does he? Nonsense, that will never do, you must have it at 
once ; it is no use sending medicine for people after they are dead and buried ! 

And what else is there to be done? You had better get some clear ice 
and have it broken up into little lumps about the size of a small walnut, and 
then set to work and suck it. It is very beneficial in many diseases of the 
throat, but especially in tonsillitis. It helps to subdue the inflammation, and is 
at the same time very grateful, for it allays the heat and pain, and checks the 
abundant secretion of mucus, which is often so harassing, from the constant 
hawking and swallowing which it occasions. You must keep on sucking the 
ice as constantly as you can, and must not give it up till you are distinctly 
better. You can't get any ? Well, it is rather a bother sometimes in the 
country. What are you to do 1 ? You must use warm applications instead of 
cold then — that is alL You may put on a good hot linseed-meal poultice, 
right across the front of the throat, extending from ear to ear. Then you 
should inhale the steam of hot water. If you haven't a proper inhaler, an 
ordinary jug will do perfectly welL Get it filled with hot water, and put 
your mouth over the top, and breathe away. You had better put a towel round 
the mouth of the jug, and then you will not burn your face. If you try inhalation 
in bed, mind you do not by a sudden movement upset the jug. Boiling water 
applied to the legs undoubtedly acts as a powerful temporary stimulus, but it is 
not a method of treatment of any service in tonsillitis. 

Very frequently a warm milk-and-water gargle proves very soothing. A well- 
known medical writer says : " The only gargle which I should consider admissible 
in the commencement of the malady is a gargle of warm milk-and-water. I have 
known of one instance in which quinsy suddenly attacked a gentleman who was 
extremely anxious to use his throat in public speaking the next day. He occupied 
himself perpetually for some hours in this sort of fomentation of the tonsils with 
hot water, and with such good effect, that on the day following he was able to 
accomplish his object." Some people use a gargle of vinegar and honey, whilst 
others devote their energies to sucking saltpetre balls. And what about calomel ? 
Isn't calomel the right thing to begin with? No, certainly not; if your bowels are 
confined you may get them open by some simple purgative if you like, but that is 
all you want. Nine times out of ten, if taken sufficiently early, aconite or guaiacum 
will effect a cure. If there is much shortness of breath the doctor had better be 
sent for, as the enlarged tonsils may be causing some obstruction, and it may be 
necessary to make a little prick in one of them to let the matter out. 

RELAXED SORE THROAT. 

Tli is may either be the sequel of an acute sore throat, or it may make its 
appearance quite independently of any previous febrile disease. 

It occurs most frequently in people of somewhat feeble constitution and 
sedentary habit. It is often caused by excessive indulgence in smoking. 

The symptoms complained of are chiefly uneasiness at the back of the throat, 



454 THE TREATMENT OF DISEASES. 

increased by swallowing, and a slight, dry, hacking cough. Impediments in speech, 
or alterations of voice, are not common, and difficulty in swallowing is -still more 
rare. 

On examining the throat by the aid of a looking-glass it will be found to be 
more or less relaxed and swollen. The uvula is usually much elongated, so that it 
bends down and touches the back of the tongue, keeping up a constant sensation of 
tickling, and giving rise to the slight hacking cough. 

This is not a febrile complaint, and there is consequently no constitutional 
disturbance. The pulse and temperature are normal, and there is neither headache nor 
loss of appetite. The patient may be a little pulled down, but this is more likely to 
be one of the factors in the production of the complaint than a result of it. 

A relaxed sore throat is by no means an easy thing to get rid of. It often hangs 
about week after week, nothing apparently doing it any good. 

In most cases it depends on what we call " debility," or " want of tone," of the 
whole system, and until this is remedied local applications are not likely to do much 
good. In most cases the general health may be improved by the administration of 
the ammonia and bark mixture (Pr. 13). It is a powerful tonic, but its action 
should be aided by taking three or four glassfuls of good port wine daily. Sometimes 
more benefit would be obtained from the quinine mixture (Pr. 9). When there is 
marked anaemia, one of the astringent preparations of iron, such as Pr. 1 or 2, 
may prove of service. The phosphate of lime and iron powders (Pr. 77) are in many 
cases useful 

It is very essential that plenty of out-door exercise should be taken, and the 
patient should remain in the house as little as possible. On a summer's afternoon 
or evening, a run up the river on one of the boats is an excellent tonic. 

Elongated uvula occurring from long-continued and repeated attacks of inflam- 
mation, and from general relaxation of the fauces, especially in follicular disease of the 
throat, causes an inclination to cough and to vomit, sometimes difficulty of swallowing, 
a feeling as if there was a body at the back of the throat to be constantly swallowed. 
When arising from relaxation, which is one of the causes of its annoyance to singers 
and public speakers, it can be restored to its natural healthy condition by astringent 
gargles and attention to the general health. 

Next, as to local applications. Undoubtedly one of the best, if not the best, is 
glycerine of tannin. Get a bottle of it from your chemist, and a brush. Sit down 
in a chair with your mouth wide open, and get some good-natured friend to 
thoroughly swab out the back of your throat for you with this application. Have 
this done for you two or three times daily for three or four days. If the condition 
of your throat keeps you awake at night, get it done at bed-time as welL It is 
a powerful astringent, as you will probably find out. It will quickly cure a cough if 
this has been kept up by the irritation of an elongated uvula. This method of 
treatment is often followed by the most satisfactory results. Tannin lozenges or 
red-gum lozenges are sometimes used, but they are not at all equal to glycerine of 
tannin. 

When the throat is dry and glazed, guaiacum lozenges often answer well ; one or 
two should be taken occasionally. A gargle made by adding a drachm of tincture of 



RHEUMATIC FEVER, OR ACUTE RHEUMATISM. 455 

capsicum to half a pint of water will be found useful It should be employed three 
or four times a day. Pr. 84 is a good one. An alum gargle is often recommended, 
but it is far inferior to the glycerine of tannin. 

The inhalation of steam impregnated with some stimulating volatile principle is 
of the greatest service. An excellent formula is, three drachms each of creosote 
and glycerine added to three ounces of water ; a tea-spoonful to be added to a pint 
of hot water and the steam inhaled for five minutes twice or three times a day. 

In chronic sore throats spray inhalations often prove very usefuL The following 
ingredients are most to be recommended : — 

(1) Alum ... 15 grains to the ounce of water. 

(2) Tannin . . .15 grains „ „ „ 

(3) Perchloride of Iron 1 grain „ „ ,, 

(4) Sulphate of Zinc . 5 grains » » » 

The quantity of either of these solutions to be used at each inhalation is two or 
three tea-spoonfuls. They are all astringent, and we are unable to say which should 
be employed in any particular casa 

If you are suffering from sore throat you should either temporarily give up 
smoking or should smoke in the very strictest moderation, for it will be remembered 
that the smoke of tobacco almost constantly comes in contact with the soft palate, 
the tonsils, and the pharynx ; if chewing is the preference, the juice equally 
influences the same parts, by lubrication during the act of swallowing. 



RHEUMATIC FEVER, OR ACUTE RHEUMATISM. 

Rheumatism may occur either as an acute or as a chronic disease. When it 
occurs in the acute form we call it acute rheumatism, or rheumatic fever. 

Rheumatic fever is in this country one of our commonest, most painful, and in 
some respects most perilous diseases. It is perilous, not because it kills the sufferer 
outright, but because it too frequently lays the foundation of heart disease. 

The commonest exciting cause of rheumatic fever is cold or cold, and wet 
combined. A young man goes out for a walk, gets wet through, comes home, 
neglects to change his clothes, and sits about in his wet things, gets a chill, and a 
few days after is taken ill, and is found to be suffering from acute rheumatism. 
This is a common story, and one which is familiar enough to every one who has seen 
much of sickness and suffering either in the wards of our hospitals or in the privacy 
of home lifa There are, of course, differences in detail : one person gets overheated 
and sits in a draught, another is put into damp sheets, and so on, but the principle 
is the same. Scarlet fever is sometimes followed by a complaint which, if not 
identical with rheumatic fever, very closely resembles it It is probable that the 
eruption of scarlet fever, by arresting the functions of the skin, acts in very much 
the same way as does exposure to cold and wet. In a certain number of cases of 
rheumatic fever the patient i3 unable to attribute the complaint to any definite 
cause, and it is probable that when there is a strong family predisposition it may 
arise, as we say, spontaneously. 



458 THE TREATMENT OF DISEASES. 



Rheumatism, both in the acute and chronic forms, is probably an hereditary 
disease, but this influence is far less marked than in the case of gout. 

Rheumatic fever is principally a disease of youth, and in this respect again it 
differs essentially from gout It is found to occur most commonly between the ages 
of sixteen and twenty. 

It is rather more common in men than in women. 

Its development is favoured by anything which lowers the general state of 
health. It is partly from this cause, and partly from the fact that they are more 
constantly exposed to wet and cold, that rheumatic fever occurs most frequently in 
those who are poor and ill-fed, and whose lot it is to toil 

Rheumatic fever is always most prevalent in climates remarkable for damp and 
variable weather, and it is consequently not to be wondered at that it is a very 
common disease in many parts of this country. 

We must now proceed to consider the course of an ordinary attack of rheumatic 
fever. "We have already supposed the case of a young man suffering from acute 
rheumatism as the result of exposure to wet and cold. What happens to him 1 At 
the time he probably experiences some kind of chill or rigor, although it need not of 
necessity be very severe. Two or three days after he feels feverish, and finds that 
some of his joints are affected. His temperature is high, his pulse rapid, and the 
whole surface of the body hot and bathed in perspiration, having a peculiar acrid or 
acid odour. His tongue is coated with a thick creamy fir, there is loss of appetite 
and usually increased thirst, with constipation of the bowels. The urine is scanty 
and high-coloured, and gives rise to a copious red deposit on cooling. The ankJes, or 
perhaps the knees, are painful and powerless to bear the weight of the body ; on 
examination they are found to be hot, tender, swollen, and somewhat flushed on the 
surface. 

When the disorder is at its height it is difficult to conceive a more complete 
picture of helplessness and suffering than that to which the patient is reduced. A 
strong and powerful man generally unused to illness lies on his back motionless, un- 
able to raise his hand to wipe away the drops of sweat which flow fast from his brow 
in the paroxysms of pain, or the mucus which irritates his nostrils. Indeed, he 
is so helpless that he has not only to be fed, but to be assisted at every operation of 
nature. The sweat in which he is drenched brings him no relief ; his position admits 
of no change ; if he sleeps, his sleep is short, and he awakes with an exacerbation 
of pain which renders him fretful, impatient, and discontented with his lot and 
all around him. 

The duration of an attack of acute rheumatism is very variable, but it lasts, as 
a rule, for about twenty-one days. There is probably no disease which is more 
variable in its duration than rheumatic fever. Some people get over an attack in 
five or six days, whilst others take as many weeks before they can succeed in com- 
pletely throwing it off The pain, redness, and swelling of the joints gradually sub- 
side, the temperature fails, the sweating diminishes, the tongue becomes clean, and 
after a time the patient is pronounced convalescent. 

So far we have considered only a simple case of rheumatic fever, iu which the 
inflammation has been limited to the joints. In a large number of cases the 



RHEUMATIC FEVER, OR ACUTE RHEUMATISM. 457 

extends to the pericardium, or bag or membrane which encloses the heart, 
giving rise to the disease which we call "pericarditis." This inflammation may 
result in the formation of a quantity of fluid in the pericardium surrounding the 
heart, and then we have a condition of " pericardial effusion." Frequently the in- 
flammation attacks the endocardium, or membrane lining the heart, and then we 
have what is called " endocarditis." Sometimes the substance of the heart itself is 
attacked, and then we have that condition which we speak of as " myocarditis." 
In fact, in nearly all cases in which there is pericarditis or endocarditis there is 
more or less myocarditis. The occurrence of these complications is a matter of very 
serious moment to the patient. Sometimes they set in with pain and tightness in 
the chest, but they may come on quite insidiously, and without anything to attract 
attention to what is going on. The medical man can always detect their existence 
by carefully listening over the region of the heart, and it is for this reason that he 
is always so particular to examine the chest with his stethoscope every day. Were 
he not to take this precaution he would have very little real knowledge of the 
progress of the case. 

Pleurisy sometimes occurs as a complication of rheumatic fever, but far less com- 
monly than heart disease. 

The inflammation in rheumatic fever is seldom confined to one joint, but shifts 
about in the most erratic manner. This morning, for example, the pain may be 
confined to the right knee, a few hours later it may have entirely subsided, whilst 
before night it may re-appear in the corresponding joint on the opposite side," or 
perhaps in the ankles or wrists. This " metastasis," as it is called, is always a 
marked feature of acute rheumatism. In the majority of cases in the first attacks 
only the larger joints of the body are affected. 

The pain in the joints is generally very severe, but less intense than in gout. A 
humorous Frenchman, endeavouring to convey his idea of the relative pains of gout 
and rheumatism, once said, " Place your joint in a vice, and screw the vice up until 
you can endure it no longer. That may represent rheumatism. Then give the 
instrument another twist, and you will obtain a notion of gout." 

The temperature of the body, as estimated by the thermometer, is usually 
elevated by some three or four degrees. The rapidity of the pulse is in acute rheu- 
matism no guide to the amount of fever, as the existence of heart disease as a 
complication would tend to influence its rate. To arrive at a knowledge of the 
amount and severity of the fever it is absolutely necessary to employ the 
thermometer. 

The smell of the perspiration in this complaint is very characteristic, and will 
often enable the practised observer to make a shrewd guess as to the nature of the 
illness from which the patient is suffering before asking a single question. 

A person who has once suffered from rheumatic fever is very likely to suffer from 
it again. The occurrence of one attack imparts a great susceptibility to the system 
for its return, and this is increased with every successive attack, so that after a time 
the patient is liable to become the victim of frequent seizures. It very commonly 
happens that the second and third attacks are less severe than the first. 

Sometimes the disease assumes a sub-acute form, intermediate in its characters 



458 THE TREATMENT OP DISEASES. 

between chronic rheumatism and rheumatic fever. In these attacks there is usually 
slight swelling, heat, and tenderness of the joints, but there is very little, if any, 
fever. Even in patients who have suffered long and severely from repeated attacks 
of acute or sub-acute rheumatism it is unusual to find that any deformity or alteration 
in the shape of the joints has been produced. 

We have already had occasion to refer incidentally to some of the chief points 
in which gout and rheumatic fever differ. It is, however, a matter of convenience 
to have these facts arranged in a tabular form. It is of the greatest importance to 
be able to distinguish the two diseases, for gout is readily amenable to the influence of 
colchicum, whilst acute rheumatism is but little influenced by its administration. 

Differences between Gout and Acute Rheumatism. 

Gout. Acute Rheumatism. 

Age. —Occurs most commonly in people over Occurs most commonly in young people, 

thirty. 

Sex. — Occurs much more frequently in men Occurs with almost equal frequency in the 

than in women. two sexes. 

Hereditary. — Is decidedly hereditary. Is hereditary, but not very decidedly. 

Social Condition. — Occurs most commonly in Is the lot of the poor and ill-fed. 

those who live luxuriously. 

Joint. — In earlier attacks usually affects only Usually attacks the larger joints of the body, 

one joint at a time, and most commonly the and frequently several at once. 
great toe. 

Chalk-stones. — Often associated with the for- Never leads to the formation of chalk-stones. 

mation of chalk-stones. 

Perspiration. — Profuse perspiration not com- Profuse acid perspiration a prominent 

mon. symptom. 

Heart. — No tendency to inflammation of the Heart frequently affected, 

membranes of the heart. 

We must now consider the course of treatment to be adopted in cases of rheu- 
matic fever. As this is not a contagious disease, there is of course no necessity for 
isolating the patient. The usual precautions should be taken for ensuring cleanliness 
and thorough ventilation of the room and all that it contains. The chief points to 
which attention should be directed have been referred to whilst speaking of the 
general treatment of fever. The patient must, of course, be confined to bed, and 
should be kept as quiet as possible both physically and mentally. As profuse perspi- 
ration is a prominent symptom of the complaint, the sufferer should lie between the 
blankets, and not in the sheets. Linen which is wet or damp is apt to strike cold, 
and is not only unpleasant, but very likely to prove dangerous to the patient A 
sudden check to the perspiration cannot fail to be injurious, and may even lead to 
a rapid transference of the inflammation from the joints to the heart It should 
always be remembered that rheumatic fever is a very painful complaint, and that 
the touch of the physician, the handling of the nurse, or even the shaking of the bed 
by the footstep of an approaching friend, may cause the sufferer the most exquisite 
pain. 

Respecting the diet there is little to be said. When the fever runs high, food 



MI1UMATIC FEVER, OK ACUTE RHEUMATISM. 459 

can be advantageously given only in the liquid form. Milk is one of the best kinds 
of nourishment which can be administered for the maintenance of the strength. 
When it is not readily assimilated, and proves too heavy for the stomach, it may 
be advantageously mixed with an equal quantity of soda water or with lime water. 
Besides milk, beef-tea, mutton-broth, jellies, arrowroot, and other similar easily 
digestible substances may be given. To alla\ the thirst, soda water, lemonade, 
toast-and-water, or even plain iced water will be found useful. Wine or brandy 
is in young people seldom required, unless indeed there be much depression, as the 
result of heart mischief. 

As the fever abates, a more generous diet may be allowed, commencing with 
light rice or sago or arrowroot puddings, and gradually progressing to white fish 
and fowl, and then to beef and mutton. The more the strength of the patient can 
be maintained, the less tedious will be the recovery. 

A large number of different drugs have been recommended for the treatment of 
acute rheumatism — a fact which may be taken as an indication that we are at present 
acquainted with no specific for the disease. 

The nearest approach to a specific for acute rheumatism will be found in salichie, 
a substance obtained from the willow. It should be given in thirty-grain doses in an 
ounce of water every two hours, according to Pr. 12. In very bad cases it may be 
given every hour until the pain is relieved. Very much larger quantities have been 
given without the production of any inconvenience. Given quite at the commence- 
ment of the illness, it will sometimes quickly cut short an attack. In cases in which 
it does good the beneficial action is usually apparent within twenty-four, and always 
within forty-eight, hours of its first administration. In acute cases the relief of 
pain and the fall of temperature usually occur simultaneously, but in sub-acute 
cases the pain is sometimes decidedly relieved before the temperature begins to fall. 
It has been claimed for salicine that it prevents the occurrence of heart disease, 
but the evidence on this point is inconclusive. Although this drug proves beneficial 
in the large majority of cases of acute rheumatism, it sometimes fails. In cases in 
which benefit has been experienced from its administration, it should be continued 
in twenty-grain doses every four hours for a week after the temperature has fallen 
to the normal. The influence of salicine on the temperature in acute rheumatism 
will be seen by reference to the chart given in the article on Temperature. 

Salicylic acid has also been used in the same way as salicine, but it is very 
insoluble in water, is very nasty to take, and is not readily obtained pure. The 
only advantage it appears to possess over salicine is that it is cheaper. 

Aconite has been highly praised by many eminent authorities in the treatment of 
acute rheumatism, and there can be no doubt of its usefulness. In many cases, however, 
it must be admitted that its administration appears to be ineffectual It is especially 
indicated when the fever is high and there are violent shooting or tearing pains, 
worse at night, and aggravated by the touch. The most successful results are 
obtained when it is administered quite at the commencement of the disease. The 
aconite mixture (Pr. 38) may be used, the dose being a tea-spoonful every second or 
third hour. This is not at all equal to the salicine treatment. 

Bryony may be given when the patient suffers from lancinating or stitching 



460 THE TREATMENT OF DISEASES. 

pains, apparently affecting the muscles rather than the bones, and increased on the 
least movement, but improved by rest. It may be given according to Pr. 49. 

When the pain in acute rheumatism is very severe it may be necessary to 
administer opium. A small dose of laudanum may be given by the mouth, but in 
the majority of cases a hypodermic injection of morphia will not only act more 
quickly, but will be less likely to upset the stomach. It must be remembered that 
opium is merely a palliative, and in all probability exerts no influence on the progress 
of the disease. 

Small blisters in the neighbourhood of the affected joints often prove efficacious 
in relieving the pain. 

By some people the administration of nitre in rheumatic fever is supposed to be 
attended with favourable results. As much as two or three ounces of the salt, dis- 
solved in plenty of water, have been taken in the twenty-four hours without causing 
any inconvenience ; but it must be admitted that there is no conclusive evidence to 
show that these large doses do any good. A great objection to their use is that un- 
less the perspiration is very profuse patients are unable to take the large quantities 
of fluid in which the salt must, of necessity, be dissolved. 

Bicarbonate of potash has been frequently given in thirty-grain doses every four 
hours. In many cases it relieves the pain, but it is unavailing in lessening the 
intensity or duration of the fever. 

Large doses of tincture of perchloride of iron — from twenty to thirty minims 
every four hours — are sometimes given, but we are at present unable to express any 
definite opinion as to the value of this mode of treatment. 

In some cases benefit has been derived from the administration of lime-juice in 
doses of eight ounces daily. 

Colchicum is useless in this disease. 

There can be no question as to the value of the cold pack in acute rheumatism. 
When the pain is too great to admit of the patient being moved, the front only of 
the body should be packed, and a cold compress, renewed every two or three hours, 
should be wrapped round each of the painful joints. In cases in which there is a 
prejudice against the cold pack the body should be thoroughly sponged with tepid or 
cold water several times a day, using soap if the perspiration is offensive. There is 
not the slightest fear of increasing the liability to heart mischief by tho adoption of 
this method of treatment. 

It will be seen from what we have said that there is great discrepancy of opinion 
respecting the treatment of acute rheumatism. Some doctors have even gone so far 
as to assert that all remedies are useless, probably assenting to the dictum of a cele- 
brated physician, who, when asked what was good for rheumatic fever, replied, "Six 
weeks." It should be remembered, however, that that was before the days of 
salicine. 

Individuals who have once suffered from rheumatic fever must be extrei lely 
careful as to their clothing ; they should always wear a flannel vest and drav srs, 
which may vary in thickness at different periods of the year. The feet should be 
kept dry and warm, and every precaution taken to avoid catching cold. 

In all cases of rheumatic fever the attendance of a medical man is necessary. 



RHEUMATIC GOUT. 461 



In conclusion, we should -wish to say on* word of comfort, and that is, that 
however bad the attack of rheumatic fever may be, and even when it is complicated 
by heart disease, it seldom or never proves immediately fatal, and the patient is 
almost sure to get over the illness. 



RHEUMATIC GOTO 

The term " rheumatic gout " is one which is employed some, hat loosely both by 
medical men and the public. It is not uncommon to hear gouty people say that they 
are suffering from rheumatic gout, simply because the disease which for years wag 
manifested in the feet only now implicates other joints, as the elbows and hands. 
In fact, the same malady is often regarded as gout when it is confined to the feet, 
and as rheumatic gout when it affects the upper extremities. Sometimes the sub- 
acute forms of rheumatism are improperly called rheumatic gout, particularly when 
they affect the upper extremities. There is, however, a third disease which is 
neither gout nor rheumatism, but quite distinct from both, and it is this which it is 
our intention to discuss under the term of rheumatic gout. The ordinary technical 
term for this complaint is "rheumatic arthritis," but it is sometimes known as 
u nodosity of the joints." 

True rheumatic gout may occur either as an acute or as a chronic disease, but 
as the latter form is much the more common, it is to this that our attention will be 
principally directed. 

Chronic rheumatic gout may occur in either sex, and at almost any age. The 
ordinary course of the disease is somewhat as follows : — A young woman who is 
decidedly out of health, perhaps as the result of over-work and confinement to the 
house, catches cold, and after a few days experiences some pain in one of her knees, 
and on examination slight swelling and tenderness are detected. As the result of 
rest and judicious treatment, the pain subsides, and no more is thought of the matter. 
A few weeks later, or it may be months, the patient catches another cold, and the 
same or another joint is affected in a precisely similar manner. On this occasion, 
however, treatment is apparently of no avail, and the inflammation, instead of sub- 
siding, gradually spreads to other parts. After a time almost every joint in the 
body may be affected, the complaint causing great distortion and deformity. These 
changes take place slowly, and may be attended with but little disturbance of the 
general health. In confirmed cases the hands are usually thin from the absorption 
of fat and the wasting of the soft tissues, and the knuckles are greatly enlarged so 
as to form big lumps, or nodes ; sometimes the fingers are so bent and distorted one 
over another that they are, for all practical purposes, useless. The elbow in many 
cases cannot be straightened, and the wrists are rigid, and scarcely admit of motion 
in any direction. The knee is commonly, much enlarged and rounded, and is often 
bent with difficulty. Sometimes, in very bad cases, the patient is rendered helpless 
and a cripple for life. 

When the disease commences in the acute form, it closely resembles rheumatic 
fever ; several joints are attacked, the swelling is considerable, and there is 
distinct increase in the temperature of the affected parts, with pain, tenderness, 



462 THE TREATMENT OF DISEASES. 

and redness. In this complaint the profuse sweating which is so prominent a 
symptom of rLeumatic fever is entirely absent, and the inflammation exhibits 
no tendency to fly from joint to joint, or to attack the heart or its membranes. 

Rheumatic gout, as we have seen, is not a disease which is confined to any 
particular age. It sometimes occurs in children of from ten to twelve, and 
has been known to commence in very old people, above seventy. It is 
commonly thought that women are more likely to be attacked than men, and 
it is a recognised fact that any irregularity in the menstrual functions 
predisposes to its occurrence. It is not hereditary, a point in which it differs 
very markedly from gout. Everything which causes debility, or loss of tone 
in the system, as, for example, an attack of bleeding from the womb or else- 
where, deep or prolonged grief, or severe or protracted mental anxiety, acts as a 
predisposing cause of the disease. It is said in some cases to have resulted 
from rapid child-bearing, and from over-suckling. Cold is frequently an 
exciting cause, particularly if combined with depression of the functions of the 
nervous system. Malt liquors and wines exert no influence on its production. 

It is of the greatest importance to be able to recognise the nature of the 
disease in cases of rheumatic gout, for upon its correct understanding often 
depends the future comfort and physical well-being of the unfortunate sufferer. 
It is often, too often, mistaken either for gout or rheumatism. From an 
attack of acute gout it may be distinguished by the duration of the complaint, 
by the large and small joints being equally attacked at the onset, by the 
great toes not being specially involved. Rheumatic gout is a progressive 
disease; it has no intermissions, for during the whole of the patient's life the 
nodes go on gradually enlarging, and impeding more and more the motions of 
the limb. The malady spreads from joint to joint without any alleviation 
in those which have been once attacked. In very chronic cases it is often 
only from the history of the onset that one is able to distinguish gout from 
rheumatic gout. In chronic rheumatism one seldom meets with the distortion 
of the joints which is so characteristic of the complaint now under consideration. 

We must now consider the best method of treating this disease. It must 
always be borne in mind that it is a very intractable disease, and that in many 
cases all treatment proves unavailing. The most favourable cases for treatment 
are naturally those in which the disease is not far advanced, the affected joints 
few in number, and their mobility but partially interfered with. When treatment 
is resorted to quite at the commencement of the complaint, the disease may 
sometimes be eradicated from the system and a complete recovery may be the 
result. 

In all cases a sustaining plan of treatment is imperatively demanded. All 
lowering treatment tends materially to increase the rapidity and severity of 
the disease. Colchicum, which does so much good in gout, is worse than 
useless, hence the importance of distinguishing between the two diseases. 
Everything that can be done should be done to support the strength of the 
patient. If the disease has been caused by loss of blood, and there is anaemia, 
the different preparations of iron are earnestly called for. A selection should 



RHEUXATIC GOUT. 463 



be made from Prs. 1, 2, 3, 4, 5, 6, 7, and 63. When in addition to the 
bloodlessness there is a relaxed habit of body, the more astringent preparations, 
as, for example, Prs. 1 and 2, are indicated. 

When the nutrition is imperfect from any cause independent of anaemia, 
or loss of blood, cod-liver oil will be found of the greatest advantage. It is 
especially indicated in patients of spare habit, and when the disease has been 
attended with, wasting. When cod-liver oil cannot be taken, pancreatic emulsion 
may be substituted. When the complaint has apparently arisen from depressing 
mental causes, such as anxiety, grief, or prolonged attendance on the sick, nux vomica 
— ten drops of the tincture in a wine-glassful of water three times a day — quinine 
(Pr. 9), or ammonia and bark (Pr. 13), may be administered with advantage. 

Iodide of potassium (Pr. 32) is often of service, especially when the pains are 
distinctly worse at night. Sometimes, when no benefit is experienced from the 
ordinary five-grain dose, relief may be obtained by increasing it to ten, fifteen, or 
even twenty grain doses three times a day. It must be remembered that iodide of 
potassium is somewhat of a lowering remedy, and its effects should therefore be 
carefully watched. In many cases it proves advantageous to give it dissolved in 
the bark mixture (Pr. 13). The syrup of iodide of iron (Pr. 4) taken twice a day, 
and continued for some months, may prove of benefit, and it is said by some to have 
the power of completely arresting the progress of the disease. 

Arsenic is undoubtedly of considerable value. The indications for its employ- 
ment are unknown, and its action is apparently somewhat capricious. In some 
cases it acts like a charm, stiffened joints for a long time considerably enlarged 
becoming reduced to their natural size, and finally regaining their suppleness. 
Large doses, as, for example, five drops of the arsenic solution, or its equivalent, five 
tea-spoonfuls of the arsenic mixture (Pr. 40), three times a day, are necessary to 
produce this result. This treatment should be resorted to only under the immediate 
direction of a medical man, as some people are very susceptible to the action of the 
drug, and it is necessary to know when to stop its administration. It should always 
be borne in mind that the medicine may have to be taken with but slight inter- 
missions for weeks or months, and that if an improvement does not speedily ensue, 
it is no proof that the medicine will ultimately prove ineffectual. 

Actsea racemosa (cimicifuga) yields very satisfactory results in many cases of 
rhumatoid arthritis. It proves most successful when the pains are worse at night, 
and it is especially indicated when the disease is traceable to some derangement of 
the womb, a sudden suppression of the periods, an abortion, or a painful and 
difficult confinement. It is also indicated where the complaint first makes its 
appearance at the " change of life." The joints may not be enlarged, and the pains 
may flit from joint to joint instead of lodging steadily in one place. Painful cramps 
of the leg, aggravated by cold and wet weather, and by certain winds, frequently 
torment the sufferer, and break his rest at night. Actsea not only frequently gives 
relief from the pain and cramps, but induces quiet and refreshing sleep. In addition 
to these cases actsea sometimes proves of service when the disease occurs in men, and 
even when the pains are worse during the day. The actsea may be given in five- 
minim doses of the tincture in a little water every two or three hours. 



464 THE TREATMENT OF DISEASES. 

In many cases local applications prove of service. In the early stages, when 
there is tenderness and swelling of the joint, temporary relief may be obtained by 
the application of a blister. When the affection has become chronic, and blisters 
have effected all they are capable of accomplishing, the application of narrow strips 
of plaster, one over another, so as to support the joint, may do good Simple spirit 
lotions or belladonna liniment well rubbed in will sometimes ease the pain. Friction 
is usually not only serviceable but grateful The joint may be well sponged with 
strong brine, and then rubbed dry so as to cause the salt to be absorbed. 

Baths are very useful, especially when the skin is sluggish in its action, but care 
should be taken that they are not repeated sufficiently often to produce debility. 
The Turkish bath is often of the greatest service in these cases. The cold, or in 
winter tepid, douche may be played for about two minutes on the affected joint, 
which should then be rubbed till it is quite warm and dry. The use of hot sulphur 
baths often proves of service in chronic cases. An arsenic bath is sometimes 
employed. It is made by adding to the water four ounces of common washing soda 
and twenty grains of the salt known as arseniate of soda- 
Respecting the diet little need be said. The patient should, if possible, live 
generously, and beer, wine, or spirits may be taken in moderation. For people 
whose pecuniary circumstances will admit it, a frequent change of air and scene is 
to be advocated. Prolonged mental exertion is hurtful, and all causes of anxiety 
should as far as possible be avoided. A removal to a moderately warm, dry, 
bracing climate during the winter months is to be advocated. There can be but 
little doubt that as a rule many of the foreign saline and alkaline waters, such as 
those of Carlsbad, Wiesbaden, and Vichy, do more harm than good. The springs 
most adapted for the subjects of rheumatic gout are those which contain iron in 
some easily digestible form. 

RHEUMATISM, CHRONIC. 

Chronic rheumatism is a complaint with which few elderly people are altogether 
unacquainted. It is sometimes the sequel of rheumatic fever, but more frequently 
a separate constitutional affection coming on quite independently of any previous 
acute attack. There is at first only slight constitutional disturbance, but the 
sufferer is constantly annoyed and his existence at length rendered miserable by 
wearing pains, causing him many a restless night, and destroying all comfort during 
the day. 

The joints which are most frequently the seat of the pain are the knees, ankles, 
hips, and shoulders. Redness i3 seldom present in chronic cases, but stiffness and 
swelling of the joints are common accompaniments of the complaint. . In many 
cases pain is for a long time the only symptom, and even this may be latent unless 
the part be moved. In some instances the pain is worse at night, being aggravated 
by the warmth of the bed, but in others warmth affords the greatest relief. It often 
exhibits great tendency to shift from joint to joint, often subsiding and then re- 
curring. It is usually aggravated by vicissitudes of weather, and especially by the 
prevalence of east winds and cold and damp states of the atmosphere. 

Chronic rheumatism is most common after thirty, and is especially prevalent 



RHEUMATISM, CHRONIC. 465 



among the labouring poor, and those who are exposed to changes of season and 
weather, and to cold and wet. It is not, however, by any means confined to the 
poorer classes, for it frequently attacks those whose lot absolves them from the 
necessity of earning their daily bread. In many cases it is associated with, if not 
dependent on, derangement of the digestive organs. It is frequently of syphilitic 
origin, the pains of secondary syphilis being not uncommonly confounded with those 
of chronic rheumatism. 

We must now consider the different methods of treating chronic rheumatism. 
It is desirable, in the first place, to pay attention to the condition of the general 
health, and should this be below par, steps should be taken to improve it. Care 
should be taken to see that the organs of digestion are in proper working order, and 
that digestion is performed naturally and easily. Such evils as indigestion and 
constipation should be removed with as little delay as possible. The patient must 
be protected against atmospheric vicissitudes by warm clothing, and should be cased 
in flannel from the neck downwards. 

Chronic rheumatism, as everybody knows, is a very obstinate complaint, and 
many different remedies have been used or suggested for its cure. The medicine 
may be given internally, or the treatment may be purely local, or both methods may 
be combined. We will speak first of the internal remedies. 

Iodide of potassium is a most valuable medicine for this complaint. It is 
especially indicated when the pain is worse at night. As we have already said, the 
pains of secondary syphilis cannot, as a rule, be distinguished from chronic rheuma- 
tism, but the nocturnal increase of suffering is to be regarded as an indication for 
the employment of iodide of potassium, whether the pain is referable to rheumatism 
or to some other cause. The fact of a patient suffering from a syphilitic taint would 
increase the chances of this remedy proving successful. Two table-spoonfuls of the 
iodide of potassium mixture (Pr. 32) should be taken three times a day. 

Salicine, which succeeds so admirably in acute rheumatism, often does good 
in the more chronic forms. Pr: 12 may be employed. 

Rhus toxicodendron, the poison-oak, is useful in rheumatic lameness of the 
lower extremities. It is indicated in all cases of rheumatism in which the pain is worse 
when at rest, but is relieved by motion. It also does good where on first moving 
after rest the pain is increased, and relief is not experienced until gentle and con- 
stant motion has been continued for some time. Drop doses of the tincture of rhus 
may be given in a tea-spoonful of water every two hours. This drug is often some- 
what tardy in its action. 

Actaea racemosa is useful in many forms of chronic rheumatism of the joints, 
and is more likely to do good when the pains are worse at night or in wet or windy 
weather. It has been found by an eminent writer on treatment to be of signal 
benefit in the following class of cases :• — The patient is at first troubled with pains, 
apparently rheumatic, in most of the joints, unaccompanied by fever or swelling. 
The disease soon seats itself in one part, as the wrist and hand ; the tissues here 
become much thickened and the bones enlarged, till after a time all movement is 
lost and the member becomes useless. Warmth allays the pain, and it almost ceases 
at night. The attack presents many of the characters of gonorrhceal rheumatism, 
30 



466 THE TREATMENT OF DISEASES. 

but there is no history of gonorrhoea. Actcea will often give instant relief in these 
oases, and restore the joints to their original suppleness and usefulness after iodide 
of potassium and other remedies have been tried in vain. It may be given in three- 
drop doses of the tincture every three hours in a tea-spoonful of water. 

Aconite (Pr. 38) is often of service, and is more especially adapted to rheumatism 
of the shoulder and other large joints. 

Pulsatilla (Pr. 43) often affords relief when the knee, ankle, or instep is the seat 
of the complaint. It is especially indicated when the pains fly from place to place. 
It nearly always proves useful when the patient is a delicate female suffering from 
some irregularity of the periods. 

Bryony (Pr. 49) is useful chiefly when the lower limbs are affected. It is 
especially indicated when the pain is increased by motion. It has been found to 
succeed best in people of dark hair and complexion. 

Dulcamara is indicated when the rheumatism distinctly owes its origin to damp. 
We cannot speak very enthusiastically in its favour. 

Nitrate of potash is indicated when the pains are accompanied by scanty high 
coloured urine, becoming turbid on cooling. Ten grains of the $»lt dissolved in 
water and taken hourly or every two hours will, in most cases, a«>on increase the 
flow of urine and render it clear and limpid, when the rheumatic pains generally 
decline. 

Lime-juice, taken in doses of from six to eight ounces daily, will sometimes 
prove successful when everything else has failed. It is not uncommon to hear 
people say that they have gone the whole "round of the doctors" without ex- 
periencing any benefit, and have then cured themselves by taking lime-juice. 

Guaiacum i \ often employed, especially in what is called " cold " rheumatism, in 
which the symptoms are relieved by warmth. Half -drachm doses of the ammoniated 
tincture of guaiacum may be given every four hours in milk. It is the chief 
ingredient in the remedy known as " Chelsea Pensioner," which has obtained a 
great reputation with many old soldiers as a cure for " rheumatics." Its composi- 
tion is as follows : — 

Chelsea Pensioner. 
Take of Powdered guaiacum, an ounce. 

Powdered rhubarb, two drachma. 
Bitartrate of potash, a drachm. 
Sublimed sulphur, a drachm. 
Powdered nutmeg, half a drachm. 
Honey, a pound. 
To be mj xed thoroughly. Two large table-spoonfuls to be taken night and morning. 

Another formula is : — 

Take of Powdered guaiacum, a drachm and a half. 
Mustard powder, three drachms. 
Sublimed sulphur, three drachma 
Powdered rhubarb, forty-five grains. 
Nitrate of potash, forty -five grains. 
Mix thoroughly. A tea-spoonful of the powder may be taken in milk at bed-time, 
or sufficient honey, treacle, or glycerine may be added to form an electuary, and 
of this a tea-spoonful may be taken- 



RHEUMATISM, CHRONIC. 467 



So much then for the internal remedies for acute rheumatism. Let us now 
consider what local applications are at our disposal for the treatment of this 
obstinate complaint. 

Iodine liniment may often be painted around the affected joints with advantage. 
It in many cases quickly relieves the pain. 

When the pain is confined to one joint, a mustard or linseed poultice will often 
afford relief. 

The application of flowers of sulphur often proves of use. When the complaint 
is situated in the lower extremities, it is not by any means a bad plan to resort to 
the old-fashioned custom of dusting the inside of the stockings with sublimed 
sulphur. A sulphur and linseed-meal poultice, equal parts, may be tried. The 
local application may be combined with the internal administration of sulphur, 
the dose being twenty or thirty grains in milk. 

Concentrated essence of Jamaica ginger often proves efficacious. A tea-spoonful 
should be taken two or three times a day in wine and water, or other vehicle, 
and the affected part well rubbed with a mixture of equal parts of the essence 
and brandy. Should no benefit be experienced, a piece of flannel should be 
wetted with this mixture and worn on the part, the application being repeated 
as often as the skin will bear it. 

There are several accessory means of treatment which may be adopted with advan- 
tage. For instance, the dull aching in the joints which often remains after an attack 
of acute rheumatism will often yield to galvanism. This is a mode of treatment 
which is most likely to prove of service when only one or two joints are affected. 

The cold douche is often useful in removing the pain and stiffness of joints 
crippled by chronic rheumatism. 

The cold pack is also frequently successful in these cases. 

Warm baths are of great service, and especially baths of salt water at a 
temperature of not less than 100°. 

The Turkish bath will in many cases afford prompt and complete relief, and 
this is a mode of treatment which we have in many cases seen followed by the most 
satisfactory results. 

Very frequently a course of shampooing would prove successful. A professional 
■hampooer may usually be obtained from the nearest Turkish bath establishment. 

When the symptoms are very chronic, the cold sulphurous waters of Richfield, 
or the hot sulphur springs of Arkansas, may be resorted to. 

Sometimes drinking the alkaline waters of Vichy would do good, or when there 
is constipation in addition to the rheumatism, benefit may be experienced from a 
course of Carlsbad waters. 

For rheumatic people who can afford it, Carolina, Georgia, and Colorado 
would be good winter quarters. A temporary residence at a hydropathic establish- 
ment might be attended with advantage. 

It may be said that we have here a very large number of remedies recommended, 
but which should we begin with % In the majority of cases we should commence 
treatment with the iodide of potassium mixture and the Turkish bath. We believe 
that iodide of potassium is of all others the drug which proves most successful, and 



468 THE TREATMENT OP DISEASES. 

it would even effect a cure in cases in which the nocturnal exacerbation is not a 
prominent symptom. 

"We cannot leave the subject of rheumatism without saying a few words on 
what is known as gonorrheal rheumatism. This affection consists of inflammation 
of and about the joints, following an attack of the complaint from which it derives 
its name. It differs from ordinary rheumatism in many important respects. In 
from ten days to three weeks after the establishment of the primary disease, one or 
more of the joints become stiff, painful, and swollen, possibly as the result of the 
patient having got a chill from exposure to the weather, or from sitting in a draught 
of cold air. At the same time the feet may be painful, there may be some 
inflammation about the eyes, and there will be considerable fever, with dry skin, 
and a furred tongue. The knee is more frequently affected than any other joint, 
possibly because it is a large and complicated structure, but little protected by 
muscles from atmospheric influences. The complaint occurs almost exclusively in 
men, and after the first attack the patient is exceedingly liable to a recurrence. Each 
attack is usually more virulent in its character than the preceding. After the first 
visitation slight stiffness may remain for several weeks, and the result of several 
attacks may be the occurrence of a permanently stiff and disabled joint, leaving the 
patient a cripple for life. 

When the patient has reason to believe that he is suffering from this variety of 
rheumatism, he should at once consult a medical man, and lay the whole facts of 
the case before him. If the patient is foolish enough to suppress any part of the 
history, he may pay a penalty of lifelong misery. 

When the complaint is vigorously treated at the very commencement of the 
attack, its progress may sometimes be arrested. When there is much constitutional 
disturbance, anti-febrile treatment will have to be resorted to, and it may even be 
necessary to abstract a small quantity of blood from the arm by bleeding. Leeches 
applied to the inflamed joints often aggravate the symptoms, and may do more harm 
than good. The constant application of poultices or hot fomentations to the affected 
joint, which must be kept absolutely at rest, will prove advantageous. The Turkish 
bath may be resorted to with very great benefit, the pain often quickly subsiding 
on the occurrence of profuse perspiration. Abstinence from meat and stimulants 
is usually absolutely necessary. 

In chronic cases a combination of the iodide of potassium mixture (Pr. 32), 
with the frequent employment of the Turkish bath, is most likely to do good. 
When the patient is much pulled down, it may be necessary to keep up the strength 
by a slight stimulating and tonic treatment. When the pain and swelling have 
completely subsided, gentle friction with shampooing may restore mobility to the 
affected joint. Sometimes it is necessary, in order to restore motion, to manipulate 
the limb after the patient has been placed under the influence of chloroform. 

In conclusion, we would say that gonorrheal rheumatism is not a complaint to 3 
be trifled with, and no man is justified in endeavouring to treat it himself. 



KHEUMATISM, MUSCULAB, 469 



RHEUMATISM, MUSCULAB. 

This is a complaint which is usually regarded as being closely allied to rheumatism 
of the joints, the difference in the symptoms being supposed to depend on the pecu- 
liarities of the structures which are affected in the two diseases. Doubt has, 
however, been thrown upon the correctness of this opinion from the circumstance 
that the complaint now under consideration is never complicated by any disease of 
the heart or of its membranes. 

Muscular rheumatism usually commences as an acute disease, but exhibits a 
decided tendency to become chronic. It may affect any of the muscles of the limbs 
or trunk, but is far more likely to occur in certain situations than in others. The 
seizures are not uncommonly quite sudden — for example, the patient may find on 
awaking in the morning that he is unable to make a certain movement, or to 
perform some particular act, without experiencing the most exquisite pain. Usually 
there is no pain whilst the muscles of the part are quiet, but the slightest movement 
suffices to excite a paroxysm. On examining the seat of suffering, nothing can as 
a rule be detected, but sometimes there is slight tenderness on pressure. There is 
often no fever or constitutional disturbance — at all events at first; but as the 
complaint progresses there may be thirst, loss of appetite, and even considerable 
elevation of temperature, as the result of the long-continued pain, and the want of 
sleep which it occasions. 

We know very little respecting the causes of muscular rheumatism. It is most 
commonly met with in people of full adult age, and not uncommonly in individuals 
of a gouty habit. Exposure to cold and damp, and the over-use of the affected 
part, may act as exciting causes. One attack of the disease engenders a liability to 
its return. 

The duration of the complaint cannot be definitely fixed. As an acute disease it 
is usually of brief duration, but in the chronic forms it often proves very rebellious 
to treatment, and its duration may be protracted almost indefinitely. 

Muscular rheumatism is not confined to any particular region of the body, but 
may occur in almost any locality. The principal varieties are lumbago and crick in 
the neck, and we shall speak of the treatment of the complaint under these two 
headings : — 

A. Lumbago. — This is a rheumatic affection of the muscles of the loins, those 
on one or both sides being involved. It is frequently very sudden in its mode of 
onset, the pain seizing the patient " all of a moment." The pain is usually 
increased by every movement of the lower part of the spine, and by pressure upon 
the muscles of the affected part. It is not uncommon to see patients with lumbago 
leaning forwards and walking almost double. If they are told to " touch their 
toes" they generally express their inability to do so, although in many cases it 
appears on investigation that the pain is caused not so much by bending down as 
by the effort to get up again. Sometimes, however, the mere effort of stooping is 
very painful. "We remember being told by a hospital patient a story which forcibly 
illustrates this fact. He was a butcher by trade, and his lumbago had been caused 
by lifting heavy weights and carrying the carcases of sheep, bullocks, <fec., on his 



470 THE TREATMENT OF DISEASE*. 

back. His complaint was very obstinate ; he was incapacitated from following hit 
ordinary occupation, and, being unable to obtain other work, was in a few weeks 
reduced to the brink of starvation. One day, when very "hard up," he was 
strolling in Regent's Park, when he saw a sixpence lying in the grass. It seemed 
almost a godsend to him, and he was on the point of stooping down to pick it up 
when the pain in the loins seized him, and he was unable, in spite of his utmost 
efforts, to get near it. He described very graphically how he stood for over an hour 
looking at the sixpence, and fearing every moment that some one should come up 
and claim it. The method he finally adopted of obtaining the long-coveted treasure 
was, we trust under the circumstances, not very culpable. Seeing a little girl 
playing on one of the adjoining walks, he called her, and said, " Here, my dear, 
I 've just dropped sixpence. Will you pick it up for me ? " and in another moment 
it was in his possession. In this instance the patient was as powerless to stoop 
down and pick up that coin as if he had been paralysed. He had not actually lost 
the power of moving, there was no palsy, but he dare not move, because the effort 
gave him so much torture. 

The remedies for lumbago are, as might be supposed, chiefly local. There 
are, however, other methods of treatment which are often attended with 
satisfactory results. 

When the pain is very severe, relief may, in the majority of cases, be obtained 
almost immediately by an injection of morphia under the skin. This is a fact 
which has been known to medical men, and extensively employed for many 
years. The only objection that can be urged against it is, that in many people 
morphia gives rise to headache, giddiness, and other unpleasant symptoms. 
Quite recently a French physician made a somewhat curious discovery. He 
had a patient whom he had frequently treated with hypodermic injections of 
morphia for acute attacks of lumbago, but always with the production of a 
train of unpleasant constitutional symptoms. One day the patient called to 
say how glad he was to find he had made some alteration in the medicine, 
for the last injection had relieved the pain as usual, but had not produced any 
headache or giddiness. The doctor at once declared that he had used the 
same morphia solution as usual, and in order to convince the patient, sent for 
the bottle to show him. On examination the bottle was found to contain nothing 
but water, and on inquiry being instituted the servant confessed that some 
days before she had accidentally upset the bottle and spilled the contents, and 
that, fearing detection, she had filled it with water. The doctor at once 
saw that the fact was of value, and hastened to publish the discovery to the 
world. It then appeared from the testimony of numerous trustworthy observers 
that even the water was not essential, that it was the puncture with the needle 
which did good, and that equal benefit might be obtained without the injection 
of any substance at all. 

The treatment of lumbago by "acupuncture," as it is called, is attended 
with the most favourable results. We have seen cases in which the relief has 
been instantaneous. The mode of procedure is very simple. The patient stands 
upright, holding up his shirt behind so as to expose the loins. The 



SHEUMATTSM, MtTSCtTLAlL 471 



only apparatus required is a good, strong, sharp needle, such as is ordinarily 
used as a shawl-pin. The person who is about to perform the friendly office for 
the patient grasps the needle firmly in his hana, and suddenly thrusts it for 
the distance of an inch or two into the loins over the painful part. The pain 
of the puncture is but momentary, and the needle, instead of being withdrawn, 
may be advantageously left sticking in for a few minutes. When the lumbago 
is double, the operation should be performed on both sides of the loins. We 
have cured many cases of lumbago by this method, and have never known 
it to be followed with any unpleasant consequences. Most instrumentanakers 
keep needles fitted in bone handles for the performance of this operation, but 
the domestic substitute to which we have referred will answer equally well. 

The Turkish bath, which is such a valuable remedy for nearly all complaints 
of a rheumatic nature, may be used with advantage in lumbago. 

When a Turkish bath is not obtainable, the ordinary domestic linseed poultice 
may prove of service. In acute lumbago, poulticing often brings speedy relief, the 
severest cases being greatly benefited in a few hours, and generally cured in one or 
two days. The poultice must be very hot, and large enough to cover the whole 
loins or the part affected, and thick enough to remain quite hot for at least half an 
hour, when it must be changed. Should no benefit be obtained, this treatment 
should be continued for three hours or longer, then the skin must be covered with a 
piece of flannel, which in its turn is covered with oil-silk. This after-treatment, like 
that of the poultices, promotes free perspiration, upon which mainly depends the 
efficacy of this plan. 

A diametrically opposed method of treatment, that of freezing the painful part, 
may sometimes be adopted with advantage. Two parts of finely-powdered ice, with 
one of common salt, are put in a gauze bag, and placed in contact with the skin 
until the sensation is abolished, and it has a leathery feel, and a shrunken, tallowy 
appearance. The application should not be continued for more than five or six 
minutes, or it may cause a blister. 

One of the best and most convenient methods of freezing the part is by spraying 
upon it with ether, the evaporation of which produces intense cold. The spray 
apparatus which will be found most convenient for the purpose is known as 
Richardson's. It is that which is described and figured whilst speaking of the 
inhalation of ipecacuanha wine in the treatment of winter cough. A single 
application of the ether spray will in many cases afford speedy relief in lumbago. 

The use of galvanism is not uncommonly attended with the most satisfactory 
results, the passage of what is known as the " interrupted current " effecting a 
speedy cure. When electricity, the needle, or poultices fail to give more than slight 
temporary relief, it will often be found that the lumbago is accompanied by high 
fever, and that it is in reality the first symptom of an attack of acute rheumatism 
or some other febrile disease. 

The application of a good strong plaster over the loins will, by affording sup- 
port to the parts, often give relief. Either the chalybeate plaster or the pitch 
plaster may be employed. It is desirable to have it spread on leather or some 
equally durable and substantial substance. In summer it is a good plan to have it 



472 the treatment of diseases. 

punched all over with a number of little holes, to admit of the evaporation of the 
perspiration, so as to avoid the troublesome itching which would be caused by its 
retention- Care should be taken to see that the plaster is smoothly and equally 
applied. An attack of lumbago, affecting perhaps the whole loins, often leaves 
behind it one painful spot which may cause distress only when the body is moved in 
one direction. Remains of a lumbago like this generally resists the usual methods 
of treatment, the pain being driven from one spot only to re-appear at another. A 
large belladonna plaster will generally mitigate the complaint, should it fail to 
remove it altogether. 

Of the internal remedies, iodide of potassium and nitrate of potash (nitre) may 
prove useful under the conditions and in the doses referred to whilst speaking of 
chronic rheumatism. The former salt, however, not unfrequently fails to affect 
lumbago, even when the complaint is distinctly worse at night. 

It has been claimed for actsea racemosa (cimicifuga) that it subdued lumbago 
more effectually than any other remedy. It is well worth trying in obstinate cases, 
but it must be admitted that it often fails. The dose is five drops of the tincture 
every two hours. 

Rhus toxicodendron is useful in many cases of chronic lumbago. It is indicated 
when the pain is worse when the patient is at rest, but is relieved by movement, 
and also in cases in which on first moving after rest the pains are increased. 

Sulphur in small doses is frequently of much advantage, and it can be 
administered either in substance or in the form of the sulphur waters of Aix-la- 
Chapelle, of Aix in Savoy, or Bareges. Arsenic (Pr. 40) is likewise occasionally 
adopted a3 a remedy in long-standing obstinate cases. 

B. Crick in the Neck. — Crick in the neck, stiff neck, or, to use the technical 
term torticollis, is usually the result of a cold or of exposure of the affected part 
to a current of cold air. The pain is sometimes in the back of the neck, but more 
frequently it affects only one side, the patient being in the latter case compelled to 
hold his head awry in order to relax the muscles. A patient suffering from a 
stiff neck not uncommonly presents a somewhat comical appearance, and is often 
made the subject of much ridicule and joking, but for all that the complaint is a 
very painful one, and is sometimes very intractable to treatment. A stiff neck in 
children is not uncommonly the cause of a considerable elevation of temperature, 
the fever lasting three or four days or more. 

When the pain of acute torticollis is very great it may be necessary to endeavour 
to obtain relief by the administration of a hypodermic injection of morphia. Local 
applications, however, not unfrequently prove successful Hot fomentations aro 
very valuable, as, for example, a piece of spongio-piline wrung out of hot water 
and applied either alone or sprinkled with laudanum, or belladonna liniment, or a 
combination of the two. Turpentine often proves useful in these cases. Over a 
flannel rung out of hot water a little turpentine should be sprinkled and applied 
till it produces redness, tingling, and smarting. It is well to bear in mind that as 
the smarting arising from the turpentine goes on augmenting for some time after its 
removal, the application should be kept on only just sufficiently long to excite a 
moderate degree of pain. 



acxmr?. 473 



Undoubtedly one of the best remedies for a stiff neck is an infusion of capsicum, 
red pepper, or chillies, as it is sometimes called. The mode of preparation and appli- 
cation is sufficiently simple. You infuse a large handful of crushed capsicum pods 
in a pint of hot or cold water for thirty-six hours. You then soak a piece of lint in 
this infusion and apply it to the affected part, covering it all over with a thin piece 
of gutta-percha or oil-silk to prevent evaporation. This mode of treatment was long 
and successfully employed by a quack in the west of England. It never blisters or 
causes any inconvenience, and is so prompt in its action that it will often completely 
cure a bad case in ten minutes. 

Respecting the internal remedies for this complaint we have not much to say. 
Benefit sometimes arises from the use of salines which act on the skin and kidneys, 
and alter the state of the blood. The following mixture may be taken with 
advantage : — Solution of acetate of ammonia, three ounces ; spirit of nitrous 
ether, two and a half drachms ; iodide of potassium, twenty-four grains ; water 
to eight ounces. Two table-spoonfuls every four hours. In cases in which the 
patient is of a gouty habit, colchicum should of course be employed. When the 
patient is much below par, the use of cod-liver oil, iron, and more especially quinine, 
will have to be resorted to. When the fever runs high, aconite (Pr. 38) is indicated ; 
when the complaint has in all probability arisen from exposure to damp, dulcamara 
should be tried ; and when it is attended with tearing, lancinating' pains, belladonna 
(Pr. 39) is the remedy. 

In the majority of cases we should put our trust in local applications, and above 
all in the capsicum treatment. The Turkish bath often proves useful as an adjunct. 



SCXJKVT. 

Scurvy, or scorbutus, as it is technically called, is a disease which is caused by 
the continued use of a dietary deficient in fresh vegetables. 

It is a complaint which has been known from the time of Pliny. Centuries ago 
historians noted the ravages of an " unknown disorder " in armies located under 
circumstances of difficulty in foreign lands and in garrisons deprived of the oppor- 
tunities of obtaining a supply of fresh provisions. In the long sea-voyages under- 
taken by the intrepid navigators of the fifteenth and sixteenth centuries the crews 
suffered terribly from this disease, which carried off large numbers and greatly 
reduced the strength of the survivors. Yasco di Gama, in his first voyage to the 
East Indies by the Cape of Good Hope, in 1497, lost 100 men out of a crew of 
160 by this affection. James Cartier, in his second voyage to Newfoundland, in 
1535, speaks of sufferings still more terrible amongst his 110 picked men. " In such 
sort," says he, " did the malady increase that there were not above three sound men 
left. Twenty-five of our best men died, and all the rest were so ill that we thought 
they would never recover again." 

It is considered by many that scurvy, either alone or by increasing the severity 
of other diseases, has proved more destructive to human life than any other disorder. 
It is a very curious and interesting circumstance that this condition, which at 
various times has been regarded as a plague, as a mysterious infliction of Providence 



±74 THE TREATMENT OP DISEASE8. 

against which it would be useless or even impious to strive, or as a disease in- 
separable from long voyages, should have been proved most conclusively to arise 
from causes which are strictly under our control, and to be curable by means which 
are afforded by every habitable country. 

Scurvy occurs only when fresh vegetable food has been for some time partially 
or completely withheld. Various complaints follow the want of other descriptions 
of food, but scurvy never makes its appearance unless the supply of vegetables is 
limited. The evidence on which this statement rests is of the most conclusive 
character, and no doubt can be entertained as to its correctness. 

The year 1846, in which there was a failing of the potato crop in many parts 
of the country, was remarkable for the prevalence of scurvy. The disease occurred 
largely among the labourers employed in the construction of some of the Scotch 
railways, and in many cases proved fatal. The men were, as a rule, earning good 
wages, and were well fed ; indeed, their extravagance in good living was a frequent 
subject of remark, but vegetables were in the majority of cases unattainable. 
Their dinner usually consisted of bread, boiled beef or bacon, pea-soup or broth, 
and suet puddings containing currants, and many of them were in the habit of 
breakfasting off beef steaks and mutton chops. For all that, however, very few 
of them had tasted potatoes since the failure of the crop, a period of over seven 
months. 

In the same year in Ireland, where the disease proved very prevalent, it was 
found that in a certain district four-fifths of the people attacked were living on 
bread and tea or coffee, and that the remainder had nothing additional but a little 
grain or an occasional piece of meat or fish. In no single instance could it be 
discovered that potatoes or green vegetables formed an habitual article of the 
sufferer's diet. 

The allied armies of England, France, Turkey, and Sardinia suffered severely 
from scurvy during the Crimean war. The total number of our men admitted into 
the hospitals with scurvy during the war amounted to considerably over 2,000 ; but 
we are told on authority that " the returns convey but a faint conception of the 
disastrous part which it acted among the troops, for although it comparatively 
rarely presented itself in well-defined forms, and as an independent infection, yet 
the prevalence of scorbutic taint was wide-spread, and in a vast proportion of cases 
evident indications of it existed as a complication of other diseases, especially fever 
and affections of the bowels." Sad as this history is, it is satisfactory to note that 
when fresh vegetables and lime-juice were served out, the complaint almost entirely 
disappeared. The sufferings of the French from scurvy were much greater than 
those of our troops ; and it is said that among them no less than 23,000 cases 
occurred. It is probable that the Turks suffered even still more severely, and there 
is no doubt that the original force which formed part of the expedition from Bulgaria 
to the Crimea was almost entirely swept off by disease, of which scurvy formed an 
important element. 

During the last American war, raw potatoes preserved in molasses were fre- 
quently issued to the troops, and were found to be of signal service in warding off 
scurvy. It is true the disease prevailed to a great extent in the United States 



8CURVT. 475 



army, but it was when the men were obliged to live on marching rations and it was 
impossible to provide them with fresh vegetables, or any anti-scorbutic. 

Since the year 1795, scurvy has been all but abolished from the British fleet, 
and when we remember that the security of this country has been on several 
occasions imperilled by the forced disestablishment of the Royal Navy through the 
ravages of this disease, it will we think be granted that we have something to be 
thankful for. It is to Dr. James Lind, " the father of nautical medicine," that we 
are indebted for the discovery that lime-juice has the power of warding off scurvy. 
It was, however, nearly half a century after the publication of Dr. Lind's celebrated 
work that any serious attempt was made to utilise it. In 1780 the number of cases 
of scurvy received into Haslar hospital was 1,457, in 1806 one only, and in 1807 
also one. Scurvy is now so uncommon that many medical men, unless they happen 
to practise in a seaport town, have never seen a case. At the same time there is a 
growing opinion that scurvy is not such a rarity in the merchant service as it ought 
to be. Although the Legislature insists, under a penalty, that lime-juice or lemon- 
juice should be issued to the crews of vessels on long voyages, there is evidence to 
show that the provisions of the Act are but too frequently evaded, one of the best 
proofs being that the Dreadnought hospital still continues to receive annually an 
average of ninety cases of the disease. There can be no doubt that very frequently 
no lime-juice at all is furnished, or a cheap imitation, consisting of tartaric acid, 
sugar, and water, flavoured with essence of lemon, is substituted. 

The " inexplicable and unlooked-for " outbreak of scurvy amongst the crews of 
the Alert and Discovery, whilst engaged in the Arctic expedition, is too fresh in the 
minds of our readers to call for any detailed notice. 

Patients who, from disease of the stomach or other similar cause, are unable to 
take solid food, and are obliged to live almost exclusively upon beef-tea, are some- 
times attacked with symptoms of scurvy. It is only necessary to bear this fact in 
mind to guard against its occurrence. 

It has been frequently urged that scurvy might possibly arise from some other 
cause besides a deficient supply of vegetable food, as, for example, the long-continued 
use of salt provisions. We have not the slightest hesitation in saying that this 
proposition is untenable, and for two reasons : — (1.) There is no case of scurvy on 
record occurring in a person adequately supplied with fresh succulent vegetables of 
good quality. (2.) The occurrence of scurvy in persons living upon salt meat may be 
prevented by the regular administration of fresh vegetables or lemon-juice. 

It has also been said that monotony of diet is an important element in the 
production of scurvy. The answer to this is that probably one of the most mono- 
tonous dietaries in the world is that upon which the poor inhabitants of Ireland 
thrive, consisting as it does almost entirely of stirabout, milk, and potatoes. They 
are a fine, well-built, often athletic race, and so long as they can obtain this food 
scurvy is unknown, but when the monotony is broken by the failure of the potato 
crop, the disease soon makes its appearance. 

The symptoms of scurvy can hardly be mistaken. The earliest sign of the 
disease is a change in the colour of the skin, which becomes pale and sallow, and 
8ven assumes a greenish tinge. Contemporary with this is a peculiar listlessness, 



476 THE TREATMENT OF DISEASES. 

and a disinclination for exertion either mental or physical. The patient usually 
complains of pains in the limbs, which he generally attributes to rheumatism. He 
seldom displays any anxiety about his health, and seems quite indifferent on the 
subject. He is keenly alive to any change in the appearance of his companions, but 
it is often a matter of no little difficulty to make him understand that he is suffering 
in the same way, or that anything is the matter with him. At first his appetite 
remains good, and his digestion continues tolerably perfect, but usually the bowels are 
confined. After a time petechias, or little spots like flea-bites, make their appearance 
on the legs and arms. They are small, of a reddish-brown colour, and are not 
elevated above the surface of the skin. Besides these, larger spots of an irregular 
shape, and apparently formed by the coalescence of several petechise, are observ- 
able about the lower part of the legs and on the feet. In many cases they so 
closely resemble bruises as actually to be mistaken for the result of violence. The 
general aspect of the patient is that of indifference or dejection. The face usually 
wears a peculiar bloated appearance. The eyes are often puffed up so that the 
patient looks as if he had been fighting. The gums present a peculiar condition, 
which is nearly always present, and may be considered as being characteristic of the 
disease. At a very early period they begin to swell at the edges, and this gradually 
progresses so that the teeth are encroached upon, and eventually almost disappear 
from sight in the huge fleshy masses which encompass them. The swollen gums are 
spongy, of a dark red colour, and display a disposition to bleed upon the slightest 
irritation. The teeth frequently become loosened in their sockets, and sometimes 
fall out. As may readily be imagined, chewing is out of the question, and even 
fluid nourishment is taken with difficulty. The smell from the breath, in conse- 
quence of the state of the gums, is generally most offensive. The skin is very dry, 
and often scales off with great readiness. 

As the disease progresses, large swellings or tumours make their appearance in 
the bend of the elbow and at the back of the knee. The skin over these enlarge- 
ments may retain its natural appearance or may become greatly discoloured. ~ 

Whilst these symptoms are gradually progressing, the patient suffers greatly 
from shortness of breath. He is frequently subject to attacks of fainting, and 
these have been known in many cases to prove suddenly fatal. The intellect, as a 
rule, remains unaffected, but listlessness is a constant symptom, and is often associated 
with great depression of spirits. 

In confirmed cases the slightest blow or pressure breaks the skin, giving rise to 
the formation of the most obstinate ulcers, which heal with the greatest difficulty. 
They increase rapidly in size, and often eat into the flesh so as to lay bare the blood- 
vessels and nerves, and even the bones. They often give rise to dangerous bleeding, 
the exhaustion consequent upon which sometimes proves speedily fatal. 

A peculiar affection of the sight often makes its appearance during the course of 
the disease. The patient can distinguish objects well enough by daylight, and even 
at night can read a book held close to a candle, but the moment he passes from the 
influence of the light he becomes absolutely blind, and has to be led about 

We must now consider the best method of treating scurvy. This necessarily 
consists of supplying the patient in the most easily assimilable form with that 



8CURYY. 47T 



material by the deficiency of which his disorder has been produced. Fruits and 
salads should be eaten ad libitum, and fresh lemon-juice, made into lemonade, should 
be taken in large quantities. The existence of diarrhoea or any other complication 
should form no excuse for withholding this treatment. No drug will do any good 
until the patient has vegetables or some anti-scorbutic remedy, and when this is 
administered an amelioration in even the most serious symptoms will soon be per- 
ceived. Lemon-juice is probably more easily digested than any other form of 
vegetable food, but oranges, limes, cabbage, lettuce, potatoes, onions, mustard and 
cress, dandelion, sorrel, or grapes, will answer almost as well. It is said that water- 
cresses prove quite as efficacious as lemon-juice in curing scurvy. Bael fruit has 
been highly recommended for the looseness of the bowels, which often accompanies 
this complaint. In addition to the administration of anti-scorbutic remedies, the 
patient's strength must be improved by such a diet as will most easily contribute to 
his nutrition. He may have beef-tea and eggs beaten up with wine, or, if he can 
bear it, solid fresh meat, roasted or boiled, with mashed potatoes, cabbage or salad. 

There are certain fruits and vegetables in addition to those we have already 
mentioned which have the power of warding off scurvy and promoti ng its cure. 

Amongst these may be mentioned apples, which often prove useful, but are 
far inferior to either oranges or lemons. Sauer-kraut has long been recognised 
as being very efficacious in this respect. It was by providing his crew with 
abundance of sauer-kraut, and encouraging them to seek for wild vegetables 
whenever he landed, that Captain Cook preserved their health during a four 
years' voyage in his ship Discovery. In the last American war the yam, 
which is extensively cultivated throughout the South, was found very beneficial. 
It is supposed from the immunity of infants from scurvy that milk possesses 
the power of preventing this disease to a large extent. A similar property is 
also attributed to many of the light French wines. Vinegar has undoubtedly 
well-marked anti-scorbutic powers. It is said that the efficacy of fruits in the 
treatment of scurvy is owing to the tartrate of potash, citrate of potash, and 
malate of potash which they contain, and these salts are consequently often 
administered, and apparently with advantage, when fresh vegetables cannot be 
obtained. 

Spruce beer is an excellent thing for warding off scurvy. The essence of 
spruce is prepared by boiling down to concentration the young branches of the 
black spruce fir {Abies nigra). Take of this essence half a pint, bruised pimento 
and ginger of each four ounces, water three gallons. Boil for five or ten 
minutes, then strain, and add eleven gallons of warm water, a pint of yeast, 
and six pints of molasses. Mix, and allow the mixture to ferment for twenty- 
four hours. This was found very efficacious by Captain Cook in his voyages. 
It is an agreeable and wholesome drink in warm weather, and it has been 
suggested that it should be used in the merchant service instead of rum, which 
has no power of preventing scurvy. We are afraid the men would fail to 
appreciate the change. 

A list of measures to be adopted in time of war, or in prolonged sojourn 
on board ship, or at stations where fresh vegetables are scarce, was drawn up 



478 THE TREATMENT OP DISEASES. 

by the late Dr. Partes, and they are so essentially practical in their nature 
that they cannot fail to be of service. We reproduce them in a slightly 
condensed form : — 

1. The supply of fresh vegetables and fruits by all means in our power. Even 
unripe fruits are better than none, and we must risk a little diarrhoea for 
the sake of their anti-scorbutic properties. In time of war every vegetable 
should be used which it is safe to use,, and when made into soups almost all 
are tolerably pleasant to eat. 

2. The supply of dried vegetables, especially potato, cabbage, and cauliflowers ; 
turnips, parsnips, &c, are less useful ; dried peas and beans are useless. As a 
matter of precaution these dried vegetables should be issued early in a campaign, but 
should never supersede fresh vegetables. 

3. Good lemon-juice should be issued daily (one ounce), and it should be seen 
that the men take it. 

4. Vinegar (half ounce to one ounce daily) should be issued in the rations and 
used in cooking. 

5. Citrate of potash or tartrate of potash should be issued in bulk and used in 
water as a drink or added to the food. The easiest mode of issuing these salts 
would be to have packets containing enough for one mess of twelve men, and to 
instruct them how important it is to place them in the soups or stews. Possibly 
they might be mixed with salt and issued merely as salt. 

The following directions for the preservation and use of lemon-juice were 
issued by the Board of Trade of England. They are intended chiefly for the 
information of shipowners and shipmasters, but are likely to prove of service undei 
other circumstances. 

Every ship on a long voyage should be supplied with a proper quantity of lime 
or lemon juice. 

The juice, having been received in bulk from the vendors, should be examined 
and analysed by a competent medical officer. All measures adopted for its preserva- 
tion are worthless, unless it can be clearly ascertained that a pure article has been 
supplied. 

Ten per cent, of brandy (sp. gr. 930) or of rum (sp. gr. 890) should afterwards 
be added to it. 

It should be packed in jars or bottles each containing one gallon or less, covered 
with a layer of oil, and closely packed and sealed. 

Each man should have at least two ounces (four table-spoonfuls) twice a week, 
to be increased to an ounce daily if any symptoms of scurvy manifest themselves. 
The giving out of lime or lemon juice should not be delayed longer than a fortnight 
after the vessel has put to sea. 

SEASICKNESS. 

We have no intention of entering into a scientific discussion as to the causes 
of sea-sickness ; those of our readers who are not suffering from mal de mer would 
probably be but little interested in it, whilst those who are paying involuntary 
tribute to old Neptune are certainly not in a fit condition to appreciate it. There is 



glA-SICKNESS. 479 



probably no derangement of organic function not absolutely a disease which causes 
a greater amount of suffering, and is more frequently fraught with real danger to 
health, and even life, than sea-sickness. 

We will proceed at once to discuss the different modes of treating the distressing 
malady. Some people have advocated the use of certain drugs and medicinal agents, 
whilst others have relied solely on mental measures. These latter, it seems to us, 
can be of use solely as adjuncts. That the mind does exert a powerful influence 
over even such a frightful malady as sea-sickness no one can deny. This is stated 
to be observed in a striking manner in shipwrecks, when danger instantly renders 
everybody alert, even those who but a moment before were prostrate and recked 
not what became of them. Not long ago a letter appeared in one of the papers 
recommending people threatened with sea-sickness " to hum a tune with regular and 
rather prolonged cadences." The writer says it proved most successful in his own 
case, and warmly advocates its general adoption. It can hardly be expected, however, 
that the passengers would consent to form themselves into a temporary choral 
society, or that this mode of treatment could be successfully maintained during a 
long voyage. Much importance has been attached to retaining the horizontal position 
from the first moment of going on board, but this alone will not suffice to ward off 
an attack. In fact, we could hardly expect that it would do so, for it is well known 
that many animals whose position is not vertical suffer severely from sea-sickness. 
Quite recently it was reported that an elephant crossing from Boulogne to 
Folkestone was greatly distressed, and dogs are not unfrequently sick in crossing 
the Channel. There is no doubt that one's position with regard to the vessel is not 
without its influence. The nausea which with the face to the bow is trifling may 
be increased to immediate vomiting by turning round into the opposite position for 
a few minutes. In association with this fact it will be remembered that the motion 
in a swing, which is agreeable as long as the eyes are open and the movement 
watched, is changed to intense nausea as soon as the eyes are closed and the motion 
unforeseen. Moreover, it is well known that many people feel sick when riding in 
a carriage with their backs to the horses. 

Of late years the treatment of sea-sickness by means of the spinal ice-bag has 
come into vogue, and the evidence adduced in its favour is very striking. It is 
supposed that in sea-sickness there is an abnormal supply of blood to the spinal 
cord, and it is obvious that upon this supposition any mode of treatment which 
would reduce this quantity would prove beneficial. At first sight it would seem 
that the application of ice to the spine would be anything but agreeable ; but those 
who have used it are unanimous in asserting that, on the contrary, it is quite 
pleasant. It is obvious that ice applied in bladders, or by any of the ordinary 
methods, would occasion great discomfort, and would restrain the movements of the 
patient, and compel him to remain for the most part in one position. The spinal 
ice-bag is made of india-rubber, the mouth being closed by means of a clamp, 
which effectually prevents the water from escaping as the ice melts. These bags, 
which are usually known as " Chapman's spinal ice-bags," may be obtained fiom 
most surgical instrument makers and druggists. The following sizes are made : — 
8, 10, and 12 inch, suitable for children ; 14, 16, and 18 inch, suitable for boys and 



480 THE TREATMENT OF DISEASE8. 




girls ; 20 and 22 inch, suitable for women ; 24 and 26 inch, suitable for men. The 
bags are divided into cells — usually three. By this arrangement the ice is pre- 
vented from falling to the bottom, and can be kept accurately in contact with all 
parts of the spina It is of importance not to fill the cells sufficiently to make them 
round, or only a small portion of the bag will touch the skin. The mouths of all 
the cells are effectively closed by means of the clamp, so that not a drop of water 
can escape even when all the ice has melted. Before purchasing it is as well to 
see that the clamp acts \ roperly. Directions for filling and applying accompany 
each bag, so that no difficulty will be experienced on this score. The bag is re- 
tained in position by means of tapes, or may be sustained in the case of men by 
buttoning the waistcoat and coat lightly over it, or, in the case of women, by 
tightening the dress in like manner. When properly secured the wearer need not 

remain lying down, but is able to 
sit up or walk about as usual. For 
short passages the bag should be 
filled before starting, but on most 
of the trans- Atlantic steamers ice 
is obtainable in any quantity, and 
the bag may be replenished as 
necessity indicates. Each bagful 
Fig. 9.— sphtai. ici-baq. when applied to the back melts in 

about a couple of hours. For the 
passage between Dover and Calais one bagful suffices, and one will be sufficient 
between Folkestone and Boulogne unless in cases of unusual severity. Between 
Newhaven and Dieppe three bagfuls are required, and between Dover and Ostend 
two. As the Channel steamers do not usually carry ice, at all events in sufficient 
quantities for filling ice-bags, intending passengers should have the bag filled ii. 
London, and then wrapped up in a shawl or in flannel vests or petticoats or other ■ 
non-conductors of heat that may happen to be in their portmanteaus or carpet bags. 
In warm weather it may be advisable to have the ice-bag packed in a box containing 
sawdust. For passages of several hours' duration it may be necessary to carry a 
supply of ice, properly packed by the ice merchant, and an ice-breaker for the 
purpose of reducing it to fragments. From two to three pounds of ice for every 
two hours the passage lasts is the quantity required for an adult. People whose 
liability to sea-sickness is not very great will usually find that the malady may 
be wholly prevented by the application of the ice-bag as soon as they begin to feel 
squalmish. In all cases the ice-bag should be placed in immediate contact with the 
skin, and it is recommended that it should not be brought higher up the spine than 
the middle of the back of the neck. When the patient is lying down, the ice-bag 
has a tendency to slip upwards to the back of the head, but this is easily remedied. 
People who are unusually prone to suffer from sea-sickness should apply the bag 
immediately on going on board, or before the vessel starts. In the case of women 
far advanced in pregnancy the bag should not extend as low down as the loins. As 
auxiliary measures, swallowing little pieces of ice, and the application of a hot-wate* 
bottle to the feet, are of importance. 



bea-sick^ess. 481 

When ice or the ice-bag is not at hand, an inhalation of nitrite of amyl may be 
employed with advantage. Three drops of the nitrite of amyl are poured on a 
pocket handkerchief, and held close to the nose. The inhalation must be conducted 
rapidly, so as to obtain the full influence of the drug. It may cause flushing of the 
face and a feeling of pulsation in the head, but these effects are temporary, and soon 
pass away. A warm and comfortable glow then takes the place of the chilly sweat 
which is so disagreeable in this complaint, and is usually followed in the course of 
half an hour or so by a pleasant slumber, from which the sufferer awakes to eat a 
hearty meal. Should the sickness recur, as it may do, after the lapse of twenty- 
four hours, the inhalation must be repeated. It is desirable that the patient should 
be in bed, or in the recumbent position, when under treatment, so as not to interfere 
with the subsequent sleep. One doctor, recording his experience, states that out of 
124 cases of bondjide sea-sickness this mode of treatment proved eminently suc- 
cessful in 121, there being no return of the vomiting after the inhalation of the 
nitrite of the amyl, and the remaining three cases were unsatisfactory only in so far 
that they required a further dose or so of the amyl. Many chemists now keep 
little glass capsules, each containing three or five drops of nitrite of amyl. They 
may be used with advantage. 

A very good remedy for sea-sickness is chloral, but whether it acts by simply 
benumbing the nerves of the stomach, or by reducing the susceptibility of the whole 
nervous system, we do not know. At all events, a passenger may take thirty grains 
of chloral at Dover, fall into a drowsy, half-conscious state, and find himself at 
Calais free from sickness. Sometimes one or two drops of pure chloroform taken in 
a wine-glass of water will prove efficacious. Hypodermic injections of morphia are 
occasionally resorted to, but their use is not justifiable until other remedies hare 
been tried and failed. 

The substance known as petroleum, mineral naphtha, or rock oil, enjoys a high 
reputation in the treatment of sea-sickness. It should be taken on going on board, 
a drop or two on a small piece of sugar, and repeated every two or three hours. A 
pill containing three drops of creosote is another good remedy. 

Ipecacuanha wine, in drop doses, which proves so successful in the treatment of 
many kinds of vomiting, would probably succeed in sea-sickness, although we are 
not acquainted with the records of any cases in which it has been tried. 

A surgeon on board one of the vessels of the White Star line recently informed 
us that in obstinate cases he had often obtained relief by the use of iced dry cham- 
pagne. It is essential, he says, that the wine should be dry, for sweet champagne 
only makes matters worse. 

In the Levant the daily internal use of iron is a very common cure for sea-sick- 
ness. Sailors, when suffering from this complaint, obtain their iron in a very primi- 
tive manner, for they scrape off a portion of the rust adhering to the anchor and 
anchor-chain, and th?n swallow it in a little water. 



482 THE TREATMENT OF DISEASES. 



SHAKING PALSY, OR PARALYSIS AGITANS. 

This is an affection not uncommonly met with in old people. It is characterised 
by the occurrence of involuntary tremulous or shaking movements of the limbs, 
head, or body. It occurs almost exclusively in men, and the large majority of cases 
are met with above the age of fifty. In some instances it appears to be hereditary ; 
for we had recently under our care a patient with this complaint whose father had 
guffered in the same way for many years, It is said that it may be caused by 
violent muscular exertion, by injuries or wounds, by excessive terror or mental 
emotions, but the evidence on this point is far from conclusive. It is supposed that 
in some cases rheumatism has laid the foundation for this lamentable disease. 

The onset of the complaint is generally insidious, and the progress is so slow that 
the patient has often a difficulty in saying exactly when it began. A feeling of 
weakness or a disposition to tremble fastens upon some particular part, most 
commonly one hand or arm. The tremors are aggravated by mental emotion or 
agitation, whilst rest and quiet diminish or stop them. Usually they may be con- 
trolled by grasping a weight, or by a slowly and deliberately-performed voluntary 
act. These tremors, at first slight and occasional, gradually increase, and after a 
time extend to other parts. The patient experiences considerable difficulty in 
performing any act requiring manipulative dexterity. He becomes unable to read 
or write or hold a book, and often has considerable difficulty in dressing and feeding 
himself. He finds it almost impossible to drink in the ordinary way, the fluid being 
spilled and the glass or cup knocked to and fro against the mouth. Patients 
deprived of assistance have sometimes been obliged to lap water like a dog. It is 
very painful to witness the struggles of the sufferer in his efforts to effect some 
desired movement ; the more he tries the worse he becomes. He is even obliged to 
walk with circumspection, and the legs are not raised to the height nor with the 
promptness the will directs, so that much attention is requisite to prevent falling. 
Sometimes a difficulty is experienced in preserving the upright posture when sitting 
or standing, but especially in walking there is a propensity to lean forwards, which 
gradually increases, and the patient is in constant danger of falling on his face. The 
forward tendency may become invincible. Forced to walk on the toes and fore part 
of the feet, while the body is thrown forwards, the patient is irresistibly impelled to 
take short quick steps, and to adopt unwillingly a running pace — in fact, he is 
obliged to run to keep up with himself. Sometimes, in advanced cases, an attendant 
has to step backwards in front of him, with his hands placed on his shoulders, in 
order to maintain his equilibrium. This forward tendency is not observed in every 
instance, and the tremors often occur alone. Occasionally, though rarely, there is a 
disturbance of balance in the opposite direction, and the patient is impelled to run 
backwards. "We are told of a man who had to be balanced to and fro before start- 
ing, and who, if arrested in his forward movement, immediately began to hurry 
backwards, and could not stop himself. 

Our description refers chiefly to severe and advanced cases. In many instances the 
complaint is so mild and its progress so slow, that were it not for the inconvenience 
arising from the unsteadiness of the hand in writing and other manipulations the 



183 



patient would not consider that he was suffering from any complaint at all Some- 
times the affection is confined to the muscles of the neck, and then the head is 
always nodding or shaking from side to side. In these slowly progressive cases the 
disease has no tendency to shorten life, and its duration may be indefinitely 
prolonged. An inmate of the Chelsea Hospital who was first affected at the age of 
sixty lived to be 107. 

When fully established it is an obstinate complaint, and not at all amenable to 
treatment. The mere violence of the movement, however, is no evidence of 
incurability, for slight tremors are sometimes the most obstinate, Benefit is often 
experienced from the administration of phosphorus (Pr. 53 or 54), or arsenic (Pr. 40). 
Pr. 1, taken three times a day, five drops of solution of strychnia being added to 
each dose, sometimes does good. The general health may be improved by cod-liver 
oil The application of galvanism by a medical man often does good. 



SLEEP — SLEEPLESSNESS* 

For the maintenance of an organ in a condition of health it is necessary 
that it should be allowed intervals of rest, during which the processes of nutrition 
and repair may go on undisturbed. Even those actions which are most continuous, 
such, for example, as respiration and the pulsation of the heart, have distinct periods 
of suspension Thus after each beat of the heart there is an interval, during which 
the organ is at rest This amounts to one-fourth of the time requisite to make one 
pulsation and begin another. During an aggregate of six hours out of the twenty- 
four the heart is not working, and is in a state of repose. It takes short periods of 
rest, like a sailor, but it has its due allowance of sleep for all that. And this, too, 
is equally true of breathing. If we divide the respiratory act into three equal parts, 
one will be occupied in inspiration, one in expiration, and the other by a period of 
quiescence. l>uring eight hours out of the twenty-four the chest and lungs are 
inactive. And so with the other organs of the body, each has its time for work and 
its time for rest And of our muscles, none, even during our most untiring waking 
movements, are kept in continued action. We may be " on the move " all day, but 
for all that we are not moving every part of the body at the same moment, or we 
should soon be exhausted, and our muscles would refuse to perform their office. 

But for the brain there is no real rest, except during sleep. So long as the indi- 
vidual is awake he is always thinking, the brain is always active, always " on the 
work," and there is no such thing as rest. No man yet ever succeeded in thinking 
of nothing at all • you cannot do it if you try. The substance of the brain is 
consumed by every thought, by every action of the will, by every sound that is 
heard, by every object that is seen, by every substance that is touched, and by every 
painful or pleasurable sensation, so that each instant of our lives witnesses the decay 
of some portion of its tissue, and the formation of another to take its place. During 
our waking moments the formation of the new substance does not go on with the 
same rapidity as the decay of the old ; repair cannot keep pace with the process of 
destruction — hence the necessity for sleep. The state of repose attendant upon 
this condition allows the balance to be restored, and hence the feeling of freshness 



484 THE TREATMENT OP DISEASES. 

which attends, or should attend, our waking moments. The more active the mind 
the greater the necessity for sleep, just as with a steamer, the greater the number of 
revolutions its engines make the more imperative is the demand for fuel. 

Most people require seven or eight hours' sleep out of the twenty-four, although 
many get on very well with only five or six. Students working for examinations 
often restrict themselves to four or five hours nightly for a few weeks, and then try 
and make up for it by passing nine or ten hours in bed for three or four weeks after- 
wards. No man can play such tricks with his health with impunity. 

The necessity for sleep is sometimes so great that no effort of the will can resist 
it. Sentinels have been known to sleep on their posts, even in the face of the most 
imminent danger. Active bodily exertion will not always suffice to ward off sleep. 
Many men have been known to sleep on horseback during night marches. In some 
of our long walking matches against time, the pedestrian has been known to sleep at 
night, still keeping up his weary round. During the battle of the Nile many of 
the boys engaged in handing ammunition fell asleep, notwithstanding the noise and 
confusion of the action, and the fear of punishment It is said, too, that on the 
retreat to Corunna whole battalions of infantry slept while in rapid march. 

" Blessings," exclaimed Sancho, " on him that first invented sleep ! It wraps a 
man all round like a cloak." The deprivation of sleep is one of the greatest punish- 
ments that can be inflicted. The following story, quoted on good authority, will 
serve to illustrate this fact : — " A Chinese merchant had been convicted of murdering 
his wife, and was sentenced to die by being deprived of sleep. This painful mode 
of death was carried into effect under the following circumstances : The condemned 
was placed in prison under the care of three of the police guard, who relieved each 
other every alternate hour, and who prevented the prisoner falling asleep night or 
day. He thus lived nineteen days without enjoying any sleep. At the commence- 
ment of the eighth day his sufferings were so intense that he implored the authorities 
to grant him the blessed opportunity of being strangled, guillotined, burned to 
death, drowned, garrotted, shot, quartered, blown up with gunpowder, or put to 
death in any conceivable way their humanity or ferocity could invent." This will 
give some idea of the horrors of death from want of sleep. Damiens, who 
attempted the assassination of Louis XV. of France, and who was sentenced to be 
torn to pieces by four horses, was for an hour and a half before his execution 
subjected to the most infamous tortures, with red-hot pincers, melted lead, burning 
sulphur, boiled oil, and other diabolical contrivances, yet he slept on the rack, and it 
was only by continually changing the mode of torture, so as to give a new sensation, 
that he was kept awake. He complained just before his death that the deprivation 
of sleep was the greatest of all his torments. Amongst the fearful iniquities of the 
" ordeal " and " torture," the system of Mersiglio was highly commended. This 
consisted in keeping the victim from sleep for forty hours ; upon which practice it 
has been cynically remarked that a hundred martyrs exposed to it would become 
confessors to a man. 

The immediate cause of sleep is believed to be a diminished supply of blood to 
the brain, and this will serve to explain the influence of many conditions in the 
production of sleep. Thus, for example, it has been shown that animalw often fall 



SLEEP — SLEEPLESSNESS. 485 

sound asleep on losing a large quantity of blood, a proportion being, of course, drawn 
from the brain. Most people have noticed the influence of heat — that of the fire, 
for example — in causing drowsiness, and eventually sleep, if sufficiently prolonged. 
During the prevalence of high temperatures the blood flows in increased proportion 
to the surface of the body, and consequently the quantity in the brain is diminished. 
A slight degree of cold excites wakefulness at first ; but if the constitution be strong, 
the effect is to favour the production of sleep. This it does by reason of the deter- 
mination of blood to the surface of the body which moderate cold induces in the 
vigorous. The ruddy complexion and the warm hands and feet produced in such 
persons under the action of this influence are well known. If, however, the cold 
be very intense, or the reduction of temperature sudden, the system even of 
the strongest fails to resist it, and then a very different series of phenomena result. 
Stupor, not sleep, is the consequence. The blood-vessels of the surface contract, 
and the blood accumulates in the internal organs, the brain among them. Many 
instances are on record showing the influence of extreme cold in the production 
of sleep, or rather stupor. One of the most striking is given in Captain Cook's 
"Voyages," in regard to an excursion undertaken by Sir Joseph Banks, Dr. 
Solander, and nine others, over the hills of Terra del Fuego. Dr. Solander, knowing 
from his experience in Northern Europe that the stupor produced by severe cold would 
terminate in death unless resisted, urged his companions to keep in motion when they 
began to feel drowsy. " Whoever sits down" said he, " will sleep, and whoever sleeps 
will wake no more." Thus, at once admonished and alarmed, they set forward ; but 
they had not gone far before the cold became suddenly so intense as to produce the 
effects that had been most dreaded. Dr. Solander was the first who found the inclination 
against which he had warned others invincible, and he insisted on being suffered 
to lie down. Mr. Banks (as he was then) entreated and remonstrated with him in 
vain ; down he lay upon the ground, although it was covered with snow, and it was 
with much difficulty that his friends kept him from sleeping. Richmond also, one 
of the black servants, began to linger in the same manner ; when he was told that if 
he did not go on he would in a short time be frozen to death, his answer was that 
he desired nothing but to he down and die. The Doctor said he was willing to go 
on, but that he must first take some sleep ; although but a short time before he had 
told the company that to sleep was to perish. It was found impossible to carry them, 
and there being no remedy they were both at length suffered to lie down, being partly 
supported by some bushes, and in a few minutes they fell into a profound sleep. 
Soon after some of the people who had been sent forward returned with the welcome 
news that a fire was kindled about a quarter of a mile ahead. Mr. Banks then 
endeavoured to wake Dr. Solander, and happily succeeded ; but though he had not 
slept five minutes, he had almost lost the use of his limbs, and the flesh was so 
shrunk that his shoes fell from his feet. He consented to go forward with such 
assistance as could be given him, but no attempts to relieve the servant vrere 
successful. He, together with another black left with him, died. 

Another potent cause of sleep, and one of which we habitually avail ourselves, is 
diminution of attention. Shutting the eyes so as to exclude the light, getting 
beyond the sound of noises, refraining from the employment of the other senses, and 



486 THE TREATMENT OF DISEASES. 

avoiding thought as much as possible, will do much to induce sleep. When we 
isolate ourselves from the external world, we lessen the amount of blood supplied to 
the brain, and in this way sleep results. It is not, however, always easy to do this. 
The nervous system is excited, ideas follow each other in rapid succession, and 
we lie awake for hours, vainly longing for happy oblivion. The more the will 
is brought to bear upon the subject, the more it rebels, and the less willing it 
appears to be forced into a state of quietude. In this case something 
may be done by endeavouring to tire out the brain Many ways of accomplish- 
ing this object have been proposed and are employed by different people. The 
great point about them all is that they are tiring and monotonous. Counting a 
hundred many times, listening to the ticking of a clock, working sums, and 
thinking of some disagreeable or tiresome subject have all their advocates. Some- 
times sleep may be induced by placing a brass pan — a sponge-bath will answer 
admirably — in such a position that water may fall into it drop by drop. Southey's 
experience, as related in " The Doctor," is well worth quoting, more particularly 
as he indicates several methods which may in some cases prove efficacious. " I 
put my arms out of bed," he says, " I turned the pillow for the sake of apply- 
ing a cold surface to my cheek. I stretched my feet into the cold corner; I 
listened to the river and to the ticking of my watch; I thought of all sleepy 
sounds, and of all soporific things — the flow of water, the humming of bees, the 
motion of a boat, the waving of a field of corn, the nodding of a mandarin's head 
on the chimney-piece, a horse in a mill, the opera, Mr. Humdrum's * Conversa- 
tions,' Mr. Proser's 'Poems,' Mr. Laxative's 'Speeches,' Mr. Lengthy 's 'Sermons.' 
I tried the device of my own childhood, and fancied that the bed rushed with me 
round and round. At length Morpheus reminded me of Dr. Torpedo's ' Divinity 
Lectures,' where the voice, the manner, the matter, even the very atmosphere and 
the stream of candlelight were all alike somnific ; where he who, by strong effort, 
lifted up his head and forced open the reluctant eyes, never failed to see all around 
him asleep. Lettuces, cowslip wine, poppy syrup, mandragora, hop pillows, spider's- 
web pills, and the whole tribe of narcotics, up to the bang and the black drop would 
have failed ; but this was irresistible, and thus, twenty years after date, I found 
benefit from having attended the course." 

Digestion favours the production of sleep, by inducing a flow of blood to the 
stomach, so that the brain is left in a state of anaemia, or bloodlessness. Some 
people always feel sleepy after a meal, although they may have partaken of food in 
the strictest moderation As a rule, persons who eat largely, and have good digestive 
powers, sleep a great deal, and there are many who cannot sleep at all at night unless 
they have partaken of a hearty supper. 

Debility is almost always accompanied by a disposition to inordinate sleep. 
People who are out of condition nearly always feel drowsy and heavy, and disinclined 
for active mental exertion The fact is, the brain is one of the first organs to feel 
the effects of a diminished amount of blood, or deterioration in quality, and hence in 
old age, or under the influence of a deficient quantity of food, or through the action 
of some exhausting disease, more sleep is usually taken than when the physical 
health is in its normal condition. 



8LEEP — SLEEPLESS1TE88. 487 

The approach of sleep is characterised by a languor which is agreeable when it 
can be yielded to, but which, when circumstances prevent this, is far from being 
pleasant. It is a delicious moment, certainly, that of being well nestled in bed, and 
feeling that you will soon drop gently to sleep. Many people however, and children 
especially, are rendered irritable and ill-tempered when they get sleepy. In the 
majority of cases the senses lose their activity in a certain definite organ. The 
sight is, of course, the first to be lost, the closure of the eyeballs interposing a 
physical obstruction to the entrance of light Even when the eyelids have been 
removed, or from disease cannot be closed, the sight is still the first of the special 
senses to be abolished. Moreover, in those animals, the hare for example, which 
do not shut their eyes during sleep, the ability to see disappears before the action of 
the other senses is suspended The taste is the next to fade, and then the smell ; 
hearing follows, and sensation yields last of all, and is the most readily re-excited. 
Practically, we know that it is much easier to awake a man by shaking him than 
by shouting at him. 

Although during sleep the operations of the senses are entirely suspended as 
regards the effect of ordinary impressions, the purely animal functions of the body 
continue in action. The heart beats, the lungs respire, the stomach digests, the 
skin exhales vapour, and the kidneys secrete urine. With the brain, however, the 
case is somewhat different, for while some parts retain the property of receiving im- 
pressions or developing ideas, others have their actions diminished, exalted, perverted, 
or altogether arrested. Relative to the different faculties of the mind as affected by 
sleep, great variations are observed. It has been supposed that several of them are 
exalted above the standard attained during wakefulness. Many remarkable stories 
are related, showing the high degree of activity possessed by the mind during sleep. 
Thus, it is related of Tartini, a celebrated musician of the eighteenth century, that 
one night he dreamt that he had made a compact with the devil, and bound him to 
his service. In order to ascertain the musical abilities of his subordinate, he gave 
him his violin, and commanded him to play a solo. The devil did so, and performed 
so admirably that Tartini awoke with the excitement produced, and seizing his violin 
endeavoured to repeat the enchanting air. Although he was unable to do this with 
entire success, his efforts were so far effectual that he composed one of the most 
admired of his pieces, which, in recognition of its source, he called the " devil's 
sonata." A somewhat similar anecdote has been preserved in a family of rank in 
Scotland, the descendants of a distinguished lawyer of the last century. This eminent 
person had been consulted respecting » case of great importance and much difficulty, 
and he had been studying it with intense anxiety and attention. After several days 
had been occupied in this manner, he was observed by his wife to rise from his bed 
in the night and go to a writing-desk which stood in the bedroom. He then sat 
down and wrote a long letter, which he put carefully by in the desk, and returned to 
bed. The following morning he told his wife that he had dreamed a most interesting 
dream ; that he had dreamt of delivering a clear and luminous opinion respecting a 
case which had perplexed him, and that he would give anything to recover the train 
of thought which had passed before him in his dream. She then directed him to 
the writing-desk, where he found the opinion clearly and fully written out, and ii 



483 TEE TREATMENT OF DISEASES. 

afterwards proved, to be perfectly correct. The weak point in this case is that there is 
no evidenoe to show that the gentleman in question was really asleep when he wrote his 
opinion. Circumstances that actually occur during the night are often mistaken for 
dreams. A gentleman on getting up one morning fancied that he had dreamed of a 
fire occurring in the vicinity of his house ; he mentioned the circumstance to his wife, 
and to his surprise she informed him that the supposed dream was a reality, and that 
he had got up to the window, looked at the fire, talked with her about it, and that in 
fact he was at the time fully awake. 

It sometimes happens that circumstances long forgotten are recalled in our 
dreams. A gentleman who had learnt Greek in his youth, but had subsequently 
completely forgotten it, could in his dreams read the Greek works he had been 
accustomed to use at college, and had a most vivid impression of fully understanding 
them. It is related, too, of the Countess de Laval, a woman of perfect veracity and 
good sense, that when ill she spoke during sleep a language which no one could 
understand. At last an old nurse detected the dialect of Brittany; her mistress 
had spent her childhood in that province, but had lost all recollection of the Breton 
tongue, and could not understand a word of what she had said in her dreams when 
it was repeated to her. Her utterances applied, moreover, exclusively to the ex- 
periences of childhood, and were infantile in structure. Nothing can be more 
remarkable than those cases in which a dream has served to reveal the hiding-place 
of some long-lost document or family record. In many instances the circumstances 
are well authenticated, and there can be no doubt as to their correctness. The facts 
have been known and then completely forgotten, and have finally been recalled to 
memory during sleep, or possibly at the moment of awaking. 

Most people dream more or less, but, curiously enough, some never do so under 
any circumstances, or rather, perhaps we should say that on awaking they have no 
recollection of having done so. Even the ancient writers were aware of this fact, 
and Pliny refers to men who never dreamed. Plutareh alludes to the case of 
Cleon, who, although he lived to an advanced age, had never dreamed. Yet, in 
spite of this, the great majority of writers hold the view that the brain is never at 
rest. Sir William Hamilton caused himself to be aroused from sleep at intervals 
throughout the night, and invariably found that he was disturbed from a dream, the 
particulars of which he could always distinctly recollect. It is probable that we 
originate nothing in our dreams. We may imagine things which never really 
existed, or of which we have heard or read, but the images we make of them are 
either composed of elements familiar to us, or are based upon ideal representations 
which we have formed in our waking moments. For example, before the discovery 
of America, no European ever dreamt of American Indians, simply because nothing 
existed within his experience which could have afforded any idea of the appearance 
of such people. Columbus and his followers may have dreamt of the continent of 
which they were in search and of its inhabitants, but the images formed of the latter 
must necessarily have resembled other beings they had seen or had heard described. 
After the discovery, however, every one dreamt of Indians as a matter of course, 
just as we do now even, although we may have no personal experience of tb* 
denizens of the far West. Dreams always have some foundation, and in the great 



SLEEP — SLEEPLESSNESS. 489 



majority of cases are excited by the events of the previous day. It is related of a 
tyrant of old that one of his courtiers once related to him a dream that he had 
had, in which he had assassinated his master. " You could not," exclaimed the 
tyrant, " have dreamed this without having previously thought of it," and then 
ordered his immediate execution. Sometimes dreams are the result of the ex- 
ternal conditions under which the sleeper is placed. Thus many people whilst 
suffering the pangs of hunger have dreamt of gorgeous banquets and of tables loaded 
with the most appetising viands. We are told of an officer in the army whose com- 
panions were in the habit of amusing themselves at his expense. They had discovered 
accidentally that they could produce in him any kind of dream simply by 
whispering in his ear. Once they conducted him through the whole process of a quarrel 
which ended in a duel, and when the parties were supposed to have met a pistol was 
put in his hand, which he fired, and was awakened by the report. On another 
occasion they made him, when asleep, believe that he was in an engagement, when 
he exhibited great fear and showed a decided disposition to run away. Against this 
they remonstrated, but at the same time increased his fears by imitating the groans 
of the wounded and dying. When he asked, as he often did, who was hit, they 
named his particular friends. At last they told him that the man next to him in his 
company had fallen, when he instantly sprang from his bed, rushed out of the tent, 
and was aroused from his dream, and rescued from his supposed danger, by falling 
over the tent-cords. 

Sleeplessness is very frequently the accompaniment of some disease or disorder, 
and is to be regarded as one of the symptoms characterising it, which will disappear 
under treatment directed to the original malady. But not unfrequently want of 
sleep occurs as a purely functional disorder. When night after night a person lies 
awake for hours, either failing to sleep, or getting it only by fits and starts, serious 
results are sure to follow. Inability to sleep is one of the most constant precursors 
and accompaniments of brain exhaustion and general decay, and when long persistent 
may result in insanity. It is probable that no one cause is so productive of mental 
degeneration as constant wakefulness, for not only is the brain prevented from obtain- 
ing rest, but it is kept in a state of continual tension which, if not relieved, must 
sooner or later lay the foundation of grave organic disease. 

A very common cause of wakefulness is over mental exertion. An author, for 
example, strains every nerve to finish his book by a certain date, sitting up night 
after night, disregarding the calls of nature and the dictates of common sense. At 
last his task is completed, and then when he tries to rest he finds he cannot sleep. 
It may be long before the health recovers from the excessive strain it has under- 
gone. It is a matter of every-day experience that the body and mind may become 
so weary that it is impossible to sleep — over-tired as we call it. Sleeplessness some- 
times arises from derangement of the liver. When this is the case the patient is 
often heavy and drowsy after a full meal, and he may fall asleep at once on retiring 
to rest, but after one, two, three, or four hours he awakes, and then he either lies 
awake for hours or is constantly falling asleep, dreaming or having the nightmare 
and awaking — four or five times, or even oftener, in the course of an hour — until 
the morning comes, when he drops into a quiet sleep of an hour or more, and gets up 



490 THE TREATMENT OF DISEAS1 



tired and irritable. This particular form of sleeplessness is often induced by certain 
articles of diet, or by some injudicious combination of them. An indiscretion that 
will excite headache, giddiness, or palpitation in one, causes sleeplessness in another. 
In these cases the rational treatment is obviously that of biliousness. A blue-pill or 
two will often do more to effect a cure than a whole arsenal of opiates or soporifics. 

Yery often sleeplessness arises from the stomach, rather than from the liver. 
This may be the case when there are no other obvious symptoms of indigestion ; the 
appetite may be good, and there may be no pain, flatulence, or other discomfort 
after meals. This form of sleeplessness has long been recognised. Thus an old 
writer says, " Persons who labour under a weakness of the stomach, as I have for 
a great number of years past, know that certain foods, without their being conscious 
of it, prevent sleeping. So I have been awakened a hundred times at 
two o'clock in the morning, when I did not feel any particular impression in 
the stomach, but I knew that I had been awaked by an irregular operation of 
that organ, and I have then recollected what I took at dinner, which was the 
cause of it. w In these forms of sleeplessness harm is often done by the adminis- 
tration of opiates. Very often relief may be obtained by careful attention 
to diet, and particularly by strict moderation in the use of wine or beer. 
In many cases a dose of carbonate of potash or carbonate of soda on going to bed, 
or on first awaking in the morning, is of service. Many people who suffer from 
this form of sleeplessness never do so well as after a dose of calomel, or a blue-pill. 

There are many other circumstances which have a tendency to produce 
sleeplessness. Smoking strong tobacco late at night, especially after errors of 
diet, is by no means an unfrequent cause. Strong odours, as of flowers, perfumes, 
or even embrocations, may act in the same way. Excessive exercise as in 
dancing, mental excitement, as in late entertainments, in amusements, or in 
music, may be mentioned. Care, trouble, sorrow, mental anxiety, are all enemies 
to sleep. Children are not unfrequently prevented from sleeping by bad dreams, 
too often frtcited by the tales or threats of ignorant or injudicious nurses. The 
practice of taking " forty winks " after dinner, though not in itself objectionable, 
if the authorised number be not exceeded by undue indulgence, may forestall 
the night's rest and make it diffi« lit to get off to sleep. Often enough the 
most relishing snatch of slumber out of bed is the one which a tired person 
takes before he retires for the night, while lingering in his sitting-room. The 
consciousness of being very sleepy, and of having the power to go to bed 
immediately, gives great zest to the unwillingness to move. Some people, it 
is to be feared, go to bed with a fixed idea that they cannot sleep, and they 
dwell on that idea, and consequently do not sleep. And, lastly, women of a 
nervous, excitable temperament are often annoyed by an inability to obtain 
sound repose during pregnancy, or they may suffer from complete insomnia 
after delivery,, 

We will now consider the best mode of curing sleeplessness, and we wish to 
state, in the first place, that the practice of resorting to a narcotic on every trivial 
occasion is as bad as bad can be. There is a great deal to be done before we can 
even think of taking medicine. To begin with, it is necessary to try and find out 



491 



the exciting cause of the wakefulness, and then to remove it if possible. If a man 
is over-working himself it is of not the slightest use giving him drugs to make him 
sleep, unless he will consent to go under easy sail for a time. That would be the 
abuse of medicine, not its use. Much may be done by measures which tend to 
improve the general health, and these are chiefly of a hygienic character. Is the 
room in which the patient sleeps all that it should be 1 Is it large and airy and, at 
all events, moderately well ventilated ? If not, this must be remedied without delay. 
Has the patient a fair allowance of bed-clothes ? Possibly he would be benefited 
by having a fire in his room at night, or a hot-water bottle to his feet. Is he 
regular in his habits ? He should go to bed every night at the same hour, and get 
up at the same time in the morning. A man who is irregular, and goes to bed one 
night at ten, and the next not till two or three in the morning, cannot expect to 
sleep well, and he certainly does not deserve to. Many people pass far too many 
hours in bed — seven or eight is enough for any man. We know people who are 
never satisfied, and are always complaining because they cannot sleep twelve hours 
at a stretch. To be able to do so would be no indication of health, but rather the 
contrary. Many a man has been cured of his inability to sleep by taking a warm 
bath the last thing before going to bed. Often enough there is some error in diet 
which requires to be looked to. Many people find they cannot sleep if they go to 
bed on an empty stomach. With many, a hearty supper of plainly-cooked and 
nutritious food rather favours sleep than otherwise. Of course, indigestible 
substances, such as cheese or pastry, should be avoided. A glass of good bottled 
stout is by no means a bad provocative of sleep. A plain biscuit after lying awake 
for some time will often bring relief Some people sleep best when propped up in 
bed, and others when lying quite flat on their backs. A low pillow, a hard pillow, 
or a hop pillow may conduce to sleep. If the air of the bedroom be dry, and there 
is a sense of stifling or stuffiness, it is a good plan to have the floor freely sprinkled 
with water containing a little Condy's fluid ; or if warmth as well as moisture be 
desired, the steam may be allowed to escape into the room from a kettle on the hob. 
Walking, riding, or driving in the open air, change of society, of scene, of air 
(provided only that it be pure and bracing) may prove remedial A good walk 
two hours before bed-time is beneficial in many cases. Reading exciting works of 
fiction late in the evening is to be prohibited, and everything possible should be 
done to prevent the normal functions of the brain from being over-excited during 
the day. Sometimes advantage is derived from getting rid of curtains and bed- 
hangings. The practice of keeping the bedroom window open all night is a good 
one. We are told that Bacon used to indulge in a posset of strong ale to subdue the 
activity of his brain before going to bed ; and in imitation of his practice we some- 
times recommend in cases of debility that a tumblerful of port wine negus, or of 
mulled claret, or of hot elder wine, or of white wine whey, should be taken the last 
thing. In other instances, where the skin is hot and dry, a glass of cold water may 
be useful. Should the bowels be habitually constipated, this must be seen to (see 
Constipation). If there be headache, a rag dipped in cold water and applied to the 
forehead may give relief. Attempts may be made to get into " the land of Nod " 
while comfortably seated in an easy chair. 



492 THE TREATMENT OP DISEASES. 

We have already had occasion to refer to the influence of monotonous sounds in 
producing sleep. Soothing sounds will lull adults as well as children. Brushing 
the hair, friction of the skin, rubbing the palms of the hands or the backs of the 
arms, will have a quieting influence on some persons. In exceptional cases sleep 
may sometimes be conciliated by the monotonous biddings of mesmerism, when 
drugs might fail to procure it, and such sleep may become in certain diseases a mode 
and an instrument of cure. What has been called "hypnotism" may occasionally 
have its uses. The following extract from a paper on the subject will explain 
the modus operandi : — " My usual mode of inducing sleep," says the writer, " is 
to hold any small bright object about ten or twelve inches above the middle of 
the forehead, so as to require a slight exertion of the attention to enable the 
patient to maintain a steady, fixed gaze on the object; the subject being either 
comfortably seated or standing, stillness being enjoined, and the patient requested 
to engage his attention, as much as possible, on the single act of looking at the 
object, and yield to the tendency to sleep which will steal over him during this 
apparently simple process. I generally use my lancet- case, held between the 
thumb and first two fingers of the left hand; but any other small bright object will 
answer the purpose. In the course of about three or four minutes, if the eyelids do 
not close of themselves, the first two fingers of the right hand, extended and a little 
separated, may be quickly, or with a tremulous motion, carried towards the eyes, so 
as to cause the patient involuntarily to close the eyelids, which, if he is highly 
susceptible, will either remain rigidly closed or assume a vibratory motion—the eyes 
being turned up, with, in the latter case, a little of the white of the eye visible 
through the partially-closed eyelids. If the patient is not highly susceptible, he will 
open his eyes, in which case request him to gaze at the object, &c., as at first; and 
if they do not remain closed after a second time, desire him to allow them to remain 
shut after you have closed them; and then endeavour to fix his attention on 
muscular effort, by elevating the arms if standing, or both arms and legs if seated, 
which must be done quietly, as if you wished to suggest the idea of muscular action 
withojit breaking the abstraction, or concentrative state of mind, the induction of 
which is the real origin and essence of all that follows." 

One of the best remedies for sleeplessness is bromide of potassium. It has been 
found of especial use in obviating that sleeplessness and wandering at night not un- 
frequently occurring during convalescence from acute diseases. In sleeplessness from 
other causes, as worry, over-work, grief, or indigestion, it may be employed with every 
expectation of success. It is especially indicated if besides sleeplessness the patient, 
although of abstemious habit, suffers from delirium resembling that of delirium 
tremens. In the sleeplessness of delirium tremens itself the bromide is of con- 
spicuous benefit. It is to be given in a single dose of twenty grains at bed-time or 
three table-spoonfuls of the mixture (Pr. 31). 

Chloral is another valuable remedy for the relief of sleeplessness. It should be 
given shortly before bed- time, and the patient should avoid excitement, and keep quite 
quiet, or it will produce restlessness instead of sleep. It is very efiicacious in subduing 
the sleeplessness of old people, and the wakefulness induced by excessive mental 
fatigue. The dose is a tea-spoonful of the syrup of chloral There is not the slightest 



SOMNAMBULISM AND SLEEP-WALKING, 493 

objection to giving it in combination with bromide of potassium, and for an adult a 
very good combination is two table-spoonfuls -of the bromide of potassium mixture 
(Pr. 31) with a tea-spoonful of syrup of chloral. 

The sedative draught (Pr. 37) may be used. 

As we all know, opium is a remedy frequently employed for the production of 
sleep, but it is a drug that must be employed with the greatest caution. Many a man 
has entered upon his last long sleep through the injudicious administration of a dose of 
laudanum. Never give a sleeping-draught containing opium to any one with extensive 
lung disease or with disease of the kidneys. Chronic sleeplessness, independent of any 
notable disease, should not be treated with opium if it is possible to avoid it. As a 
rule, bromide of potassium and chloral are much safer and better agents than laudanum. 
Still, when sleeplessness is caused by severe pain, or our other remedies have failed, we 
may be glad to resort to an opiate. When opium is given to produce sleep, attention 
must be paid to the time of its administration. It should be given at the usual 
time for sleep, or when the patient feels inclined to dose, so that it may aid Nature, 
herself striving to induce the same result ; small doses are then as effectual as larger 
given at a less seasonable time. As a rule, a dose of opium requires about two hours 
to produce its effects. It is conveniently given in the form of laudanum, twenty drops 
in a wine-glassful of water. Sometimes a morphia suppository succeeds better than 
when the drug is given by mouth. These suppositories are little cones of wax about 
half an inch long, containing a dose of morphia. When pushed up the back passage 
they dissolve with the heat of the body, and the effects of the drug are produced. 
The morphia suppository is a pharmacopceial preparation, and they may be obtained 
from any chemist. Only one is to be used at a time. The hypodermic injection of 
morphia must not be forgotten, although it is not a mode of treatment that we are 
justified in resorting to without absolute necessity. 

Chlorodyne may often be given with advantage. 

Coffee is an admirable remedy for some forms of sleeplessness. A spoonful or 
two of very strong coffee without sugar or milk will speedily subdue the sleeplessness 
arising from agitation of mind or body, or from extreme anxiety or mental labour. 
The wakefulness of children and of old people is especially under its control. 

A small tea-spoonful of spirits of ether or spirits of chloroform, in a wine-glassful 
of water at bed-time, will often induce sleep. The peevish sleeplessness of children 
is often removed by tea-spoonful doses of infusion of chamomile. When restlessness 
depends on indigestion, errors of diet, excesses of any kind, or on constipation, 
nux vomica may do good. Five drops may be taken in a wine-glassful of water 
three or four times a day. 



SOMNAMBULISM AND SLEEP-WALKING. 

The phenomena exhibited by a person in the condition of somnambulism are so 
wonderful that they have from the earliest times excited the superstitious feelings of 
the ignorant, and claimed the most serious attention of the learned. To see an 
individual apparently asleep, and yet capable of performing the most intricate action 
without the aid of the senses, is so diametrically opposed to our ordinary experience 



494 THE TREATMENT OF DISEASES. 

as to excite feelings of astonishment almost amounting to awe. That somnambulism 
is not merely a partial awakening, is shown by the difficulty always experienced in 
arousing the individual, and by the bewilderment and slow return of consciousness 
by which it is followed. Moreover, decided somnambulists are entirely ignorant of 
all that has occurred during their strange sleep, whereas dreams during a partial 
waking are always remembered, more or less. 

Somnambulism is to some extent hereditary, though not markedly so, and it is 
most likely to occur in families in which there is a proclivity to affections of the 
nervous system. Young people are more subject to it than those of mature age ; in 
fact, there are few children who do not exhibit at some time or other manifestations 
of the condition in question, such as muttering and talking in their sleep, laughing, 
crying, or getting out of bed. The sexes are equally subject to it, although in adult 
life it more rarely attacks men than women. The immediate cause of an access is 
commonly some indiscretion in diet, as, for example, a late or unusually heavy supper. 
Mental emotion, excessive intellectual exertion, violent grief, and other similar 
disturbing causes, are not unfrequently assigned as excitors of an outbreak in those 
in whom they are of occasional occurrence. Somnambulism is a serious complaint, 
not only from the awkward and even dangerous positions in which it places the 
patient when deprived of his senses, but also for the constant and wearying 
anxiety which it occasions his friends. How frequently we see in the papers 
the heading " Death of a Somnambulist." At the same time, it is by no means 
inconsistent with a fair condition of general health, and it is not uncommon 
amongst boys and girls at school, who, bodily and mentally, are quite equal to their 
companions. 

It is really marvellous what strange acts are occasionally performed during a con- 
dition of somnambulism. We are told, for instance, of a young ecclesiastic who 
during sleep frequently wrote sermons, and even composed music. The music was 
written with great exactitude. A cane served him for a ruler — the clef, the flats, 
and the sharps were all in their right places. All the notes were first made as 
circles, and then those requiring it were blackened with ink. The words were 
written below. One night, in the middle of winter, this young man during the 
somnambulistic condition imagined that when walking on the bank of a river he 
saw a child fall in. The severity of the weather did not prevent him from deter- 
mining to save it. He threw himself on the bed in the posture of a man swimming, 
went through all the motions, and after becoming well fatigued with the severity of 
the exercise, felt a bundle of the bed-clothes, which he took to be the drowning child. 
He seized it with one hand, while he continued to swim with the other, in order to 
gain the bank of the imaginary river. Finally, he placed the bundle in a place 
which he evidently considered to be dry land, and rose, shivering, with his teeth 
chattering as though he had emerged from icy water. He remarked to those present 
that he was frozen, that he would die of cold, and that his blood was like ice. He 
then asked for a glass of brandy, in order to restore his vitality, but there being 
none at hand, a glass of water was given him instead. He, however, detected the 
difference, and asked peremptorily for brandy, calling attention to the great danger 
he incurred from the cold. Some brandy was finally obtained. He drank it with 



SOMNAMBULISM AND BLEEP-WALXim 495 

much satisfaction, and remarked that he felt much better. Nevertheless he did not 
awake, and returning to bed, slept tranquilly the rest of the night. 

Another case is recorded of a young man, a servant, who rose every night in 
his sleep, descended to the cellar, drew some wine from a cask, and drank it 
Frequently he went out into the streets, and sometimes even wandered inte 
the country. 

A gentleman of very nervous temperament on one occasion dreamt that his place 
of business was on fire. He got up in his sleep, dressed himself, and walked a dis- 
tance of over a mile to his office. He was aroused by being stopped by the private 
watchman, who was at first under the impression that he had caught a burglar. 

In relation to the activity of the senses during somnambulism there is great 
diversity of opinion among those who have studied the affection. This is doubt- 
less due to the fact that somnambulists differ as regards the use they make of 
their senses, some availing themselves of the aid they can derive from these 
sources, whilst others do not appear to employ them at alL Let us take an 
example or two. One night a student was found, in the somnambulic condition, 
translating a passage from Italian into French, and looking out the words in the 
dictionary. Now, in this case, one would suppose that he was using the sense o£ 
sight, and yet undoubtedly sleep-walkers do wonderful things without the aid of 
their eyes, and in many instances they are known to have acted as though they 
saw in a room which was perfectly dark. Thus a lady during her sleep was seen 
by her husband to go into a dark closet adjoining their bedroom, open a trunk, 
and begin to arrange the contents. It contained clothing of various kinds, which 
had been put into it the day before without being sorted. She classified all the 
articles, such as stockings, handkerchiefs, shirts, &c., without making a single 
mistake, and without the possibility of being assisted by light sufficient for ordinary 
eyesight. Another case is recorded of a young lady who was accustomed to rise 
from her bed in a state of somnambulism, and to write in complete darkness. A 
remarkable feature was that if the least light, e^en that of the moon, entered the 
room, she was unable to write. She could do so only in the most perfect obscurity. 

It has been maintained that somnambulism is a condition closely allied to reverie 
or absence of mind. When we are strongly pre-occupied with any subject, the 
objects around us make no impression on our senses or on our mind. Archimedes, 
while meditating on a discovery, was an entire stranger to all that was going on 
around him. On one occasion whilst so engaged, Syracuse was taken by the enemy, 
but he was not diverted from his thought either by the chant of victory of the 
conqueror, or by the cries and groans of the wounded and dying. A person 
intently engaged in reading will often answer questions without suffering his train 
of thought to be interrupted. When he has ceased his study, he is surprised when 
told that he has been conversing. When we are walking in the street and thinking 
of some engrossing circumstance, we turn the right corners, and find ourselves where 
we intended to go without being able to recall any events connected with the act of 
getting there. During a state of reverie the mind pursues a train of reasoning often 
of the most fanciful character, but still so abstract and intense, that though actions 
may be performed by the body, they have no relation with the current of thought, 



496 THE TREATMENT OF DISEASES. 

but are essentially automatic. Thus a person in this condition will answer ques- 
tions, obey commands involving a good deal of muscular exercise, and perform other 
complex actions without disturbing the connection of his ideas. When the state of 
mental preoccupation has disappeared, there may be no recollection of the acts that 
have been performed. In the case of a person playing the piano and at the same 
time carrying on a conversation we have a striking illustration of the simultaneous 
performance of a mental and an automatic act. The mind is engaged with ideas, 
and the spinal cord directs the manipulations necessary to the proper rendering of 
the musical composition. A person who is not proficient in the use of the instrument 
cannot at the same time play and converse with ease, because the spinal cord has not 
acquired a sufficient degree of automatism, and the mind cannot be divided in its 
action. Darwin has recorded a striking example of the independent action of the 
brain and the spinal cord. A young lady was playing on the piano a very difficult 
musical composition, which she performed with great skill and care, though she was 
observed to be agitated and pre-occupied. "When she had finished she burst into 
tears. She had been intently watching the death-struggles of a favourite bird. 
Though her brain was thus absorbed, the spinal cord had not been diverted from the 
office of carrying on the muscular and automatic actions required for her musical 
performance. 

Occasionally the attacks of somnambulism have been so long and so frequent, 
that there is as much of a sleeping as there is of a waking state, and thus has 
arisen the singular phenomenon known as " double consciousness." Trains 
of thought are carried on from one attack to the next, though in the normal 
interval the mind is quite unconscious of them. In a remarkable instance 
of this kind, the patient, a servant girl, began by being subject to attacks of 
extreme sleepiness; next, in these sleeps she began to be talkative. Soon there 
appeared to be some method in what she said; she personated an episcopal 
clergyman, went through the baptismal service for three children, and delivered 
an extempore prayer. Another time she thought she was a jockey at Epsom, and 
rode round the kitchen on a stool. On awaking these pranks were forgotten, 
although in succeeding fits she remembered all that had occurred. Thus one night 
one of her fellow-servants was rude to her when somnambulistic. The next 
day the insult was forgotten, but shortly afterwards she had another attack, and 
told her mother about it. It is stated that education may be carried on, and even 
languages acquired, during somnambulism, but this is very doubtful. 

The subjects of somnambulism not unfrequently suffer in addition from night- 
mare. In nightmare there are generally apparitions, horrible or ludicrous, with 
always a distinct consciousness of inability to move. It may arise from the presence 
of indigestible food in the stomach, or from wind, or acidity. The suffering usually 
commences with a disagreeable vision, and the sleeper attempts to escape from some 
imaginary danger. Then he experiences a sense of suffocation, which increases 
until there is an imperfect consciousness that he is in bed. But still there continues 
the tormenting oppression from the weight on the chest, which keeps him lying on 
his back. The oppressed breathing becomes more and still more painful ; palpita- 
tion of the heart sets in, attempts are made to move the arms, but it is found 



SOMNAMBULISM AND SLEEP-WALKING, 497 

imi>ossible to do so, and the countenance assumes a ghastly expression, with the 
eyes half open. In a minute or two the power of movement returns, the patient 
by a mighty effort succeeds in rousing himself, fearing each moment lest the horrible 
paroxysm should recur. 

Morbid dreams are not unfrequently among the premonitory symptoms of 
insanity, and should be regarded as an indication, either that the digestive organs 
are not performing their functions properly, or that the patient is over-taxing his 
strength bodily or mentally, or perhaps both. Many cases of insanity preceded by 
terrifying dreams have been recorded. In one a lady dreamed that she had 
committed murder under circumstances of great atrocity. She cut up the dead 
body, but could not with all her efforts divide the head, which resisted her blows 
with an axe and other instruments. Finally she filled the nose, eyes, and mouth 
with gunpowder, and applied a match. Instead of exploding, smoke issued slowly 
from the orifices of the skull, and was resolved into a human form, which finally 
assumed the shape of a police officer sent to arrest her. She was imprisoned, tried, 
and sentenced to execution by being drowned in a lake of melted sulphur. While 
the preparations were being made for the punishment she awoke. This dream was 
repeated on several subsequent nights, and finally it made such an impression on 
her mind, that she had to be placed under restraint. 

We must now turn our attention to the measures that may be taken for the cure 
of somnambulism, and the allied conditions to which we have had occasion to refer. 
To begin with, it is essential that the patient should be removed from the society of 
those who would be disposed, thoughtlessly perhaps, to foster into a habit the 
recently-established disease. This of course applies chiefly to the case of boys and 
girls at school. Then the patient must be prevented from falling into that morbidly 
deep sleep in which the phenomena we have described are usually produced. He 
should never be allowed to indulge in what has been called the " intoxication of 
repose." This is best accomplished by waking him up once or twice in the night, 
before he has had time to walk or talk or perform other unseemly acts. In the case 
of adults, this may be accomplished by an alarum, which may be purchased for a few 
shillings. This simple precaution will often succeed in effecting a cure. Should 
the patient always or usually become somnambulistic at a certain hour, the alarum 
should awake him a little before that time. People have sometimes cured them- 
selves by tying their wrists to the bed-post before going to sleep. Care should be 
taken to lie with the head high, and the body should not be covered with too great 
a weight of bed-clothes. When the health is below par it should be seen to at once, 
or treatment will prove of little avail. Constipation should be remedied without 
delay. Plenty of exercise should be taken in the open air, and the hours of sleep 
may be advantageously limited to six or seven — that is, for an adult. The bedroom 
should, if possible, be large and airy, but at all events the windows should be left 
open all night for a good inch at the top, winter and summer. Heavy suppers must 
be avoided, and malt liquors are to be taken with caution. The best supper for a 
somnambulist is a glass of milk and a piece of dry bread or a biscuit. He should 
sleep on a hard mattress in preference to a feather bed. The specific medicine for 
these cases is bromide of potassium — two or three table-spoonfuls of the mixture 
82 



498 THE TREATMENT OF DISEASES. 

(Pr. 31) every night. Should this fail to afford relief in a fortnight, five grains of 
bromide of ammonium should be added to each dose. The bromide of potassium is 
of essential service in the case of the somnambulism of young children. The child 
usually gets out of bed while fast asleep, walks about the house, and performs, as if 
awake, various acts quite unconsciously. The state is not accompanied by any 
terror, although in some cases there is squinting. In these cases, from half a table- 
spoonful to a table-spoonful of the bromide of potassium mix ture will prevent the 
screaming and remove the squinting. The affection in children being almost always 
connected with deranged digestion, the condition of the stomach and bowels should 
be attended to, but even in spite of these derangements the bromide will give quiet 
and refreshing sleep. 

For nightmare the treatment is practically identical with that of somnambulism, 
and the bromide of potassium may be employed with every confidence. In cases 
where the attacks are obviously due to acidity, a dose of bicarbonate of potash or 
bicarbonate of soda in water, taken either at bed-time or in the middle of the night, 
will often afford relief Many people sleep with a reel tied round their loins, and 
this, probably by preventing them from lying on the back, not unfrequently succeeds 
in warding off attacks. This device is often resorted to in spermatorrhoea with 
success. 

SORE THROAT (CLERGYMAN'S), 

This is a form of sore throat which merits our best attention. It arises partly 
from the straining of the voice in public speaking, and partly from the inspiration of 
cold and dusty air through the nose and mouth during the act. It is not by any 
means confined to clergymen, for barristers, actors, and singers are frequent sufferers. 
It is not unfrequently met with in medical men, especially in those who hold hospital 
appointments, and have much lecturing or teaching to do. There is another public 
speaker who is frequently a sufferer, and that is the costermonger ; indeed, a few 
years ago it was irreverently proposed to change the name of the complaint, and call it 
" costermonger's sore throat." Photographers and others who are much exposed to 
the fumes of acrid chemicals in confined chambers often suffer from a very similar 
condition. 

This form of sore throat is frequently in its earlier stages a purely nervous 
affection, being unattended with any organic change. Subsequently, however, it 
gives rise to congestion, inflammation or relaxation of the mucous membrane of the 
throat, together with elongation of the uvula, and chronic enlargement of the 
tonsils. 

The symptoms consist principally of an uneasy sensation in the upper part of 
the throat, with constant inclination to swallow, as if there were some obstruction 
which could be removed by that act. Frequently attempts are made to clear the 
throat by coughing and hawking, and the patient is always going " hem ! "■ in a manner 
which is as distressing to himself as it is annoying to others. At the same time the 
voice undergoes an alteration, there being loss of power and hoarseness, and some- 
times even complete aphonia (loss of voice) towards evening. Many of the symptoms 
are worse in the morning, probably from the mouth becoming dry during sleep, and 



BORE THROAT (CLERGYMAN'S). 499 

they are nearly always worse after an unusual exertion of the voice, as, for example, in 
the case of ecclesiastics on Sundays. The elongated uvula frequently gives rise to a 
tickling in the throat or to the sensation of the presence of a foreign body, especially 
on bending the head backwards and on lying down. The sleep is frequently 
disturbed from this cause. 

Our remarks on the treatment of relaxed sore throat are in a great measure 
applicable to this complaint. If taken early, comparatively little difficulty will 
be found in effecting a cure. In its early stages the treatment should consist 
chiefly in the use of tonics, especially iron and quinine, the cold plunge or shower 
bath, or sea-bathing and temporary change of scene and occupation. Two or three 
glasses of port wine daily will prove of use. This, however, will not always effect 
a cure. In more chronic and obstinate cases, iodide of potassium (Pr. 32), or bromide 
of potassium (Pr. 31), or bromide of ammonium may be tried. It should be 
borne in mind that iodide of potassium is u, oOmewhat lowering and depressing 
drug, and we should not advise its continuance for more than ten days unless 
distinct benefit is perceived. Belladonna (Pr. 39) is often used with advantage, 
particularly when the throat is ulcerated and of a bright red colour, and there is pain 
on swallowing. A tincture of pokeweed {Phytolacca decandra) has been highly recom- 
mended. The indications for its use are hoarseness, or loss of voice, with great 
dryness and a feeling as of a lump in the throat. It should be taken in three-drop 
doses, in a little water every three hours. It may also be used as an inhalation, or as 
a gargle, the strength being twenty-five drops of the tincture to a quarter of a pint 
of water. 

The glycerine of tannin, of which we have already had occasion to speak so 
highly, is the application on which we should place most reliance. Any of the 
inhalations, the formulae for which have been given, may be tried with a fair 
prospect of success. Benzoic acid lozenges often act beneficially. A cold wet 
compress applied to the throat every night at bed-time frequently proves a very 
effectual remedy. 

There are certain accessory modes of treatment to which it is of the greatest 
importance to pay attention. In the first place the inflamed organ must have rest. 
In the case of an inflamed knee-joint, the necessity for rest is at once acknowledged, 
and no time is lost in devising means with this object ; but in the case of an inflamed 
throat or larynx, it is usually the last thing thought of. Any one suffering from 
clergyman's sore throat should be extremely careful not to exert the damaged organ 
in any way. Even ordinary conversation should be carried on in an undertone, 
and should not be prolonged. 

There is another point which is very commonly neglected. Every working man 
requires one day'e rest in the seven. The duties of a conscientious clergyman are 
every bit as toilsome and far more harassing than those of a mechanic or day labourer, 
and he should make it a rule to take a thorough holiday every Monday. It should 
be a day of out-door recreation, and cessation from all work. This will in some 
degree compensate for the great mental and physical expenditure involved in the 
discharge of the duties of the Gospel on Sunday. 

Clergymen and lecturers often get into the habit of speaking in a voice which xi» 



500 THE TREATMENT OF DISEASES. 

not natural to them. They use an assumed tone of voice, in many cases probably 
unconsciously imitating some one whose delivery they admire. Undue stress is laid 
on the larynx and vocal cords, which ultimately yield to tension. The best way is 
to take the opinion of a teacher of elocution on the point, and follow his advice. 

The beard and moustache should be permitted to grow, as they form the best of 
all protections for the throat. In men, throat affections occur chiefly, and it is said 
almost exclusively, amongst those who do not wear a beard. It is the opinion of 
many medical men that the beard not only adds materially to the general health 
and comfort of the individual, but is a powerful agent in prolonging life. It is said 
that amongst the records of the older medical writers there are few references to 
diseases of the throat, and that this is attributable to the then almost universal 
custom of wearing a beard. This may be true, or it may not ; but at all events, 
if you habitually suffer from sore throats, our advice is — grow a beard if you can. 

The sulphuretted waters of tr" Pyrenees, especially of Les Eaux Bonnes, are 
viewed by the French as almost a specific for mal de gorge des ecclesiastiques, and 
undoubted benefit is often derived from their use, especially when the voice remains 
weak after the other symptoms have been removed. 



BORE THROAT (ORDINARY). 

This is simple inflammation of the throat, without the affection of the tonsils 
which, as we have seen, is characteristic of quinsy. 

The most frequent cause of this complaint is exposure to damp and cold. All 
causes which tend to lower the condition of the general health, and more especially 
over-work in a vitiated atmosphere, act as predisposing causes. It is met with 
chiefly in young people, but may occur at any age. Those who have had one attack 
are very likely to suffer from it again. 

The chief symptoms are heat and dryness in the throat, with acute pain on 
swallowing, and more or less of hoarseness of the voice. There is a constant desire 
to cough, without anything being hawked up. Drinks sometimes regurgitate through 
the nostrils, and there is often much pain and stiffness about the angles of the jaw. 
From the quantity of saliva secreted, there may be an almost constant desire to 
expectorate. The symptoms are usually aggravated towards night. 

The complaint is accompanied by more or less constitutional disturbance, the 
temperature varying from 101° to 102° Fahr., and the pulse from 100 to 120 beats 
in the minute. Sometimes the commencement of the attack is marked by slight 
rigors or chilliness, with headache and aching pains in the limbs. 

The inflammation usually continues for about a week, and then gradually subsides. 
It is unattended with danger, unless, indeed, the larynx becomes affected, and there 
is shortness of breath, when the doctor should be sent for. Sore throat, although 
a comparatively trivial complaint, should not be neglected, as it is apt to become 
chronic, and it then runs an indefinite course, and is by no means easy to cure. 

The patient should remain in-doors, but need not take to his bed, rest and a 
uniform temperature being all that are required. The diet should consist chiefly of 



BORES, OR ULCERS. &01 



"slops," as, for example, strong beef-tea, milk, eggs, <fec. No stimulants are as a 
rale necessary. 

The medicinal treatment is very s imil ar to that which we have recommended in 
quinsy. In the early stage, when the patient is , feverish, aconite (Pr. 38) should 
be given. It is indicated when the prominent symptoms are dryness, roughness, 
and heat in the throat, accompanied by a choking sensation. Belladonna (Pr. 39) 
is useful when the fever has been brought down by the aconite, and when there 
is pain on swallowing and the throat feels as if it had been scraped raw. The 
grey powder (Pr. 71) is useful when there is a sensation of a lump in the throat, 
or when the secretion of saliva is much increased. 

Quite at the commencement of the attack a Turkish bath may be expected to do 
good. The constant sucking of ice or gargling with milk-and-water always proves 
beneficial. 

SORES, OR ULCERS. 

Ulcers are of common occurrence on the legs. They are especially liable to be 
produced by all those circumstances that favour weakness of the circulation, and 
lowered vitality, as, for example, exposure to cold and wet, want of food, and 
long standing. They are common at or after the middle period of life, 
especially in the poorer classes. In constitutions or parts predisposed to it, the 
slightest irritation may produce ulceration. Tall people more frequently suffer from 
sore legs than do short. When situated over bony prominences they are far more 
difficult to heal than when they have a good thick layer of muscle or fat beneath 
them. 

There are many varieties of ulcers, not solely being dependent on local conditions, 
though these undoubtedly influence them greatly, but to a great extent due to 
constitutional causes. In fact, the aspect of a sore and the character of the discharge 
are excellent indications of the state of health and general condition of the patient, 
as well as of the local disease. Even the influence of sleep is well marked. After a 
restless night a sore is commonly painful, throbbing, inflamed, and swollen, and is 
apt to spread, whilst after a refreshing sleep it presents a much more healthy 
appearance. The simplest form of ulcer is what is called the healthy ulcer. It is 
usually circular or oval in shape, slightly depressed, and covered with matter. It 
has a natural tendency to get well. Its treatment should be as simple as possible. 
The best thing is to get some lint, cut it to the size of the ulcer, dip in a weak 
carbolic acid lotion (1 in 400), then lay it on the sore, and cover it with a rather 
larger piece of oiled-silk, and prevent it from getting dry. A nicely-applied 
bandage will keep the dressing in place, and will also give support to the part. 
When an ulcer is weak or indolent, and exhibits no inclinatien to get well, it is a 
good plan to apply some stimulating lotion. One of the best is known as " red- 
wash." It is made by dissolving forty grains of sulphate of zinc in a pint of water, 
and then adding half an ounce of compound tincture of lavender. It is used on lint 
in exactly the same way as the carbolic acid lotion. It is in constant use in many of 
our city hospitals for cuts, "sores, and abrasions of all kinds. When an ulcer gets 
inflamed, a condition characterised by much redness, heat, and swelling of th© 



9Q1 THE TSEATMOT OF DISEASES. 

surrounding parts, with a thick, offensive discharge, often streaked with blood, the 
application of a piece of lint, kept constantly moist with a mixture of spirit and 
water, will do good. It should not be covered with oiled-silk, and the leg should be 
supported either on the sofa or on a chair. For ulcers of the leg resulting from 
enlarged or varicose veins, nothing is better than to use the red lotion, and then to 
wind a bandage made of some elastic material all up the leg, beginning from below. 
The bandage should be put on in the morning, before getting out of bed. An 
elastic stocking will do equally well, and is less trouble, though of course it is more 
expensive. 

Constitutional treatment is an important element in the cure of ulcers ; in fact, 
unless this be attended to the best regulated local measures , may be employed in 
vain. For the process of healing to go on satisfactorily, it is absolutely necessary 
that the strength should be well supported. When the patient is weak and pulled 
down, such remedies as quinine (Pr. 9 or 11), cod-liver oil, or Parrish's 
Chemical Food should be used. When there is anseinia, or poorness of the 
blood, a few doses of iron (Pr. 1 or 2) will often work wonders. When there is any 
suspicion of a gouty taint, either hereditary or acquired, the colchicum mixture 
(Pr. 33) should be taken, and the strictest moderation must be employed in the use 
of stimulants. When the patient has at any time — even years before — suffered 
from constitutional syphilis, he should consider the possibility of his sore being due 
to that cause, and would do well to resort for a time to the iodide of potassium 
mixture (Pr. 32). In every case the nutrition must be carefully attended to. If a 
patient is losing weight his ulcer will not heal. It is only when the nutrition is 
capable of maintaining or increasing the bodily weight that the healing process can 
be expected to take place. The bowels must be kept freely open, and a warm bath 
should be taken occasionally. 

There is no better mode of treating ulcers than by rest When an ulcer proves 
obstinate and will not heal, take a thorough rest, if it be only for a week. There is 
no occasion to keep in bed, but no walking is admissible, and the leg should be con- 
stantly supported, and should never be allowed to hang down. When rest positively 
cannot be taken, bandaging is always a safe mode of treatment, the actual sore 
being protected by damp lint from contact with the coarse fabric of the bandage. 
A dirty bandage must never be used. The frequency with which the wound is 
dressed will in a measure depend on the amount of discharge. As a rule, twice a 
week is often enough. In the treatment of ulcers, as of so many other complaints, 
undeviating cleanliness is of the utmost importance. The uncleanly habits of many 
people, who allow their feet and legs to remain unwashed from week's end to week's 
end, induces an imperfect vitality of the skin, which favours the formation of ulcers, 
and renders them difficult to cure. Washing the lower extremities daily is one of 
the most potent means of preventing and curing sores on the legs, restoring, as it 
does, the lost vitality of the parts. 

There are many other modes of treatment that may be resorted to should these 
measures fail Finely-powdered cinchona bark dusted over foul, indolent, or 
sloughing sores, and left to form a kind of poultice, not unfrequently promotes the 
healing process. Glycerine of carbolic acid is a useful application for fetid sores, 



iUNSTROKE. 503 



quickly removing the offensive odour of the discharge. A good soothing application is 
calendula lotion (Pr. 97). It is made by adding thirty drops of tincture of calendula 
(the common marigold) to a tea-cupful of water. Common lime-water, to which a little 
glycerine may be added, is a soothing application for sores from which there is much 
discharge. Glycerine of tannin lightly painted over a discharging ulcer will cover 
it with a film of coagulated mucus, beneath which the reparative process takes place 
rapidly. For ulcers with a hard base and overhanging edges, a good lotion may be 
made by dissolving one grain of common bichromate of potash in eight ounces of 
water. When a sore is indolent, and shows but little tendency to heal, it is a good 
plan to draw a stick of lunar caustic over the surface once or twice. It causes very 
little pain. In very obstinate cases the surgeon often resorts to the process of 
"skin-grafting." This consists in removing very minute fragments of skin from 
some other part of the body, or even from another person, and then putting them 
on the surface of the sore. They are to be covered with little squares of oiled-silk, 
dressed with some simple lotion, and then left undisturbed for four or five days. 
At the end of that time they will probably have disappeared, but soon each of these 
spots becomes a centre from which healing takes place rapidly. For a small ulcer 
two or three " grafts " will have to be used, for a larger one half-a-dozen, or perhaps 
more. They are conveniently taken from the forearm or leg, being cut off with a 
pair of scissors. The process gives no pain, and the great point is to cut so small 
a piece that no blood is drawn. This mode of treatment greatly facilitates the 
process of cure. 

SUNSTROKE. 

Sunstroke, coup de soleil, insolation, or heat apoplexy, for by all these names is 
this complaint known, has been recognised from the earliest times, and could in fact 
hardly have escaped observation. There is a case of it related in the Bible. " And 
Manasses was her husband, of her tribe and kindred, who died in the barley harvest. 
For as he stood overseeing them, and bound sheaves in the field, the heat came 
upon his head, and he fell on his bed and died in the city of Bethulia." The 
second instance relates to the son of the Shunammite woman, who was restored 
to life by the prophet Elisha : " And when the child was grown, it fell on a day, 
that he went out with his father to the reapers. And he said unto his father, 
* My head t my head* And when he had taken him, and brought him to his 
mother, he sat on her knees till noon, and then died." 

Sunstroke is not confined to tropical regions ; New York and other northern 
cities suffer from its yearly visitations. At certain seasons the number of cases, 
in proportion to the population, far exceeds that of the more tropical towns. In 
New York, especially, the mortality has been very great. During the summers 
of 1866 and 1868 an immense number of cases were recorded, which caused the 
following report of the Sanitary Committee of the Board of Health, upon sun- 
stroke, to be approved and published by the Board : — 

Sunstroke is caused by excessive heat, and especially if the weather is " muggy." 
It is more apt to occur on the second, third, or fourth day of a heated term than 
on the first Loss of sleep, worry, excitement, close sleeping rooms, debility, abuse 



504 THE TREATMENT OF DISEASES. 

of stimulants, predispose to it. It is more apt to attack those working in the 
sun, and especially between the hours of eleven o'clock in the morning and four 
o'clock in the afternoon. On hot days wear thin clothing. Have as cool sleeping 
rooms as possible. Avoid loss of sleep and all unnecessary fatigue. If working 
in-doors, and where there is artificial heat — laundries, &c. — see that the room is 
well ventilated. 

If working in the sun wear a light hat (not black, as it absorbs heat), 
straw, &c, and put inside of it, on the head, a wet cloth or a large green leaf ; 
frequently lift the hat from the head and see that the cloth is wet. Do not 
check perspiration, but drink what water you need to keep it up, as perspiration 
prevents the body from being overheated. Have, whenever possible, an additional 
shade, as a thin umbrella, when walking, a canvas or board cover when working 
in the sun. When much fatigued do not go to work, but be excused from it, 
especially after eleven o'clock in the morning on very hot days, if the work is in 
the sun. If a feeling of fatigue, dizziness, headache, or exhaustion occurs, cease 
work immediately; lie down in a shady and cool place; apply cold cloths to and 
pour cold water over head and neck. If any one is overcome by the heat, send 
immediately for the nearest good physician. While waiting for the physician give 
the person cool drinks of water, or cold black tea, or cold coffee, if able to swallow. 
If the skin is hot and dry sponge with, or pour cold water over, the body and 
limbs, and apply to the head pounded ice wrapped in a towel or other cloth. If 
there is no ice at hand, keep a cold cloth on the head, and pour cold water on it 
as well as on the body. 

If the person is pale, very faint, and pulse feeble, let him inhale ammonia for 
a few seconds, or give him a tea-spoonful of aromatic spirits of ammonia in two 
table-spoonfuls of water with a little sugar. 

Persons of full habit addicted to the use of spirituous liquors are generally 
victims of the cerebro-spinal variety. Hard-working individuals are more liable 
to the cardiac form. 

In typical cases of sunstroke the symptoms may be divided into premonitory 
and immediate. The premonitory symptoms are not always evident. The patient 
complains of headache and a burning sensation about the head, and during the 
night is restless and wakeful. The skin is dry and uncomfortably hot, and there 
is frequent desire to evacuate the bladder. The face is flushed, and eyes congested ; 
the bowels are usually constipated. A person presenting these symptoms, who, 
nevertheless, continues to work under the hot sun, or in an overheated building, 
will be suddenly seized with vertigo, intense headache, and dimness of vision. His 
limbs refuse to support him, and he soon falls to the ground. Insensibility sets 
in; the breathing becomes stertorous, pupils contract, and the skin is intensely hot. 
The temperature of the body, ascertained by a thermometer in the axilla, varies 
from 100 Q to 107°, in rare cases reaching 109°. The pulse is rapid, and often full; 
as the case progresses towards a final termination it becomes weaker and irregular, 
but still very rapid. The coma may be either partial or complete, and occasionally 
there are convulsions. The bowels are sometimes relaxed, and vomiting is not 
infrequent 



euiriTROM. 505 

There are various grades or manifestations of sunstroke. Some who come 
ttnder the physician's care complain of intense weakness and pain in the head. 
Others are stupid and wandering, while complete insensibility accompanies the 
great majority of cases. In some the general malaise and warning symptoms 
precede the insensibility for several days ; others are stricken down in a moment, 
without previous uncomfortable sensations. 

In those varieties of sunstroke characterised by exhaustion or syncope the 
patients are more apt to die suddenly without special premonitory troubles. In 
such cases the countenance is paler than in the cerebro-spinal variety. The 
respiration is sighing or gasping instead of being stertorous. The pulse is generally 
rapid, compressible, and irregular. The pupils may be dilated, the heat of the 
skin is not extreme ; sometimes there is a combination of the cardiac and cerebro- 
spinal varieties. 

The reason why consciousness is lost from exposure to extreme heat is not 
fully understood ; overheating, of the blood is said by some authorities to call for 
excessive action in the nerve-centres, which rapidly exhaust their force and 
power. 

Maclean and others regard the heated blood as producing great depression of 
the nervous system, and thus preventing it from performing its functions. The 
latter theory seems the most plausible. 

Even if we accept this view, there are changes in the nerve-fibres and cells 
which we have as yet been unable to recognise or fully understand. These changes 
in many cases makes recovery from sunstroke more to be dreaded even than 
death itself They give rise to the varied sequelae of sunstroke, such as amaurosis, 
obstinate and distressing headache, and impairment of the intellect. 

Insanity in its varied forms is a common sequence. In some instances the 
brain is found to be softened after death, in others there is no special lesion 
perceptible. 

Another common sequel of sunstroke is persistent headache. The pain is usually 
fixed and most severe, and is not unfrequently referred to the nape of the neck. 
When not fixed, but shifting, it will usually be found to depend on debility of the 
digestive organs, or some other constitutional condition, calling for general rather 
than special treatment. Quinine and iron and gentian and soda will in this variety 
do more good than arsenic, phosphorous, and the other so-called nervine tonics. 

Now as to the treatment of sunstroke. Throw some water over your patient, 
and carry him as quickly as possible to the nearest shade. Strip off his clothes, 
and douche his head, face, and chest with cold water. If this treatment be quickly 
and energetically performed it may save his life. Should the skin remain hot, 
repeat the douche at intervals. Apply ammonia, or sal volatile, or smelling-salts to 
the nose occasionally. If sensibility be not restored by the douche, apply a blister 
to the nape of the neck, or get the head shaved and put a blister on the scalp. Two 
drops of croton oil placed at the back of the tongue will cause the bowels to act, 
and will do good. Get medical advice as soon as you possibly can. 

Bleeding should never be resorted to. When the patient is bled he nearly 
always dies. In illustration of the pernicious effects of bleeding in sunstroke the 



506 THE TREATMENT OF DISEASES. 

following case is related : — " During active service in the presence of the enemy, an 
officer of rank had sunstroke. The assistant-surgeon in medical charge of the 
battery where this happened had the sufferer instantly removed to the nearest 
shade, stripped him, used the douche freely, and had the satisfaction to see his 
patient revive and consciousness return. An official superior "an older, not a 
better " physician, unhappily coming up at this critical moment, insisted on opening 
a vein ; a few ounces of blood trickled away, and so did the life of the officer." 
Death immediately followed the operation. 

When there are convulsions the administration of chloroform is often attended 
with the most beneficial results. By prompt, careful, and judicious treatment one 
may fairly hope for recovery. At the same time, those who recover are scarcely 
ever the men they were before ; they are subject to persistent headache, lose their 
memory and their force of intellect, and become incapable, fatuous, and even 
paralytic. Epilepsy often occurs in those who have an hereditary tendency to it. 
For the persistent headache following sunstroke the best treatment is bromide of 
potassium, in two-table-spoonful doses of the mixture (Pr. 31). An occasional 
blister applied to the nape of the neck will do good. The general health should, as 
far as possible, be maintained and improved by friction of the skin, bathing, 
exercise in the open air, and so on. 

For the prevention of sunstroke the following rules are important : — A cold bath 
should be taken every morning, to ensure a free and clean skin. Natural perspira- 
tion should not be checked. The clothing — flannels are the best— should be light 
and loose, and the head and spine should be protected by thin folds of white linen 
•r serge, which may be kept wet if the heat is excessive. All intoxicating liquors — 
beer, wines, and spirits — are to be avoided ; but water, tea, lemonade, or some other 
simple drink should be taken freely. 

Directly there is experienced any sense of pain or tightness about the forehead, 
or dizziness, or weakness, the sufferer should lie down, and have cold water poured 
gently over his head. Cold tea or coffee or iced water should be given to drink. 
A little sal volatile will do no harm, but spirits should not be given unless the 
prostration is very great. 

The following are briefly the rules which should guide the management of 
soldiers and others travelling in tropical climates : — The weak and sickly had better 
be left behind when the heat is very great. The costume should be adapted for the 
early morning hours before sunrise, as well as for the scorching heat which follows. 
A flannel shirt should be worn, and the neck should be perfectly free. Nothing 
should be permitted to impede the free movements of the chest. The men should 
march " easy," and the pace should not exceed three and a half miles an hour. 
There should be a halt of five or ten minutes every hour, and a longer half way, 
when every one should have a biscuit and a cup of coffee. When the sun is up the 
halts should be so timed that they may be obtained in the shade of trees. In camp 
as much space should be allowed between tents as possible. 



TETANUS— LOCKJAW. 507 



TETANUS LOCKJAW. 

Tetanus is a disease the prominent feature of which is spasm. We medically 
recognise two different kinds of spasm. In one form, which we call tonic spasm, 
there is a continuous contraction of the muscles, just as when you get cramp in the 
calf of the leg. In the other kind, clonic spasm, there are alternate contractions 
and relaxations of the muscles, just as you get, for instance, in convulsions. In 
tetanus the spasm is entirely tonic, the muscles being in a constant state of 
contraction. 

Most cases of tetanus are caused either by exposure to cold and wet, or by bodily 
injuries. Not unfrequently both causes co-operate in producing the disease. When 
it sets in spontaneously — as it does sometimes — or as the result of cold, it is called 
idiopathic tetanus; and when it comes on after a wound or injury we speak of it as 
traumatic tetanus. In this country idiopathic tetanus is rare, nearly all our cases 
being traumatic. It is a curious circumstance that tetanus occurs much more fre- 
quently in hot climates than in cold. In India tetanus is frightfully common, and 
is a frequent cause of death after operations. 

Tetanus is liable to follow injury of any kind, to any part of the body. It may 
set in after the slightest scratch or wound, or after the most severe surgical 
operation. The disorder more frequently supervenes upon injuries of the 
extremities than of the trunk, head, or neck, and upon wounds made by puncture, 
than upon other hurts. Penetrating wounds of the sole of the feet, such as may be 
inflicted by treading on a nail, and injuries to the ball of the thumb, are more likely 
than other injuries to be followed by tetanus. There is a prevalent opinion that 
tetanus is very apt to arise from a cut between the first finger and thumb, but we 
are not aware that this has any foundation in fact. 

The symptoms set in suddenly, the muscles of the neck, jaws, and throat being 
usually first affected. The patient experiences a difficulty and uneasiness in bending 
or turning his head, and says he feels as if he had a sore throat and stiff neck. He 
finds also that he is unable to open his mouth with his customary ease. At length 
the jaws close, sometimes gradually, and sometimes it is said, quite suddenly with a 
snap. In the majority of cases the disease begins in this way — hence the origin of 
the name lock-jaw. As the disease proceeds the remaining muscles, those of the 
trunk, and lastly those of the extremities, become implicated. The spasm never 
entirely ceases, except in some cases during sleep, but it is aggravated every quarter 
of an hour or so, the increased cramp lasting for a few minutes and then partially 
subsiding. When the big muscles of the back are chiefly affected they bend the 
body into the shape of an arch, so that during a paroxysm the patient rests on 
nothing but his head and heels. Sometimes it is the muscles on the front of the 
body that are chiefly involved, and the patient is then bent forward till the head 
and knees are almost in contact. Occasionally, though very rarely, the muscles on 
one side only are affected, and then the body is bent laterally. The suffering 
caused by tetanic spasm is absolutely frightful to contemplate. The face becomes 
deadly pale, the brows are contracted, the eyes are fixed and prominent, the nostrils 
are dilated, the corners of the mouth drawn back, the teeth exposed, and all the 



508 THE TREATMENT OF DISEASES. 

features fixed in * ghastly grin. The tongue is apt to get between the teeth, and to 
be severely bitten. The contractions are often attended with intense pain, which is 
worse during the paroxysm, and extends over the whole body. With all this 
disturbance of the muscular system there is commonly very little derangement of 
the other functions of the body. The intellect is not affected, and the patient is 
painfully alive to the critical nature of his condition. Death at length closes the 
scene, the release being due partly to suffocation, and partly to exhaustion. 

The tetanic symptoms may come on at any time after the receipt of the injury, 
from a few hours to a couple of weeks. After the disease has set in, its rate of 
progress is very variable, but death is most likely to occur between the third and 
fifth days. If the patient survive the ninth day of the disease, his prospects of re- 
covery are much more favour* Me, and the spasmodic symptoms may gradually abate 
and disappear. When the s^. ... not violent, when the paroxysms are short, and 
recur at long intervals, and when the patient is able to sleep, we may hope for a 
favourable termination. In traumatic cases the longer the disease delays its assaults 
after the receipt of the injury, the milder, in general, does it prove. 

There is no difficulty in recognising the existence of tetanus. There is no 
other disease for which it could be mistaken, with the exception, perhaps, of that 
wonderful complaint hysteria, which may simulate almost anything. The symptoms 
produced by poisonous doses of nux vomica, or its active principle, strychnia, are, 
however, almost identical with those of tetanus, and it is well-nigh impossible to 
distinguish between them. When a large poisonous dose of nux vomica is 
administered death either rapidly ensues or the symptoms decline, and recovery 
takes place. Nux vomica may, however, be given in small doses, frequently 
repeated and gradually increased so as to imitate exactly the phenomena of tetanus 
from natural causes. 

We will now speak of the treatment of tetanus. The patient must be put to 
bed, and should be kept as quiet as possible. The slightest touch, a breath of cold 
air, or the sla mm ing of a distant door will often excite a paroxysm. Nothing 
proves more injurious than meddlesome nursing. We have as yet no specific for 
tetanus, and it is consequently impossible to speak dogmatically as to its treatment. 
We can do little more than enumerate the remedies from which most benefit has 
been derived. The drug on which we place most reliance is Calabar bean. To do 
any good it must be given in large doses, but we can hardly recommend its adminis- 
tration except under the personal superintendence of a doctor. Large doses of 
chloral sometimes do good, and even when this remedy fails to effect a cure it often 
prolongs life and eases the pain. The inhalation of nitrite of amyl might do good. 
Gelseminum (Pr. 41) has been warmly praised in the treatment of tetanus, and 
several cases are recorded in which recovery has followed its administration. The 
application of an ice-bag to the spine, a measure which has been found extremely 
useful in convulsions, is well worthy of a trial. The spinal ice-bag was described 
when speaking of sea-sickness (see Sea-sickness). The continuous adniinistration 
of chloroform has in some cases proved beneficial. In tetanus resulting from 
injury it is very necessary that the wound should be carefully examined to see 
whether by chance any foreign substance may not have been left in the wound. 



TOOTHACHE. 509 

In one instance on reopening a wound which had healed a splinter of wood 
was discovered ; and on another, a piece of rusty iron pressing upon a nerve. 

TOOTHACHE (ODONTALGIA). 

Strictly speaking, toothache is not in itself a disease, but is rather a symptom of 
many other diseases. An enumeration of all the causes of toothache would be little 
else than a list of each and all the morbid conditions to which the teeth are liable. 
Inasmuch, however, as the pain is the chief and often the sole subject of complaint 
it is a matter of convenience to speak of toothache as if it were a separate and 
distinct disease. 

Speaking generally, we may say that decay is the most common predisposing 
cause of toothache, and that sudden changes of temperature, the application of 
irritants, and general bad health are the most frequent exciting causes. Let us take, 
for example, an ordinary case of toothache, in which the pulp of the tooth becomes 
inflamed. In the first place a hole is discovered in the tooth, which may have 
resulted from decay or from some mechanical injury. Food and other matters 
collect in the aperture, and are from time to time removed. Their presence at first 
gives rise to no trouble, but after a while certain irritants, such as sugar, or salt, or 
acid matters, when lodged in the tooth occasion considerable inconvenience, which 
ultimately amounts to positive pain. The removal of the irritating matter is soon 
followed by the restoration of comfort. This state of things may go on for some 
time, but sooner or later the pain, instead of passing off, steadily increases, assumes 
a throbbing character, becomes still more acute, and extends to the neighbouring 
teeth and the side of the face, the faulty tooth forming the centre of its intensity. 
After the lapse of some hours the pain usually subsides, to return again on the 
slightest provocation. This is a story we fear is only too familiar to many of 
our readers. 

Like all other pain, toothache is more or less intermittent ; it is seldom that it 
is perfectly continuous, or if it be so it will vary greatly in intensity at different 
times. The character of the pain, as well as its severity, is greatly affected by the 
general condition of- the patient. A low condition of bodily vigour, whether 
produced by over-fatigue, prolonged abstinence from food, or other cause, will tend 
to produce pain of a diffused rather than of a localised character, and will markedly 
increase its severity. Many kinds of toothache temporarily take their departure 
when the system is thoroughly supported, as after breakfast or dinner. 

Very frequently, in addition to the pain, the tooth is exquisitely tender, and 
sometimes it feels as if it were longer than it ought to be. 

It is, however, not every case of toothache which is dependent on, or accom- 
panied by, decay. Mere malposition of a tooth will often give rise to the most 
intense suffering. The wisdom teeth, when they are making their way through the 
gum, often cause severe pain, even when there is ample room for them to take their 
place. Pain which is in reality due to the wisdom teeth is not unfrequently 
felt at a spot further forward in the mouth, the patient referring to some other tooth 
as the seat of his suffering. 



510 THE TREATMENT OF DISEASES. 

We must now proceed to the consideration of treating toothache. As toothache 
may, as we have seen, depend upon many different causes, it need excite no surprise 
that very many different remedies are used and have been proposed for its cure. A 
large number of nostrums are sold as applications to the teeth and gums for the 
cure of toothache. It is almost needless to say that there is no such specific remedy, 
and that a mode of treatment which in one case acts like a charm may in another 
prove a signal failure, and afford not the slightest relief. Much depends on the 
judicious selection of the remedy ; and that we may prove successful in our treatment 
it is very necessary that attention should be paid to the character of the pain and 
other attendant circumstances. We will, in the" first place, refer to some of the 
remedies most frequently employed. 

A few drops of chloroform on cotton wool inserted into the hollow of a decayed 
aching tooth often gives permanent relief, but sometimes when the anaesthetic efioct 
has passed away the pain is aggravated, the application having irritated the inflamed 
pulp. A better plan is to fold over the hollow tooth a piece of lint moistened with 
chloroform, so that the vapour only comes in contact with the interior of the tooth. 
The preparation sold as camphorated chloroform often proves useful. A mixture of 
equal parts of chloroform and laudanum, or of chloroform and creasote, constitutes 
an excellent application. 

Creasote may nearly always be employed with a fair hope of success. It may 
be mixed with an equal quantity of chloroform, or of laudanum, or with tannin. 
Laudanum either alone or mixed with tannin or creasote, and inserted into the 
cavity of the hollow tooth, enjoys a high and well-merited reputation. 

For cases in which the pulp is exposed and inflamed, a jelly is made by melting 
in a test tube some crystallised carbolic acid, and then adding an equal quantity of 
collodion. A small quantity is placed on cotton wool and inserted into the hollow, 
painful tooth. It may at first somewhat aggravate the pain, but in a few seconds 
it diminishes and soon abolishes it. Care should be taken not to let it come in 
contact with the inside of the cheek, for, as we can testify from personal experience, 
it would give rise to considerable pain and smarting. 

When there is a large hollow, and the pain is severe, a good application is a 
mixture of camphor and opium, of each one grain, made into a paste, with which 
the cavity should be filled, it having been previously dried by means of lint or 
cotton wooL 

When equal parts of chloral and powdered camphor are rubbed up together, 
they form a syrupy liquid. This will sometimes succeed in relieving toothache even 
when applied externally ; but it is more likely to afford relief when introduced into 
the cavity of the decayed tooth on cotton wool. 

A plug of lint dipped in sulphurous acid, and inserted in the hollow tooth, will 
often give immediate relief. 

It is stated on good authority that toothache may in many cases be relieved solely 
by the internal administration of medicines. Drugs given for this purpose should be 
given simply in water, and not in combination with other medicines. Should 
laudanum or creasote have been previously applied locally, the mouth should be 
thoroughly rinsed out before resorting to any new mode of treatment. 



TOOTHACHE. 511 

Grey powder proves useful in many forms of toothache, and is rej, **"ded 
by many as one of the best remedies for this complaint. It is use.l for 
toothache resulting from a decayed tooth. It proves of most value whe/i the 
pain is gnawing, tearing, or boring in character, and is aggravated by eating, 
and also at night in bed, but is temporarily relieved by cold water. It is of 
value when the pain affects the entire side of the face extending upwards to 
the head, and backwards to the ears. It is especially indicated when the 
toothache is accompanied by an increased flow of saliva, and by profuse 
perspiration in bed, which fails to afford relief. One of the "sugar and grey" 
powders (Pr. 71) should be given every ten minutes for an hour. In many 
cases it is a good plan to introduce a small quantity of grey powder, of course 
not mixed with sugar, into the hollow of the decayed tooth. 

Aconite is useful in toothache arising from cold. It is especially indicated 
when the pain is sharp and stinging, and is relieved by cold water. This form 
of toothache is usually accompanied by heat of the face and chilliness*. A 
drop of the tincture of aconite, or a tea-spoonful of the aconite mixture (Pr. 38), 
should be taken every ten minutes. This may be advantageously con bined 
with the local application of a few drops of the tincture on cotton wool. 

Belladonna is found to do best when there are shooting, throbbing pains 
affecting several teeth on one side, so that it is impossible to say exactly which 
tooth it is that is . aching. This form of toothache not unfrequentl^ shifts 
from place to place, and it is usually increased by both hot and cold applications. 
It is often accompanied by determination of blood to the head, flushed face, 
excessive sensitiveness to external impressions, such as noise or light, and by 
dryness of the mouth, and mental confusion. A drop of the tincture of 
belladonna, or a tea-spoonful of the belladonna mixture (Pr. 39), should be taken 
every ten minutes. 

Arsenic is used when the pain is grinding in character, when it is increased 
by touching the affected tooth, or by lying on the painful side. This form of 
toothache is usually increased by rest and by cold, but is relieved by moving 
about, and by the application of warmth. Arsenic is also indicated when the 
pains are jerking in character, or when they occur chiefly, or are much aggravated, 
at night. It usually proves of benefit when the sufferer is much exhausted 
by the pain. A small tea-spoonful of the mixture (Pr. 40) should be taken 
every ten minutes for an hour. 

Bryony is recommended when the pain is of a screwing character, when it 
is worse from warmth, is momentarily relieved by cold water, and more perma- 
nently by walking in the open air. A tea-spoonful of the mixture (Pr. 49) 
should be taken every ten minutes. 

Nux vomica is found to be useful for darting pain in the teeth, and for 
toothache of a boring or gnawing character, especially when it comes on after 
dinner. A drop of the tincture of nux vomica, or a tea-spoonful of the nux 
vomica mixture (Pr. 44), may be taken every ten minutes for an hour. 

Phosphorus should be given for tearing, shooting pains, worse in the open 
air, or after taking warm food. It is especially indicated when, in addition to 



512 THE TREATMENT OF DISEASES. 

decayed teeth, there are gum-boils. Drop doses of the phosphorus solution 
(Pr. 53) may be taken every ten minutes for two hours. 

Nitro-glycerine, or glonoine, is the remedy for pulsating toothache, accompanied 
by headache. A tea-spoonful of the one per cent, solution should be added to 
a pint of -water, and of this a tea-spoonful may be taken every ten minutes 
till relief is obtained. It is a most valuable remedy. 

Pulsatilla does good in cases where the pain comes on as soon as anything 
is taken into the mouth. The pain which is relieved by this remedy is worse 
in the evening, at night, and after the application of warmth. A tea-spoonful 
of the mixture (Pr. 43) should be taken every ten minutes. 

Chamomile tea is indicated when the violent paroxysms of toothache come 
on from exposure to a draught, or from a sudden check to the perspiration. 

Arnica is the remedy for pain in the teeth caused by mechanical violence. 
It does well in throbbing toothache, and in pain in the teeth as if they wer« 
being scraped. The tincture of arnica should be given in drop doses every ten 
minutes, or a tea-spoonful of the mixture (Pr. 42) may be taken in a like manner. 

It will be seen that our remedies for toothache are sufficiently numerous. We 
will endeavour to classify the characters of the pain and the attendant circumstances 
for convenience of reference. When the toothache arises from cold or a chill, 
aconite, belladonna, grey powder, or nitro-glycerine are the remedies to select from. 
When the pain is connected with indigestion, we look to bryony, nux vomica, 
Pulsatilla, or the grey powder. When it is associated with nervous symptoms, 
belladonna, nux vomica, or arsenic should afford relief. When it is rheumatic in its 
origin, we rely chiefly on grey powder, bryony, chamomile, or perhaps the actsea race- 
mosa. When the pain is increased by cold, aconite, arsenic, or belladonna should 
afford relief ; but when it is relieved by cold, we must trust to phosphorus or Pul- 
satilla. When toothache is accompanied by headache, belladonna or glonoine is 
indicated ; and when the teeth feel too long, belladonna, bryony, or aconite. We 
should always endeavour to use the drug which is indicated by the greatest number 
of corresponding symptoms or attendant circumstances. If a remedy affords no 
relief after five or six doses hare been taken, another should be selected. The 
necessity for keeping a stock of the most ordinarily-used tinctures will be at once 
apparent. Considerable delay must of necessity arise from having to send to a 
chemist for each medicine as it is required. 

We may take this opportunity of mentioning that pain consequent upon ex- 
traction or other dental operation may often be quickly relieved by rinsing out the 
mouth with a mixture of one part of tincture of arnica to ten of tepid water. 

It should be borne in mind that chamomile is the remedy for the irritation 
produced in children by teething. 

Gelseminum has been highly recommended for toothache. It is undoubtedly a 
very valuable remedy, but we are inclined to think that it does not do much good 
in pure toothache. It is the neuralgia arising from decayed teeth that it cures, 
and in these cases we believe that it stands almost unrivalled. Very frequently the 
pain of the decayed tooth and the neuralgia are experienced at the same time. 
If now gelseminum be given it will generally cure the neuralgia, but leave the 



TOOTHACHE. 513 

toothache unaffected. This, of course, is an advantage by no means to be despised, 
for neuralgia is usually a much more obstinate complaint than toothache. Ten-drop 
doses of the tincture may be taken every hour for three or four hours, or Pr. 41 
may be employed. 

Another excellent remedy for neuralgia arising from a decayed tooth is crotoc 
chloral. It should be given dissolved in water in five-grain doses every four hours. 

When toothache resists every other means of treatment we may have to resort 
to a hypodermic injection of morphia, but this is seldom necessary. 

Galvanism is occasionally employed in toothache. One pole is applied to the 
neck and the other is placed in contact with the painful tooth, a gentle continuous 
current being passed for two or three minutes. It does not always prove successful. 

In the majority of cases in which a tooth is decayed a dentist should be con- 
sulted respecting the advisability of having it stopped. When the patient is so 
situated that he cannot obtain professional aid he may himself clean out the cavity 
and then fill it with white wax or prepared gutta percha. Of course, in many cases, 
where the decay is extensive, the only remedy will be extraction. 

The importance of paying proper attention to the teeth cannot be over-estimated 
One great cause of the decay of the teeth is the presence of bits of food, which stick 
between the teeth and then soften and ferment in the heat and moisture of the mouth, 
and become acrid and injure the enameL The enamel is at first slightly discoloured 
at one point, then it gets soft, and eventually a little hole forms in it, which goes on 
enlarging and increasing until the deeper structures are involved and the pulp is 
exposed. Very often the secretions of the mouth mixed with the food dry on the 
teeth and between them, and form the so-called tartar, which is a powerful agent in 
the production of decay. The only way to guard against these dangers is to keep 
the teeth perfectly clean. They should never on any account be brushed less than 
twice a day. Brushing the teeth in the morning, and in the morning only, is not 
enough. When possible they should be brushed after every meal, especially when 
animal food has been taken. The avocations of many people, which take them from 
their homes, may not allow them to brush their teeth after every meal, but they 
can at all events thoroughly wash out the mouth with cold water, and thus remove 
most of the food which would otherwise adhere. The idea that frequently brushing 
the teeth tends to lacerate the gums and separates them from the teeth is erroneous. 
The oftener they are brushed the better, provided always that a moderately soft 
brush be used. The teeth should, of course, be cleaned inside and out; many 
people seem to think that as long as they clean those teeth or those parts of the 
teeth which are seen, they have done all that is necessary. The use of some simple 
tooth-powder is to be commended. When there is a tendency to decay tincture of 
myrrh often proves of much value. 

The habit of taking very hot substances into the mouth should be avoided, as the 
heat may crack the enameL On the other hand, the practice of sucking ice and 
subjecting them to the other extreme of temperature is equally to be deprecated. 
Ko one who has the slightest respect for his teeth would use them as nut-crackers. 
Smoking, but more especially chewing, tobacco is bad for the teeth. It should be 
remembered that the preservation of the teeth is in a great measure dependent on 



514 THE TREATMENT OF DISEASES. 

the condition of the health, and this should accordingly be maintained in the highest 
possible state of integrity by the use of plain nourishing food, cold bathing or 
sponging, and early or regular hours. 

TYPHOID, TYPHUS, AND OTHER FEVERS. 

By the term " pyrexia," or fever, we mean that general condition of the system 
which accompanies, and is an essential constitution of, all fevers. Its existence is 
indicated by the combination of certain symptoms which are familiar enough to most 
of us. A high temperature, a quick pulse, a dry skin, and intense thirst are pheno- 
mena common to many diseases, and when they are present we say the patient is 
feverish, or that he is suffering from fever. In some diseases, such, for example, 
as small-pox and typhus fever, these symptoms apparently constitute the essence of 
the complaint, whilst in others, as, for example, inflammation of the lungs, they are 
evidently caused by, and are dependent on, a disorder or derangement of some parti- 
cular portion of the body. In the former case, we say the fever is " primary," or 
" idiopathic," whilst in the latter, it is " secondary " or " symptomatic." All the 
complaints which we commonly call " fevers " belong to the first of these two 
divisions. 

It is absolutely necessary that we should devote some attention to the considera- 
tion of fever regarded in its abstract relations before we can hope to study 
with advantage any particular fever, such as typhus, or typhoid, or small-pox. It 
is to fever in general that the following remarks chiefly apply, but we shall have 
frequently, in illustration of our subject, to refer to particular diseases. Fever is 
usually ushered in by certain " premonitory " or warning symptoms. At first there 
is a condition of general malaise. It is not very easy to say exactly what we mean by 
this term, but that is a matter of comparatively little importance, as every one must 
have personally experienced this condition at some time or other. The patient feels 
that there has been some departure from his usual state of health. He is weak, 
" seedy," " out of sorts," and is conscious of a disinclination for any active employment, 
and of a loss of interest in his accustomed pursuits. Sometimes there is a sense of 
lassitude or weariness attended with yawning or stretching. The patient is apt to 
be affected with disturbed sleep, mental confusion or debility, and depression of 
spirits, but not unfrequently he complains of nothing but a vague uneasiness or 
feeling of discomfort, which he is unable to refer to any particular part, or to ascribe 
to any special cause. These symptoms are exceedingly variable in degree and 
duration, sometimes continuing for several days, sometimes only for a few hours, 
and occasionally they are quite wanting. 

Sometimes the occurrence of a " rigor," or shivering fit, is the first decided indi- 
cation the patient has of something being wrong. The onset of this condition i« 
not unfrequently abrupt and striking, the patient passing into it at once from the 
slight and scarcely appreciable disorder of the preliminary stage, or even from a 
state of seeming health. Sometimes, on the contrary, the chill is so slight, and is 
so intimately associated with the premonitory symptoms of which we have spoken, 
that it is impossible to decide on the exact time of its occurrence. In some cases 



FEVER AND FEVERS, 515 



there is simply a greater sensitiveness of the surface to the impression of cold, so 
that a current of cool air, or the contact of a cold body, produces a feeling of 
chilliness which runs momentarily through the frame, and then subsides. The sense 
of cold, however, is usually more permanent, and quite independent of surrounding 
objects. It begins most commonly in the back, and extends to the limbs and ovei 
the body, producing chattering of the teeth, and sometimes universal tremor and 
shaking, and this may occur although the patient may be near the fire, or 
covered with blankets in bed. In some fevers the rigors are more intense, and oi 
far more constant occurrence than in others. In small -pox they are definite and 
prolonged, and in typhus fever they are frequently well marked. In scarlet fever, 
diphtheria, measles, and acute dysentery, there may be a distinct rigor or only a 
passing sensation of chilliness. Typhoid fever usually commences insidiously, but 
in the cases in which the onset is sudden, a shivering fit is not of unfrequent occur- 
rence. The cold stage of ague may be said to be composed of a succession of rigors. 
It is not improbable that shivering fits are induced more readily in some constitutions 
than in others. The mere snipping of a blister, an operation which it is needless to 
say is perfectly painless, will, in many people so far throw the nervous system off its 
balance, as to produce a rigor. Some individuals are so delicately organised that 
they can never pass water in the open air without experiencing a transitory 
feeling of chilliness. 

It is often said that the rigor announces the entrance of the poison into the system, 
but this is obviously incorrect ; for example, a person is brought in contact with 
a patient suffering from small-pox, but it is not till twelve or thirteer days after 
that he has a rigor, and the disease declares itself. 

It would be no easy matter to persuade the patient that at the very time the 
rigor is at its height, and he is shivering with cokl, his temperature is above the 
normal, and his body much hotter than it has been for weeks and months past, 
and yet such is the case. In children the place of the rigor is often taken by a 
convulsion. A convulsion not unnaturally causes considerable alarm and anxiety 
to the friends and relatives, but it should always be remembered that in the case 
of children it, at the commencement of an acute illness, means no more than does 
a shivering fit in an adult. 

First and foremost among the conditions which indicate the existence of fever 
is an elevation of temperature. Without increased heat of the body fever cannot 
exist; elevation of temperature is the essence of fever. Formerly we judged of 
the temperature of the body by the hand, now, by means of the thermometer, we 
are enabled to estimate it accurately, and record it numerically. We used to speak 
of a patient being a "little feverish," or perhaps of his having a "high fever," but 
now we prefer to say that he has a temperature of 100° or 105°, or whatever it 
may be. The temperature is often of the greatest service in enabling us to determine 
the nature of the fever from which the patient is suffering, or, this being known, 
to detect the existence of complications or other changes in the patient ? s condition. 
In some acute diseases the range of temperature is very characteristic. Thus, in 
the different varieties of ague, the temperature suddenly and speedily rises to 
105° or 106° Fahr., and then with equal rapidity returns to the normal, there 



516 THE TREATMENT OP DISEASES. 

to remain until shortly before the return of another paroxysm. The temperature 
in some fevers is much higher than in others. For example, in an ordinary case 
of measles it seldom rises above 103°, but in scarlet fever it may reach 104°, 
or nearly 105° on the first day. When the temperature in any fever reaches 
105° the case is serious, and if it remains long above 106° the patient is in imminent 
peril. Until within the last few years a continued temperature of 107° always 
proved fatal ; but nowadays, by the use of the cold bath, we not unfrequently 
succeed in reducing the fever and saving the life of the patient. 

Fever is almost always accompanied by an increase in the rapidity of the 
heart's action, and consequently by quickening of the pulse. It is often laid down 
as a rule that a rise of one degree in the temperature of the body corresponds to 
an increase of ten beats of the pulse in the minute, and this is, in the main, correct. 
In some fevers the pulse nearly always becomes very rapid. Thus, in scarlet fever 
it is often remarkably frequent. In this disease it may rise in the case of children 
to 160 on the first day of the illness. In typhoid fever a pulse of 130 is of 
serious import, and in typhus fever death almost always ensues when it exceeds 
150. 

A harsh, dry, burning heat of the skin is one of the symptoms of fever. A 
moist skin seldom gives the same sensation of extreme heat as is experienced when 
the skin is dry. In rheumatic fever or acute rheumatism the whole of the body is 
often bathed in perspiration, even when the patient's temperature is three or four 
degrees above the normal. 

Headache is sometimes present in fever, but not always. In most cases it is felt 
in the region of the forehead ; in fact, headache, unless dependent on some disease 
of the head itself, is nearly always frontal. It is a common accompaniment of the 
hot stage of ague, and is usually very intense in small-pox and typhus fever, more 
particularly in the latter disease. 

Fever is often accompanied by pain, sometimes confined to one particular part 
of the->body, but frequently not localised. In many fevers pain in the back ii 
common, and in small-pox it is one of the most prominent of the early symptoms. 

Confusion of ideas, or even distinct delirium, is not an uncommon result of fever. 
Frequently it shows itself at night only, or it may be perceived that the patient 
wanders a little on awaking from disturbed sleep. In typhus fever it is very common, 
particularly between the fourth and the eighth days. In this disease it varies very 
much in character, and may be active and maniacal, or low and muttering. Much 
active excitement is not very common, but extreme degrees of it are occasionally 
seen, the patient praying, bawling, or blaspheming, according to his habitual turn 
of mind. Very commonly the patient lies talking quietly to himself about matters 
which interested him at the time of his seizure, or on subjects suggested by what is 
going on, or what he supposes to be going on, around him. Sometimes in his delirium 
the patient may labour under the delusion that an attempt is being made to poison 
him, and acting upon this impression he may positively refuse to take nourishment 
of any kind. Patients will often tell you after their recovery that the period of 
delirium was to them a time of utter confusion, not only as regards time, and 
place, and people, but even respecting personal identity. Occasionally the patient 



FEVER AND FEVERS. 517 



fancies that he is two or three different people, each of whom is suffering feom 
inconceivable misery or torture. 

Loss of appetite and constipation are common accompaniments of fever. In 
typhus the loathing for food may be so marked that it may be found necessary for 
the maintenance of life to feed the patient by the bowel. In rheumatic fever, 
curiously enough, the appetite is often retained. The diarrhoea, which is so prominent 
a symptom in typhoid fever, is due to ulceration of the bowel, and is consequently 
not an exception to the rule that fever is accompanied by constipation. 

The general appearance is in some fevers so characteristic that to the practised 
eye a single glance may be sufficient to determine the nature of the complaint. This 
is especially the case in typhus fever, where the general aspect is so peculiar that it 
frequently forms an important element in deciding on the nature of a doubtful 1 ' case. 

Weakness and loss of weight are necessary concomitants of long-continued fer^r. 
It should always be remembered that fever does not mean strength, but weakness. 
Many people seem to imagine that fever means power. 

In many fevers peculiar and characteristic odours are exhaled from the body of 
the patient A practised nose would instantly detect the presence of a case of 
small-pox in a ward. The copious sweat in rheumatic fever has a strong acrid 
odour. The smell from the motions is in some diseases almost insupportable. This 
is especially the case'' in acute dysentery, the foetid, even cadaverous, odour filling not 
only the room, but the whole house. 

Certain terms are applied to different varieties of fevers, according to the course 
pursued by the temperature. When the temperature rises, and remains elevated 
until the termination of the illness or the establishment of convalescence, the fever 
is said to be a " continued " fever. Most of our common fevers,, such as scarlet 
fever, measles, and small-pox, are continued fevers. When the fever comes on in 
paroxysms — first rising, then falling to the normal, then rising again, and' so on — 
the fever is said to be an " intermittent " fever. Ague affords a typical example of 
an intermittent fever. When the temperature first rises, then falls nearly, though 
not quite, to the normal, then rises again, and so on, the fever is said to be a 
" remittent " fever. Typhoid fever towards its termination is essentially a remit- 
tent fever (vide Chart, p. 535). In a remittent fever the temperature in the 
interval of the paroxysms falls, but does not return to the normal, whilst in an inter- 
mittent fever it falls quite to the normal. In an intermittent fever there are periods 
at which the patient is quite free from fever ; in a remittent fever, his fever never 
leaves him until the termination of his illness, although at certain times it is less 
marked than at others. 

Hectic fever is that form of fever which supervenes when there is an nabituai 
drain upon the system beyond what the nutriment taken in can supply and counter- 
balance. It is commonly met with in cases in which there is extensive formation 
and discharge of matter going on in some part of the body. It is a usual ac- 
companiment of many chronic surgical complaints, such, for example, as a diseased 
joint with an open sore ; and is sometimes met with in young mothers who have 
siu-kled their children too long. Its progress is often very insidious, but its main 
features are elevation of temperature, an abiding frequency of pulse, alternations of 



518 THE TREATMENT OP DISEASE8. 

chilliness with heat and flushing, followed by perspiration, and a gradual wasting of 
the body, accompanied by progressive debility. The temperature is usually remit- 
tent, there being a period of remission and a period of exacerbation occurring once, 
and sometimes twice, in the twenty-four hours. 

Certain fevers, such as measles, scarlet fever, small pox, typhus, &c, are, as we 
know, generally spoken of as infectious diseases, that is they originate, or are 
believed to originate, through the infection of the system with certain poisonous 
matters. The poisons which give rise to these diseases differ from ordinary 
poisons chiefly in the fact that they can, reproduce themselves under favourable 
conditions to an endless degree. For example, a child becomes infected with 
scarlet fever, this child can communicate the disease to ten or more people, and 
each of these to ten more in turn, and so on, so that from one child the fever 
may spread to 10, 100, 1,000, or 10,000 people. We find striking illustrations of 
this fact in the devastating scourges which at different periods in the world's history 
have spread over the surface of the globe. Infectious diseases have often destroyed 
the army of the conqueror, and have been the means of removing whole races of 
mankind from the earth. It is supposed by many students of ancient history 
that the prevalence of infectious diseases played a prominent part in the pro- 
duction of the fall of the might and civilisation of Greece and Rome. In former 
times epidemics of fever appear to have raged with much greater vigour than those 
which we nowadays are accustomed to witness. Thus we learn that in the middle 
of the fourteenth century an epidemic of fever, which occurred in Venice, carried 
off more than three-quarters of the inhabitants, and that the remainder escaped 
death only by flying to the islands. It is said that during the same epidemic more 
than a million lives fell a prey to the disease in Germany alone, and that in 
Italy scarcely the half of the inhabitants were left. Even at the present day the 
mortality from fevers is something enormous. It has been calculated that all the 
other mighty casualties of nature, such as earthquakes, volcanic eruptions, mountain 
avalanches, hurricanes, and inundations by sea, have never, in the whole of the 
world's history, destroyed even approximately half as many lives as a single 
ordinarily extensive epidemic. Even in our most sanguinary wars the devastation 
caused by the scientific instruments of death has been trifling compared with the 
mortality which has followed the outbreak of an epidemic of fever in the armies. 

The causes which have operated to modify the severity of modern epidemics are 
well worthy of our best study and consideration. It is sometimes said that there 
has been a change in the type of disease, but it is infinitely more probable that the 
advance of civilisation, and the improved sanitary conditions under which we live, 
have been the important factors. When we consider how little was done during 
antiquity and the Middle Ages to stamp out disease and arrest the progress of 
pestilences, our only wonder is that the mortality, great as it was, was not con- 
siderably greater. It is probable that people owed their protection rather to the 
difficulties of travelling, and the slowness of communication, than to any efforts of 
their own. 

It is now usually considered that most fevers are caused by the entrance of 
some very minute organism into the system. This view, at all events, in a modified 



FEVER AND FEVERS. 519 



form, is by no means of modern origin, for in the days of ancient Rome the 
physicians considered that many diseases were caused by the presence of minute 
animals in the body. In the Middle Ages it was imagined that these animals 
could be seen flying through the air in dense clouds, and it was seriously proposed 
to blow trumpets and fire guns, and make a great noise during the prevalence 
of an epidemic, so as to frighten them away. It is almost needless to say that 
the organisms which nowadays are supposed to be instrumental in the production 
of fever are very minute, and that they can be seen only with high powers of the 
microscope. 

A very marked peculiarity of the infectious diseases is what is technically known 
as their specificness — that is to say, that the same poison always gives rise to the 
same disease. We can best illustrate this by an example. A man may be exposed 
to cold and may be none the worse for it, or the result may be that he gets a cold 
in his head, or a cold in his chest, or he suffers from colic or diarrhoea, or tooth- 
ache, or rheumatism, or in fact any one of a great number of complaints. But 
should the same man be exposed to the poison of scarlet fever, he either catches that 
disease or nothing. It never, by any chance, results in small-pox or typhus fever, 
or any of the other acute diseases, and this is what we mean when we say a fever 
is specific. 

In all fevers there is a certain incubative period, or period of incubation during 
which the poison remains latent in the system without producing any effects. You 
sit up to-night with a person suffering from a fever, and you want to know how long 
it will be before you can make sure that you have not caught the complaint. Un- 
fortunately, this is a question which is not always very easily answered, for the 
period of incubation is in many fevers very variable. In some cases all we can say 
is that it may be only a few days, or as many weeks. Small-pox is the fever 
respecting which we can speak with the greatest certainty, its period of latency being 
fourteen days, or more accurately thirteen times twenty-four hours, from the moment 
of taking the disease. In some fevers — typhoid, for example — it is difficult to fix 
the exact date of the infection, and often quite as difficult to fix that of the com- 
mencement of the disease. 

Most of the idiopathic fevers ar* characterised by a rash or skin eruption. The 
appearance of this rash usually enables us readily to distinguish one fever from 
another. The rash does not appear in all fevers on the same day of the disease — 
that is, at the same time from the commencement of the illness. In chicken-pox the 
rash comes out on the first day, in scarlet fever on the second, in small-pox on the 
third day, in measles on the fourth day, in typhus fever on the fifth day, and in 
typhoid fever about the end of the first week. This is the general rule, to which, 
however, there are a good many exceptions. Thus, the rash of measles may come 
out on the third clay or the fifth day, or even the first day, of illness. Some rashes are 
much more punctual in their time of appearance than others ; for instance, typhus 
nearly always comes out on the fifth day. Then, again, the rash in all fevers does not 
first appear in the same situation. In chicken-pox it may appear on any part of the 
body ; in scarlet fever it sometimes comes out all over at once, but usually at first on 
the side of the neck and upper part of the chest ; in small-pox it is first observed on 



520 THE TREATMENT OP DISEASES. 

the forehead, face, and wrists ; in typhus on the back of the wrists ; and in typhoid 
on the chest or abdomen. In most fevers the rash comes out in a single crop, but 
in typhoid fever it appears in a succession of crops, each lasting only two or three 
days. Sometimes the fever may pursue its course without the production of any 
rash at alL Cases of small-pox are sometimes met with in which there is not a 
,'jingle spot, and in typhoid fever the eruption is said to be absent in a considerable 
number of the cases. 

Care must be taken not to mistake flea-bites for the rash of any fever. Children 
are frequently brought to the out-patient room of our hospitals covered almost from 
head to foot with the bites of these parasites. The rash of the measles is at its 
commencement often compared to that of flea-bites, but the differences between them 
are always well marked, and they may be distinguished by the most superficial 
examination. Flea-bites usually consist of a central point of redness surrounded by 
a small ring of a less intense colour, the latter temporarily disappearing on making 
pressure with the tip of the finger, but the former persisting. They are most 
commonly met with on the front of the chest, particularly under the collar-bones. 

The duration of the different fevers is very variable. For example, in measles the 
period which elapses before perfect restoration to health may be very short or it may 
be greatly prolonged; the difference being, in a great measure, dependent on the 
previous habits of the patient. Typhus fever usually lasts from twelve to twenty- 
one days, and typhoid, in moderately severe cases, for three weeks or a month. In 
scarlet fever an improvement is commonly noticed after the end of the first week. 

It is usually of the greatest importance to be able to decide as soon as possible 
as to the nature of any fever, more especially in the case of servants and people 
employed in large establishments, in order that, for the safety of others, they may 
be isolated, or removed as speedily as possible. 

Before the appearance of the rash there is nearly always some uncertainty as 
to the diagnosis. 

One may often make a very good guess from the nature of the prevailing 
epidemic, or from the presence of some contagious disease in the house or neigh- 
bourhood. 

Some fevers set in abruptly, others insidiously. Thus, scarlet fever, small-pox, 
and typhus fever come on suddenly, whilst the onset of measles and typhoid fever 
is far less abrupt. 

Information may often be obtained from the presence of some particular 
symptom. Thus : — 

1. Pain in the back would lead us to suspect small -pox or typhus fever. 

2. Headache „ „ small-pox or typhus fever, but 

more especially the latter. 
S. Headache and diarrhoea M n typhoid fever. 

4. A cold in the head 9y » measles. 

5. A sore throat „ „ scarlet fever. 

Next as to the prognosis, or probable results. The severity and danger of th* 
case is best indicated by the temperature ; — 



FEVEH AND FEVERS, 521 



When the temperature reaches 103° the fever is moderately severe. 
„ „ 104° „ severe. 



„ „ 105° „ very severe. 

n n 106° „ dangerous. 

„ „ 107° „ usually fatal. 



When the skin is moist it is a good sign. When it is moist, but also sodden, 
like the hands of a washerwoman, it indicates great relaxation of the system, and 
is a bad sign. When, in addition to the skin being sodden, it is dusky, that is a 
very bad sign, indicating as it does considerable depression of the heart's 
action. 

A fever may terminate in any one of several different ways. When the tempe- 
rature falls suddenly, the termination is said to be by " crisis." In several fevers 
there are what may be fairly called critical days. In typhus fever, the seventh 
and fourteenth days may be regarded as critical. Should the temneiature fall con- 
siderably on the seventh day, this is a favourable sign, but should it fail to do so, 
the fever pursues a course of at least six days of increased danger. In typhoid fevei 
it is not uncommon for a change in the course of the temperature to be noticed 
about the seventh day. When the temperature returns gradually to the normal, 
the disease is said to terminate by " lycis." Not uncommonly we get a combination 
of termination by lycis and crisis, the temperature falling in an irregular manner 
by jerks. 

The mortality varies considerably in different fevers. For instance, death from 
ohicken-pox is a rarity, whilst in cholera the mortality in some epidemics is as high 
as 70 or 80 per cent. 

The importance of a rational treatment of fever cannot be over-estimated. 

It must always be borne in mind that we have no specific remedy for any of our 
common fevers. We cannot hope to cure them, and in many cases the object of 
the treatment is simply to conduct the fever to a favourable termination, and to 
ward off any intercurrent disease. Nevertheless there are certain drugs which, 
although not curative in their action, may be administered with advantage, as there 
is reason to believe that they modify the course of the disease. 

First and foremost among these is aconite. Aconite is indicated in many 
affections marked by elevation of temperature, a rapid strong pulse, dry heat of 
skin, chills followed by burning heat, restlessness, constipation, and scanty high- 
coloured urine. It is doubtful whether its administration will shorten the fever of 
the acute specific diseases, such as scarlet fever, measles, &c., but it has a beneficial 
influence in these complaints, soothing the nervous system, and favouring sleep by 
inducing free perspiration. In typhus and typhoid fever aconite probably does but 
little good. It should be administered in the form of the aconite mixture (Pr. 38). 
Unless the temperature, as measured by the thermometer, falls during the twenty-four 
hours immediately succeeding the administration of the remedy, it will in all pro- 
bability do but little good. 

Tincture of gelseminum proves useful in many fevers, its action in some respects 
resembling that of aconite. It has been used with success in scarlatina, especially 
when occurring in children, and in the early stage of measles, when there is a thin 



622 THE TREATMENT OF DISEASES. 

watery discharge from the nose. Gelseminum is also indicated when the fever is 
of a remittent character. The mixture (Pr. 41) may be used 

In the early stage of many fevers, but especially in typhoid fever, baptisia has 
been found useful. It may be given in any febrile disease which assumes a low or 
" typhoid " condition. It has been found to succeed in some cases in which aconite 
has failed. The dose of the tincture is a drop in a tea-spoonful of water given every 
ten minutes for the first hour, and subsequently hourly. 

In all cases of fever it is very necessary to confine the patient to bed. The 
sick-room should be large and airy, and the less furniture it contains the better 
In infectious diseases the carpet, curtains, and other superfluous articles, should 
be removed. Proper ventilation should be ensured by keeping the windows open 
for an inch or two at the top. Draughts should be avoided. Except in the height 
of summer, it is advisable to have a fire constantly burning. 

The greatest attention must be paid to cleanliness; and stools, soiled linen, &c, 
should be removed without a moment's delay. Any smell or closeness in a sick-room 
is a sign of bad nursing. 

The room should be kept as quiet as possible, and the fewer visitors the better. 
Worry and anxiety are very bad for the patient. 

In all cases plenty of nourishment should be given. It is generally required in 
small quantities and frequently. The food should always be light and nutritious. 
Beef-tea, mutton broth, chicken or veal broth, arrowroot, gruel, eggs, milk, and 
jellies, are all useful. A variety may be found in vermicelli in beef -tea, mutton 
broth with rice or bits of toast, eggs in custard, or beaten up with milk, or with 
wine, and blanc-mange of isinglass or ground rice. 

It is very essential to have these things prepared nicely, for sick people are often 
very fanciful. Try this method of making mutton broth : — One pound of the scrag 
end of neck of mutton, two pints of water, pepper, and salt, half a pound of potatoes, 
or some pearl barley. Put the mutton into a stewpan, pour the water over it, 
pepper and salt. When it boils, skim carefully ; cover the pan, and let it simmer 
gently for an hour. Strain it, let it get cold, and then remove all the fat. When 
required for use, add some pearl barley or potatoes in the following manner : — Boil 
the potatoes, mash them very smoothly so that no lumps remain. Put the potatoes 
into a pan and gradually add the mutton broth, stirring it till it is well mixed and 
smooth ; let it simmer for five minutes and serve with fried bread. 

Beef-tea with oatmeal is a very good combination. Mix two table-spoonfuls oi 
oatmeal very smooth with two spoonfuls of cold water, then add a pint of strong 



beef-tea. Boil together for five or six minutes, stirring it well all the time. Strain 
it through a sieve and serve. 

The patient is nearly always thirsty, and he should have enough to drink t<* 
satisfy his thirst. Large draughts impair digestion and set up diarrhoea. The best 
plan is to give small quantities frequently. Yeiy commonly nothing is relished 
more than iced water, and it is a good plan to give the patient little pieces of ice to 
suck. Lemonade, soda water, currant water, raspberry vinegar, and cold weak tea, 
with or without sugar, are useful. The following makes a nice drink : — Pare the 
rind of three lemons as thin as possible, add one quart of boiling water, and a 



FEVER AND FEVERS. 523 



quarter of an ounce of isinglass. Let them stand till next day covered, theD 
squeeze the juice of eight lemons upon half a pound of lump sugar; when the 
sugar is dissolved pour the lemon and water upon it, mix all well together, strain, 
and it is ready for use. The following is a simpler method : — Well rub two or three 
lumps of sugar on the rind of a lemon, squeeze out the juice, and add to it half a 
pint or a pint of cold or iced water, or, better still, a bottle of soda water. Acid 
or acid and bitter drinks often prove very grateful. A weak infusion of cascarilla 
with a few drops of hydrochloric or nitric acid will be found useful. A glass of 
bitter may be given with advantage if there is a desire for it. 

One of the most difficult problems to be solved in the treatment of fever is the 
necessity for the administration of stimulants, and the quantity in which it should 
be given. Great as are the beneficial effects of alcohol in many diseases, it should 
always be borne in mind that it can do harm as well as good. Many people do 
very well without any stimulant at all, and in no instance should it be given 
unless there is some special indication for its employment. At the two extremes of 
life the powers of the body are easily depressed, and in young children and old people 
stimulants are accordingly called for early, and must be freely used. In the aged 
especially it is of great importance to anticipate prostration by the early employ- 
ment of alcohol, for this condition once established is with difficulty overcome. 
Young children prostrate with fever take stimulants with benefit, even in large 
quantities. In a disease like typhus fever, in which the depression is very great, 
stimulants are often called for early. The following practical rules will be found 
useful : — 

EULES FOR THE USE OF STIMULANTS IN FEVER. 

1. If, after stimulants, the tongue becomes more dry and baked, they are doing harm ; if the 
tongue becomes moist, they are doing good. 

2. If the pulse becomes quicker, they are doing harm; if it becomes slower, they are doing 
good. 

3. If the skin becomes hot and parched, they are doing harm ; if it becomes more comfortably 
moist, they are doing good. 

4. If the breathing becomes more hurried, they are doing harm ; if it becomes more tranquil, 
they are doing good. 

5. If sleep is produced, and delirium quieted, they are doing good. 

It should always be remembered that it is not the nature of the disease which is 
the indication for stimulant, but the condition of the patient. People sometimes 
ask how much brandy should be given in such and such a fever, but it is a question 
which it is simply impossible to answer. 

The kind of alcoholic stimulant employed is not a matter of any very great im- 
portance provided always that its quality is good. The patient's taste should, if pos- 
sible, be consulted ; and brandy, gin, whisky, port, or sherry may . be given. As 
a rule, we should prefer port wine or brandy. Sometimes a combination, such as the 
following, answers better than anything : — Scald some new milk, but do not let it 
boil. It should be put in a jug, and the jug should stand in boiling water. When 
the surface looks filmy, it is sufficiently done, and should be put away in a cool place 
in the same vessel. When quite cool, beat up a fresh egg with a fork in a tumbler, 
with a lump of sugar ; beat quite to a froth, add a dessert-spoonful of brandy, and 



524 THE TREATMENT OF DISEASES. 

fill up the tumbler with scalded milk. In some cases dry champagne forms an ad- 
mirable stimulant In whatever form the stimulant is given, it must be of the best. 
It is almost impossible to lay down any general rules as to the quantity. The rules 
we have given will form the best guide, and as long as the alcohol does good the 
quantity should be increased. In some cases a couple of ounces of port a day will be 
enough, whilst in others half a pint of brandy in the course of the twenty-four hours 
will not be too much. When stimulants are required at all in fevers, they should 
be given frequently, a little every hour, and not a large quantity two or three times 
a day. It is a golden rule never to give more stimulant than is absolutely necessary. 

Restlessness is very detrimental to the welfare of the patient, and sleep may 
have to be ensured by the use of opium, chloral, or bromide of potassium. In fever 
the two great dangers are from exhaustion of the nervous system and enfeeblement 
of the heart's action. The nervous system is very quickly exhausted by want of 
sleep, and more especially by delirium. The appetite, digestion, and assimilation are 
greatly influenced by sleep. This influence is well seen in ulcers on the surface of the 
body. After a restless night they are painful, throbbing, inflamed, and swollen, and 
apt to spread, whilst after a refreshing sleep they have a much more healthy appear- 
ance. In fever want of sleep produces either noisy and furious delirium, as is 
frequently seen in typhus, or wandering and muttering, with picking of the bed- 
clothes, twitching of the muscles, and great prostration. In either case opium, 
judiciously given, may save an almost hopeless life. In delirium of the furious 
kind it is well to combine the opium with tartar emetic, as this combination calms 
the excitement and produces sleep more speedily and effectually than opium given 
alone. Three or four drops of laudanum and a drachm of antimonial wine should 
be given every two hours till tranquillity and sleep are ensured. In the low 
muttering delirium, with muscular tremors, dry skin, and prostration, laudanum may 
be given with signal benefit. A drachm of laudanum is mixed with four ounces of 
water, and of this a tea-spoonful is given every five or ten minutes till three or four 
doses have been administered. If by that time the patient is not asleep, the 
medicine should be discontinued for half an hour ; then, if sleep does not come on, 
a few more doses should be given in the same way. This method often ensures 
calm, refreshing, invigorating sleep, lasting several hours, out of which the patient 
wakes free from wandering, refreshed, the tongue moister, the appetite and digestion 
improved, and the skin comfortably moist. The administration of laudanum, by pro- 
ducing refreshing sleep, often tides a patient over this critical stage with far less 
consumption of alcoholic stimulant than would otherwise have been required. 

The great advantage of giving opium in small doses and frequently is, that the 
desired result is obtained by the use of the minimum quantity. It must be 
admitted, however, that sometimes a single large or moderate dose of opium will 
answer better. Opium is especially indicated in cases in which there is either 
diarrhoea or a dry skin. Very frequently a combination of opium and chloral will 
act much more efficaciously than either drug alone. A single dose of fifteen grains 
of chloral and ten drops of laudanum may be given in an ounce of water. Fifteen 
or twenty grains of bromide of potassium may succeed in quieting the nervous 
system and producing sleep when the other drugs have been given in vain. 



FEVER AND FEVER8. 525 



Hoat and dryness of the body may be alleviated by washing the surface with 
soap and tepid water several times a day. In order to avoid the risk of catching 
cold, one part should be washed and dried and covered before another is exposed. 

The lips, tongue, and gums, when dry or coated with dried mucus-, should be 
washed and kept moistened by the application of glycerine. This greatly improves 
both the comfort and appearance of the patient If the sweet taste of the glyce- 
rine is unpleasant, it maybe diluted with an equal quantity of water or lemon- 
juice. 

Delirium, such as occurs in typhus fever, may sometimes be controlled by the 
administration of tincture of belladonna, a tea-spoonful of the mixture (Pr. 39) being 
given every quarter of an hour for the first hour, and subsequently hourly. 

The bowels should be opened daily, and it may be necessary to employ some 
mild laxative, such as castor oiL Purgatives should be used with care, as they are 
apt to set up obstinate diarrhoea. 

When the patient is drowsy, care should be taken to see that he passes \i» ^*ter 
at proper intervals. 

There are several ways in which the abnormal temperature of the body may be 
reduced. Large doses of quinine may be advantageously used for this purpose. 
The cold bath has been extensively employed in Germany for the reduction of tem- 
perature, and the results have been extremely satisfactory. These methods of treat- 
ment are described more fully under the head of typhoid fever (see TVphoid Fever). 
The cold pack often proves of the greatest service in the acute specific diseases. 
It has long been employed in scarlet fever, and 'should be used from the beginning, 
and throughout the disease. In moderate attacks it is sufficient to pack the patient 
from thirty to fifty minutes, but if the rash comes out slowly, imperfectly, and of t 
dull red colour, or if the patient is restless and wandering, the packing must be con- 
tinued an hour or two longer, and may be repeated three or four times a day. TIms 
treatment develops the rash, greatly reduces the fever, quiets the pulse, renders 
th skin moist and comfortable, and abates the restlessness and wandering. A 
short time after the application of the wet sheet, a patient previously restless and 
wandering commonly falls into a quiet, refreshing sleep, and awakes calm and free 
from delirium. The influence on the pulse and temperature is also very striking, 
the former in a few hours falling fifteen to twenty beats in the minuta The 
packing is especially indicated on suppression or recession of the rash, when serious 
symptoms are apt to arise ; the cold sheet will then bring out a brilliant rash, 
generally followed by immediate improvement of the patient's condition. It may 
be mentioned incidentally that in scarlet fever a cold wet compress, renewed every 
three hours, may be advantageously worn round the throat, and if, on the decline of 
the fever, the tonsils remain large, this application, renewed less frequently, or 
applied only at night, may be continued till these morbid conditions are got rid of. 
This is a digression. It should be stated that cold packing in the reduction of tempe 
rature proves equally beneficial in measles, small-pox, and the other fevers. 

Alcohol reduces the temperature slightly in fever, but its efficacy in tins respect 
is so insignificant, and doses so enormous must be taken to produce even trifling 
results, that it is useless to give it solely with this intention. 



526 THE TREATMENT OF DISEASES. 

In mest infectious diseases it is necessary to isolate the patient. In severe cases 
jwo people should be appointed to act as nurses, one for day and the other for night 
duty. They should confine themselves strictly to the apartments of the patient, and 
should not communicate with other inmates of the house. It is a good plan to 
give up the whole of the top floor for the sole use of the patient and his attendants. 
A large sheet should be hung outside the door of the sick-chamber, so as to com- 
pletely cover the doorway. The sheet should be dipped several times a-day in a 
pail of carbolic acid and water (in the proportion of one part to eight) kept outside 
for the purpose. A sheet should also be suspended at the top of the stairs. Food, 
&c., should be brought as far as the sheet and there left, the nurse being called 
to take it in. It is only by the greatest care that many diseases can be prevented 
fiiom spreading. 

After the patient has recovered from any infectious disease the room or rooms 
which he has occupied should be thoroughly disinfected. The woodwork should be 
washed with soft soap and water, to which carbolic acid, in the proportion of one 
pint of the common liquid to three or four gallons of water has been added. The 
room should be fumigated for three or four hours by means of burning sulphur. 
The doors and windows and the chimney should be closed, and a pound of 
sulphur should be put in a metal dish, covered with spirit, and then lighted. 
After three hours the doors and windows should be opened and kept open for 
from twenty-four to thirty-six hours. It is essential that plenty of sulphur 
should be used, and when the room is large it is desirable to have some at each 
end. Any old iron pet will do to contain it. The fumes from the burning sulphur 
are very irritating, and care must be taken to avoid inhaling them. 

The soiled line*} and bedclothes should be boiled for some hours in water to 
which chloride of lime or carbolic acid has been added. Mattresses and clothes 
which cannot be washed may be disinfected by baking them in a hot chamber, or 
by subjecting them to the fumes of burning sulphur. Hair mattresses should be 
taken to pieces before being fumigated. 

During the stage of convalescence much of the day should be spent out of 
doors, and a change of air should be resorted to as soon as the patient is able to 
bear the journey. Attention should be paid to clothing, and flannel should be 
worn next the skin. The hours of rest should be long, and sleep may be 
indulged in with advantage for a short time during the afternoon. Every care 
should be taken to ensure a good night's rest. The supper should be light, and 
should be taken one or two hours before going to bed. Plenty of good plain 
food should be eaten at regular hours. Stimulants are required, if at all, in small 
quantities, and should be taken only with meals. Sea-bathing will be found of the 
greatest possible service. The bath should be taken about three hours after break- 
fast. At first the patient should stay in the water for only a very few minutes. 
In addition to the sea-bath a cold sponge -bath should be taken every morning on 
getting out of bed. Tonics, such as iron, quinine, and cod-liver oil may sometimes 
be used with advantage. It should always be remembered that a patient during 
convalescence is in much the same condition as a child. Convalescence is a period, 
if not of growth, of great repair — a condition analagous to growth. 



TYPHOID FEVER. 527 



Sometimes after a bad attack of fever the hair comes out, and shows very 
little inclination to grow again. It occasionally happens that the scalp is left 
almost as bare as a billiard ball. This is a serious matter, especially in the case 
of young ladies. The hair not only forms the natural covering of the head, and 
protects it from cold and heat, but adds considerably to the personal appearance. 
A. good crop of hair is by no means to be despised. It is to be feared that many 
doctors consider this is a very trivial subject, and one quite beneath their notice. 
This is to be regretted, for the result is that advice is sought from hair-dressers 
and others, who, however good their intentions may be, are necessarily ignorant, not 
only of the properties of the drugs which they use, but of the structure and functions 
of the skin which they profess to treat. 

Some years ago, in the pages of the Lancet, the case was related of a gentleman 
who, having lost nearly all his hair from a severe attack of fever, consulted a 
French physician of great reputation as a hair-restcrer. His prescription was a 
drachm of the homoeopathic tincture of phosphorus mixed with an ounce of castor 
oil, the scalp to be rubbed with the preparation three times a week, after having 
been previously thoroughly cleansed with warm water without soap. This is a 
most excellent method of treatment, but there are certain accessory measures 
which might be employed with advantage. In the first place, any short, straggling, 
or colourless hairs on the scalp should be cut off quite short with a pair of sharp 
scissors, then a kind of skull-cap should be made of oil silk, so as to fit closely 
round the head just above the ears. Three tinues a week a large hot bread poultice 
should be applied to the head under this skull-cap. The patient should sleep in 
it, and on the following morning, after the scalp has been washed with warm 
water and dried with a. soft towel, the phosphorus and castor-oil preparation should 
be thoroughly rubbed in for half an hour. This local application should be com- 
bined with the internal administration of phosphorus, a capsule (Pr. 54) being 
taken every four hours. In obstinate cases it may be some weeks, or even 
months, before one's efforts are crowned with success. Very frequently the new 
hair is a shade or two darker than the old 

We may mention incidentally that when the hair has suddenly become grey 
from excessive grief or mental anxiety, the use of phosphorus both internally and 
externally will sometimes quickly restore its colour. 

Typhoid Fever. — This is a disease which has received many names. It was 
called "typhoid," and "abdominal typhus," from its supposed resemblance to typhus 
or gaol fever. In many parts of the country it is known as " low fever," or " slow 
fever," from its duration, and in other places as " autumnal fever," or " fall fever," 
from the tJme of the year at which it is most prevalent. The term " enteric fever " 
was applied to it from the fact of a certain portion of the bowel or intestine being 
always found diseased in this disorder. Gastric fever is a misnomer, for there is 
never any organic disease of the stomach. The name which we have placed at the 
head of this article is the one most commonly used. 

Respecting the early history of typhoid fever we know very little. There is no 
reason to suppose that it is a new disease, althougL it is probable that in former 



528 THE TREATMENT OP DISEASES. 

times it was less prevalent than now. For many years it was confounded with 
typhus fever, and this accounts for our ignorance of its former history. Typhus and 
typhoid are two totally distinct diseases ; in reality, there is very little relationship 
between them. Typhus fever is far more closely allied to small-pox, measles, and 
scarlet fever, than to typhoid ; and typhoid, in its mode of causation and propagation, 
bears a greater resemblance to cholera and dysentery than to typhus. 

Typhus fever is contagious, typhoid is not. Whoever touches a person, suffering 
from typhus fever runs a certain amount of risk of catching it. Doctors and nurses 
frequently suffer from this disease, when brought in contact with typhus patients. 
In Ireland, in the year 1847, no less than 500 medical men, or about one-fifth of 
the entire number, suffered from typhus, and of these 127 died. During the 
Crimean War, it is said that more than 80 surgeons died from this disease. In 
hospitals, unless those suffering from the fever are strictly isolated, it spreads 
rapidly. In the case of typhoid all this is exactly the reverse. You may spend your 
whole day by the bedside without running any risk of catching it. Physicians and 
nurses do not suffer from it more frequently than other people. In our hospitals the 
typhoid patients are placed in the general wards, and no steps are taken to isolate 
them, and yet it never spreads from bed to bed. At the London Fever Hospital, 
in 14 J years, 2,506 patients with typhoid fever were treated, and yet in that time 
only 8 cases originated in the hospital. 

Sometimes typhoid fever may break out in a hospital, but that does not prove 
that it is contagious. Residence in a hospital does not make you disease-proof. 
Some ten years ago a number of cases originated in the hospital at Basle. The 
disease was contracted there, arid many people said that it must have been caught 
from the typhoid patients in the wards. But curiously enough the majority of tLe 
cases occurred in people who had nothing to do with the wards, and who had no 
communication, direct or indirect, with the typhoid patients. For instance, there 
was a man who had just recovered from small-pox in a ward which had been 
strictly isolated He was attacked with typhoid fever immediately on his discharge, 
and he died from it. It was obvious that it must have been contracted in the 
hospital. Then, again, the apothecary and the engineer, and several washerwomen 
and kitchenmaids, who never, by any chance, entered the wards, were attacked in 
the same way. An examination disclosed the fact that in one portion of the 
building there was a defect in the drainage, and this, there is no doubt, was the 
cause of a good deal of the mischief. It was found that there was a wooden pipe 
running from the roof to the sewer, and this passed close by two of the rooms in 
which typhoid had most frequently occurred. In the sewer just where the pipe 
entered there was a fault in its construction. It turned suddenly at a right angle, 
so that all the refuse matters accumulated at this spot, and the foul gas which they 
gave off passed up the wooden pipe. Steps were taken to remove the accumulation, 
and to have the pipes thoroughly and frequently flushed, and from that time there 
was a considerable decrease in the number of typhoid cases which broke out in the 
hospital. 

Such instances are by no means uncommon. Only a year or two ago one of 
the largest and most popular colleges in Cambridge was almost decimated by 



TYPHOID FEVER. 529 



typhoid fever, for the very simple reason that in its new buildings, which had been 
erected almost regardless of cost, the pipes had been so constructed that the whole 
of the sewer system of the town found a ventilating shaft for itself through the 
bedrooms of the undergraduates. If, then, typhoid fever is not contagious, how does 
it originate 1 We know it is not given off from marshes as ague is. At one time it 
was thought to be due to the decomposition of animal substances, and the term 
" pythogenic fever," signifying " derived from putrefaction," was accordingly 
proposed for it. But it is now well known that it is not all decomposing animal 
matter that will produce typhoid — -it must consist of human excrement. And even 
this is not the whole truth, for the excrement must be derived from a person 
suffering from typhoid fever. Fresh typhoid excrement is probably harmless, but 
even the minutest portion of a decomposing typhoid stool will, if taken into the 
system rapidly, set up the disease. But how, it may be asked, could even the very 
smallest portion of a decomposing typhoid stool get into our bodies 1 Who would 
swallow it 1 The idea is utterly abhorrent. Unfortunately it is not very difficult, 
and when we get typhoid we may be pretty certain, horrible as it may appear, that 
we have been eating or drinking somebody else's excrement. It is generally 
introduced into the system through the medium of the water. In the country the 
privy is often built very close to the welL Both are near the house and near each 
other. No particular precautions are taken to prevent the contents of the privy 
from soaking into the ground, and they in course of time drain into the well 
Nothing verj much, however, comes of it ; the bad water may cause diarrhoea or 
may make people ill, hut it won't give them typhoid. Let, however, a single 
typhoid stool be emptied into the privy and the mischief is dona The typhoid 
poison soaks into the earth, gradually develops there, and after a time manages to 
get washed into the welL Then typhoid fever breaks out in the house, more typhoid 
stools are thrown in the privy, more people drink the water and get the disease, 
and then there is a regular epidemic. Perhaps some wise man comes along, points 
out the source of the mischief, the well is shut up, and the epidemic is stamped out. 
But the worst epidemics have been produced when a whole stream has been in- 
fected with the typhoid poison ; such cases are by no means uncommon. The 
infection is easily enough effected when the fields from which the stream or 
aqueduct obtains its supply are manured with excrement, containing typhoid germs. 
We can't do better than give an example of the way in which an epidemic may be 
caused. In one very fatal typhoid epidemic in a town in Germany it was noticed 
that the fever broke out only in houses supplied with water from a certain aqueduct. 
Other houses close by, which happen to derive their water-supply from another source, 
entirely escaped. It was found on examination that a brook which passed through 
the court-yard of a lunatic asylum in the neighbourhood, and received its sewerage, 
opened into the aqueduct. It was further found that in the asylum a nurse had 
recently died of typhoid fever, and that her clothes had been washed in the wash- 
house of the asylum, and that some of the soiled linen had even been soaked in the 
brook itself. This was the cause of all the mischief. We should mention in con- 
nection with this subject that ^here is evidence to show that the typhoid poison can 
be destroyed by boiling \he water. 
34 



530 THE TREATMENT OF DISEASES. 

In the year 1873 an epidemic of typhoid fever, in which over 200 people were 
attacked, broke out in London in the parishes of St. George's, Hanover Square, 
Marylebone, and Paddington. It was clearly proved that it was due to the con- 
tamination of the milk by the excrements of a man who had died of typhoid fever 
on one of the milk farms. Since this occurrence many people make a point of 
always having their milk scalded, and it is undoubtedly a wise precaution. 

Although typhoid is, in the large majority of cases, caused by taking the poison 
into the system with the food or drink, there is no doubt that it may originate from 
the inhalation of the emanations from sewers, &c, containing typhoid stools. The 
possibility of infection in this manner does not prove that the poison is a gas, and 
the general opinion is that the infectious agent consists of minute particles suspended 
in the air. 

Typhoid fever is a disease which attacks young people much more frequently 
than old. More than half the cases occur between the ages of fifteen and twenty- 
five. It is seen more frequently in men than in women, and, curiously enough, 
pregnant women and those who are suckling are seldom attacked. Unlike many 
other diseases, it attacks by preference the strong and the healthy, those who are 
suffering from chronic ailments usually escaping. It is a disease which is no 
respecter of persons ; the high and the low, the rich and the poor, are all liable 
to suffer from it ; but, at the same time, well-to-do people are far more frequently 
attacked than their poorer neighbours. From the frequency with which it prevails 
amongst the higher ranks of society, it would almost seem as if the habits of life, 
and the varied rich and plentiful diet of the more opulent classes, induced a condition 
of susceptibility to its influence. The largest number of cases occur in the months 
of September, October and November. It is probable that fatigue and exposure 
do much to accelerate an attack, although they are in themselves powerless to 
cause it. 

A person who has once had typhoid fever is not very likely to suffer from it 
again, but second attacks of typhoid are far more common than second attacks of 
small-pox, measles, or scarlatina. The immunity conferred by typhoid fever is not 
very perfect. 

We must now consider the different symptoms of typhoid fever. The attacks 
vary very greatly in severity ; in some cases they are so severe that life is almost 
inevitably destroyed, whilst in others they are so trifling that the physician is left 
in doubt whether there was any true disease or not. Our description refers to a 
simple case of typhoid of moderate severity. 

In the first place, there are usually certain premonitory symptoms. They are by 
no means characteristic, but last longer than in most other fevers. The patient has 
a general feeling of malaise, feels ill all over, is silent and indolent, and complains 
of weariness and pains in the limbs. The countenance is dull and heavy, the appe- 
tite is diminished, and the tongue swollen and furred. Sometimes there is giddiness, 
and usually headache, especially over the forehead. The sleep is restless and dis- 
turbed by bad dreams. Sometimes there are pains in the bowels, and diarrhoea, but 
not usually, unless purgatives have been taken. After a time fever sets in, ofteo 
accompanied by frequent chills. 



TYPHOID FEVER. 531 



It is not always easy to say when the premonitory symptoms ceased, and the 
actual disease began. The best method is to consider the day on which the patient 
first became feverish as the first day of the actual disease. When this point cannot 
be definitely determined, we may reckon the commencement of the disease from the 
day on which the patient had to knock off* work, or first took to his bed. 

In some cases, however, there are no warning symptoms at all, but the disease 
begins suddenly in all its intensity. The patient is in the midst of his occupation, 
or is on a journey of business, or perhaps pleasure, when he is seized with headache, 
shivering, and fever, and is found to be suffering from typhoid. 

In the first week of the disease proper the patient is feverish, the skin is hot and 
dry, and in the afternoons there are sometimes slight chills. The symptoms which 
were present in the premonitory stage gradually increase in intensity. The headache 
becomes violent, the pains in the back and joints are severe, and the patient feels 
very ill, and is usually obliged to remain in bed. On attempting to stand he feels 
dizzy and tottery. There is a great change in him, the expression of his face is 
altered, he is silent, unwilling to think, sleepy, and not easily roused. His sleep is 
disturbed by unpleasant dreams, and when in a condition between sleeping and 
waking he is apt to wander a little, and to be partly delirious. There is complete 
loss of appetite, but the patient is very thirsty. The tongue is at first moist and 
coated, but later on it becomes drier, and the fur disappears, leaving smooth, red 
streaks. Not unfrequently the nose bleeds freely at this stage. In many cases the 
bowels are at first confined, the diarrhoea, which is always a prominent symptom of 
this disease, often not appearing for a few days, or perhaps not till the end of the 
first week. Just at first there is nothing particular about the stools ; they are brown 
in colour, either thickish or watery, and are passed without pain, and usually with- 
out straining. The abdomen gradually becomes swollen, tense, and tender, even on 
the gentlest pressure, more especially on the right side. The spleen increases in 
size, just as it does in ague, though not to the same extent. It may sometimes be 
felt under the ribs on the left side, but as a rule it is not readily made out on 
account of the swollen condition of the abdomen. The urine is diminished in 
quantity, unless the patient drinks a great deal, and it is usually of a very high 
colour. 

In the second week the fever continues high and the condition of the patient 
shows how rapidly he is becoming exhausted. The headache is no longer complained 
of, and the patient becomes apathetic and drowsy, but does not sleep soundly. He 
Is not inclined for conversation, but in answer to questions usually says that he is 
very well and ails nothing. He seldom asks for drink, but drinks freely whatever 
fluids are offered him. All movements are feeble and uncertain ; the tongue is put 
out with difficulty, and only after repeated demands, and when protruded the 
patient often neglects to withdraw it. The tongue is now dry, red, and cracked, and 
in speaking is moved with such difficulty that it is no easy matter to understand 
what is said. The patient usually lies on his back, hardly stirring, except to pick 
at the bed-clothes and make other feeble movements with the hands ; the eyes are 
half closed and he mutters unintelligibly, especially in the evenings. Sometimes 
patients exhibit a more irritable mental condition ; they are restless ; disturbed by 



532 THE TREATMENT OF DISEASES. 

illusions and hallucinations, and speak in a loud voice and gesticulate violently. 
There is now profuse diarrhoea, there being usually from four to six motions in the 
twenty-four hours, and often more. The stools are commonly fluid, of a yellow- 
ochre or drab colour, and have a sickly offensive odour. In general appearance 
they somewhat resemble pea-soup, to which they are usually compared. After 
standing for a little while they separate into two layers, the upper a turbid brownish 
fluid, and the lower a light feathery-looking mass. These stools soon decompose, 
and if you take a little slip of red litmus paper and drop it in, it will turn blue, 
indicating that they are alkaline. Some medicines, such as iron, bismuth, lead, 
silver, and copper, darken the motion, and when these have been taken the stools 
will be of a dark greenish-brown or blackish colour. 

From the seventh to the tenth day the rash usually makes its appearance. It 
is very slight, and unless care be taken it may be entirely overlooked. The spots 
are about the size of a pin's head, or even smaller, and are of a pale rose colour. 
They are few in number, usually not more than from half a dozen to a dozen being 
seen at once. The total number during the whole course of the disease seldom 
exceeds fifty. They occur most frequently on the chest and abdomen, and not 
uncommonly they first make their appearance just where the collar-bone joins the 
breast-bone. On pressing on them with the tip of the finger they disappear for a 
few seconds and then gradually return. They appear in successive crops, each 
individual spot lasting for two or three days and then slowly fading away. On the 
first day of the rash only two or three spots may be observed, and on the next, four 
or five fresh ones, and on the following day as many more. If it is desired to 
watch the progress of any individual spot, it may be readily identified by drawing 
round it a little circle of ink with a quill pen. It is said that the rash is occa- 
sionally absent all through the disease, but if carefully looked for will .nearly always 
be found. Sometimes numerous small transparent spots containing fluid appear on 
the chest and abdomen. They are known as sudamina, and are caused in most cases 
by excessive perspiration. They are not of the slightest importance ; they occur in 
the progress of many diseases, and must not be confounded with the characteristic 
rash of typhoid fever. 

In the third week the symptoms continue with undiminished vigour, and even 
increase in intensity. The patient becomes so weak that he can no longer raise 
himself, but lies in a relaxed condition in the lowest part of the bed. The stupor 
may reach such a degree that the greatest difficulty is experienced in arousing the 
patient. The urine and fseces are usually passed involuntarily. Sometimes, how- 
ever, the urine is not passed at all, the bladder becomes distended, and the use of an 
instrument may be required. It is very necessary to watch typhoid patients to see 
that they pass their water. 

During the fourth week there is a change for the better, the temperature falls, 
the symptoms are alleviated, and evidences of returning interest in life appear. 
The motions are no longer passed involuntarily, or should this occur the patient is 
annoyed by it, and expresses his sorrow. The sleep soon becomes more natural, and 
the patient is refreshed by it. Patients who during the whole course of the disease 
appear to have suffered hardly at all, and who as long as they could answer always 



TYPHOID FEVER. 533 



said they were comfortable, now begin to complain of pain, and awake to a sense of 
their weakness and utter prostration. The face is pale and very thin and sunken, 
but still it wears a more natural expression. The tongue becomes moister and more 
movable, the motions are firmer and less frequent, and the appetite slowly returns 
After the thirtieth day, in the majority of cases, no more spots appear, and the fever 
is over. 

Thus the patient slowly passes into a state of convalescence, but his recovery is 
often hindered by complications, or even relapses. The fever may be readily revived 
by causes in themselves apparently trifling, such, for instance, as getting out of bed 
too soon, too early indulgence in solid food, or mental or physical exertion of all 
kinds. In hospitals patients convalescent for typhoid often have a return of the 
fever on the evening of the visiting-day if their friends have been to see them. It 
is to be feared that it is too often due to the surreptitious introduction of articles of 
food, but in some cases it may arise purely from excitement. The appetite soon 
returns, and the patient may be ravenously hungry. The first meal of solid food 
often causes a temporary rise in the temperature. If food is given too early it may 
produce a rupture of the bowel, and this may occur even after convalescence seems 
firmly established, particularly if any serious error in diet has been committed. The 
patient rapidly increases in weight, but it is often very long before he gets well 
again. Even in uncomplicated cases many months may elapse before the mental 
and bodily functions are completely restored to their natural condition. It has been 
laid down as a rule that no man can be considered fit for work for three or four 
months after a severe attack of typhoid. 

We have already mentioned incidentally the elevation of temperature in this 
disease ; but it is necessary that we should enter a little more fully into detail on 
this point. The course of the temperature is of the greatest value in determining 
not only the nature of the case, but its probable termination, the existence of 
complications, and the line of treatment, both medicinal and dietetic, to be adopted. 
Liebermeister, a very eminent German physician, says : — " The great practical 
importance of the determination of the temperature is more evident in typhoid fever 
than in any other febrile disease. It may well be asserted that a rational treatment 
of typhoid fever, without following the temperature, is not possible ; and that any 
physician who does not make two or more observations of the temperature every 
day neglects his duty. The common remark, that such observations are applicable 
to hospital but not to private practice, has been found to be erroneous. To measure 
the temperature in the rectum, or even in the axilla (armpit), requires so little time 
that a physician who does not have the requisite leisure can hardly treat such a 
patient at all. Besides this, nurses sufficiently intelligent to use the thermometer 
are requisite for any proper treatment of these patients. A physician can really 
treat his patient better if he only sees him once a day, but has a good ther- 
mometrical record kept by the nurse, than if he makes several visits and does not 
employ the thermometer." 

The nature of the disease can in typhoid fever be determined by the temperature 
alone, although, of course, the fact does not justify us in neglecting other symptoms. 
If you were to show a physician the chart of the temperature taken twice a day, he 



534 THE TREATMENT Of DISEASES. 

would in most cases be able to tell you if it were typhoid fever from which the 
patient suffered. In well-marked simple cases of typhoid, the entire duration of 
the fever is from three to four weeks. This time may be conveniently divided into 
four periods which we shall speak of as weeks, but each of which may vary in 
duration from five to ten days. 

During the first week the fever gradually and steadily increases in intensity. 

During the second week it is constant or stationary — that is to say, the 
successive morning and successive evening temperatures are almost identical. 

During the third week the fever remits, that is, the successive evening 
temperatures remain the same, but every morning the temperature is a little lower 
than it was at the same hour on the previous day. 

During the fourth week there is a gradual fall in both morning and evening 
temperature until at last the patient is feverish only in the evening. 

The accompanying chart serves to illustrate these facts. It is not taken from 
any individual cases, but gives the average course of the temperature in a large 
number of cases, and is, therefore, to some extent diogramatic. For the sake of 
simplicity only the morning and evening temperatures are given ; but, practically, 
the thermometer should be employed every four hours. 

During the first week the temperature may rise from 98*6° to 104° Fahr. or 
more. In the third week the morning temperature may be from 4° to 6° lower 
than the evening. Any marked alteration in the temperature is an indication that 
some change of importance either for the better or the worse has occurred. Often 
in this way something is discovered which would otherwise have escaped notice. 

The temperature affords valuable information in the diagnosis of typhoid fever. 
An illness is probably not typhoid fever, (1) if the temperature on the first three 
evenings, or on two of them only, is the same ; (2) if on two of the first three 
mornings the temperature is alike ; or, (3) if the temperature on the first two days 
rises as high as 104°. 

As we have already indicated, all cases of typhoid do not run a uniform 
course. It frequently happens that the attack is so mild that its very existence is 
recognised with difficulty. It is probable that in these cases a very small quantity 
of the poison has entered the system, or else that the patient is in some way we 
do not quite understand protected, or partially protected, from its influence. It 
would be useless to attempt to describe these slighter forms, as they present very 
great diversity in their course. 

The complications and sequelae of typhoid fever are very numerous, more 
numerous, in fact, than in almost any other disease. In typhoid fever there is 
inflammation, and generally ulceration of a certain portion of the bowel. This 
condition may give rise to bleeding, and blood may be found in the stools. 
Sometimes the motions are only just streaked with the blood, but sometimes it is 
passed in large quantities. When the blood is not passed at once, but is retained 
for a time in the bowel, it colours the motions black. A considerable loss of blood 
nearly always causes a sudden fall in the temperature, and the use of the 
thermometer will often tell us what has happened, and indicate the necessity for 
prompt treatment, before any blood makes its appearance in the stools. 



536 THE TREATMENT OF DISEASES. 

Sometimes the ulcers will eat their way through ^he bowel, and allow its 
contents to be poured out into the abdominal cavity. The bowel is often so thinned 
by inflammation and ulceration that the slightest force will rupture it. Straining 
at stool, violent vomiting or coughing, or a sudden change in position, may do the 
mischief. In some cases it has been found, at the post-mortem examination, that the. 
perforation of the bowel had been caused by the movements of a common round 
worm which happened to have taken up its residence in that part of the body. The 
patient often experiences at the moment of perforation a sudden and violent pain 
which may be so severe as to produce faintness. A condition of collapse usually 
rapidly ensues, and this may at once prove fatal, although in many cases life is 
prolonged for a day or two longer. The pouring out of the contents of the bowel 
usually gives rise to inflammation of the peritoneum, or lining membrane of the 
abdomen, a condition known as " peritonitis." Peritonitis not uncommonly arises 
independently of perforation, the inflammation gradually spreading from the bowel. 

A cold on the chest is a frequent complication of typhoid fever. Sometimes 
there is no cough, and its existence is detected only when the doctor examines the 
patient's chest. Usually, however, there is a cough attended with the expectoration 
of phlegm. Other and more serious mischief is sometimes detected in the lungs. 

After recovery from typhoid the patient is often subject to fainting-fits, which 
come on whenever he assumes the upright position. Should he fall to the ground 
this may be sufficient to restore the circulation of blood in the brain ; but should it 
so happen that he cannot fall, as when sitting propped up in an easy chair, the attack 
may prove fatal. 

Bed-sores form a very dangerous complication, which nothing but the strictest 
attention will avert. The patient should be rolled over on his side, and his back 
examined every day. 

After a severe attack of typhoid fever the hair usually falls off. This ordinarily 
occurs from the fourth to the eighth week of convalescence, and before it is complete 
the new hair may be seen cropping up. At first this is crisp and lustreless, but 
gradually it assumes a natural appearance. 

The Registrar-General of London shows that 20,000 people die annually of typhoid 
fever in England. As the mortality is about one in five or six, it follows that 
from 100,000 to 120,000 people must be attacked every year. Medical men enter- 
tain no doubt that if proper precautions were taken this disease might be effectually 
stamped out, and that it would disappear like the plague or ague. 

In any individual case it is extremely difficult to arrive at a definite conclusion 
repecting its ultimate termination. Children bear the disease very much better than 
adults. 

Let us now pass on to the consideration of the means which are at our disposal 
for the prevention of typhoid fever. Prophylactic measures, if attempted at all, 
must, to be of any service, be carried out thoroughly. 

When a case of typhoid fever is introduced into a community, a town or village 
for instance, previously free from the disease, there should be no difficulty in 
preventing it from spreading. The essential point is to thoroughly disinfect the 
stools. A porcelain bed-pan should be obtained, the bottom of which should b« 



TYPHOID FEVER. 537 



kept covered every time before it is used with a layer of crystals of blue-vitriol, and 
immediately after a motion the mass should be mixed with about half its bulk of 
common spirits-of-salt. These disinfectants may be obtained at any chemist's, and 
they are so cheap that their cost need never be any bar to their liberal use. In 
London and other large towns we have no help for it, and the motions must be 
emptied down the water-closets. The water-closet should be flooded several times a 
day with a strong solution of carbolic acid, and some should be placed in a dish or 
pot for constant evaporation. In the country the stools must never be emptied into 
the privy, or thrown upon dung-hills, or other similar places. A series of deep 
trenches should be dug at some distance from the house, as far as possible from the 
well or water-supply, and these should be used for the reception of the stools. A 
trench should never be used for more than two days, and should be carefully filled 
up as soon as discarded. Soiled linen should be immediately changed, and at once 
soaked in water containing Condy's fluid, and thoroughly boiled before the expiration 
of twenty -four hours. 

During the prevalence of an epidemic the greatest attention should be paid to 
the character of the water. The best mode of obviating danger is to have all the 
water used for drinking purposes thoroughly boiled. An obvious precaution is to 
see that the milk is scalded. It should be remembered that the typhoid poison may 
be received into the system through the agency of mineral water. We have no 
guarantee that any precaution is taken to ascertain that the water used in the manu- 
facture of the different aerated beverages which are now so largely consumed is pure, 
or is free from the possibility of typhoid contamination. After the attack is over 
the bedding should either be thoroughly disinfected or else destroyed. 

No person living in a house in which there is a case of typhoid fever should take 
food without previously thoroughly washing his hands in carbolic acid and water, 
and using the nail-brush. This is a point of the utmost importance to the immediate 
attendants on the sick person. 

We now pass on to the consideration of the treatment of typhoid fever. It 
is essential that from the very beginning of the attack the patient; should have 
absolute rest, both of mind and body. Some people are very loth to acknowledge 
that they are ill, and seem to imagine that the best thing to do is to fight against 
the disease. They will not " give in," and they strain every nerve, even taking 
increased physical exertion to " shake it off." This is often done by the injudicious 
advice of some friend, who, himself being in perfect health, is ready enough to tell 
the sufferer to " pull himself together " and make an effort, and he will soon be 
well. Practically, it is found that those who do not rest or obtain treatment until 
they havo been ill for some days, do badly in the long run. Even a very mild 
attack may, in these cases, imperil the life of the patient, and after the fever 
is over they creep through a convalescence so long as to be entirely dispropor- 
tionate to the gravity of the attack. We cannot do better than illustrate the 
importance of early treatment by reference to a few figures. Out of a large 
number of severe cases treated in the hospital at Basle, it was found that of 
the patients admitted before the end of the fourth day only five per cent, 
died, of those who were admitted between the fourth and the eleventh days 



538 THE TREATMENT OP DISEASES. 

thirteen per cent, died, and of those who were admitted after the eleventh day 
twenty-eight per cent. died. It has been shown on many occasions that railway- 
travelling is especially injurious to patients suffering from typhoid fever. Most 
people when they find they are ill are extremely anxious to get home, and 
will make every effort to accomplish their object. In the case of typhoid fever 
they should never be allowed to undertake a railway journey, for it will assuredly 
produce great prostration, and considerably lessen the chances of a favourable 
termination. v * 

The patient should be confined to his bed from the very commencement 
of the attack, and should not be allowed to sit up again until the evening 
temperature has been perfectly normal for from three to six days, or even longer. 
It should be remembered that getting up too soon is a fruitful source of mischief, 
and that patients make the most rapid recovery who pass the whole time of 
their convalescence in bed. It is very desirable to have two beds close together, 
so as to give the patient a change, and allow of more thorough cleaning and 
airing. The patient must never on any account be allowed to walk or step 
from one bed to the other. He may be lifted carefully in the horizontal position, 
or what is better, the beds may be so close that the patient can slip or slide 
from one to the other. 

Evacuations both from the bowel and the bladder must be made whilst lying 
down, by using a bed-pan and urinal. At first many people find a difficulty 
in relieving the bowels whilst lying on their backs, but it is astonishing what 
a little practice will do. 

It is of the greatest importance that all worry and anxiety should be avoided. 
The patient may be told that everything is going well, but he must not be allowed 
to talk about his affairs. Above all, visitors must not be admitted. If you 
tell them there is fever in the house, they will not trouble you much. As a 
rule only one person at a time is required in the sick-room. No conversation 
is admissible, and the patient should not be read to. His questions should 
be answered briefly, and his wants, both expressed and unexpressed, should be 
cared for as quickly and quietly as possible. Very much — very much indeed — 
depends upon the nursing. A good sensible nurse, either professional or 
amateur, is half the battle. It is not to be supposed, however, that one person 
can do all the nursing ; two at least are absolutely necessary. 

The temperature of the sick-room should be rather below that of our ordinary 
sitting-rooms, and it should never be allowed to fall below 56° Fahr., or rise 
above 64°. It is very important to keep up a proper system of ventilation. 
One or more windows should be opened for an inch or two at the top both night 
and day, and should this cause too great a reduction in the temperature of the 
room, a good fire must be kept burning. People who have a high fever tem- 
perature run very little risk of catching cold. 

It is a matter of the utmost importance that the patient should be properly 
nourished. The fever produces intense thirst, and plenty of fluid should be given. 
Water, either iced or not, sugar and water, weak wine and water, milk and water, 
thin barley water, and other similar drinks will be found useful. Effervescing 



TYPHOID FEVER. 539 



fluids of all kinds should be avoided, as they distend the bowel with gas and increase 
the danger of the rupture. The patient is often too apathetic to ask for something 
to drink, even when suffering severely from thirst You must never trust to his 
helping himself, but as long as he is awake should frequently put the glass or feeder 
to his lips. If he is not thirsty do not urge him to drink. 

Next, as to the food. There is no disease in which attention to di6t is of more 
importance than in typhoid fever. Articles of solid food should from the very 
first be positively* interdicted. From the time the nature of the illness is first 
recognised, or even suspected, until convalescence is thoroughly established, not a 
single particle of solid food, in any shape or form, must pass his lips. This is a 
matter of the utmost importance, in fact, a matter of life and death. Not very long 
ago a sad case occurred in one of our hospitals. A young woman, aged nineteen, 
was making a rapid recovery from typhoid fever, when her mother came to see her 
and brought her an orange. Some of the pips were swallowed; one of them 
perforated the bowel, and in a few hours the girl was dead. Mutton broth, beef- 
tea, barley water, thin oatmeal gruel, and above all, milk or milk and water, must 
be relied on for supporting the strength. The amount of stimulant, wine or brandy, 
to be administered must depend upon the condition of the patient, and also, to some 
extent, upon his previous habits. As a rule stimulants in any quantity are not 
needed in the early period of the diseasa The strength of the pulse is the best 
guide, and should it fail, brandy must be resorted to. At first, four ounces of 
brandy in the twenty-four hours will be enough, but subsequently twice or three 
times this quantity may have to be administered. It should be given well diluted. 
For patients who do not like brandy a somewhat larger quantity of port wine may 
be substituted. 

Of course, the attendance of a doctor is indispensable, but so many emergencies 
may arise in the course of the disease that we have no hesitation in indicating the 
course of treatment to be adopted. 

We know of no specific antidote for this disorder, that is, of no drug which will 
stop it at any stage of its progress, although, as it owes its existence to a specific 
poison, it is not improbable that in time one may be found. 

Of late years the Baptisia tinctoria, or wild indigo, has obtained a great reputa- 
tion for the power of aborting the disease. It must be given quite at the com- 
mencement of the fever, and it is especially indicated when the following symptoms 
are present : — Hot and dry skin, quick full pulse, furred tongue, headache, great 
thirst, wandering or delirium at night, high-coloured urine, and usually confined 
bowels. The influence of baptisia in typhoid is said to be comparable to that of 
aconite in simple fever. The tincture of baptisia is given hourly in drop doses in 
about a tea-spoonful of water. 

If we cannot cut short the disease we must try and tide the patient over his 
difficulties. The great danger is lest he should die from the intensity of the fever 
and the deleterious influence of the high temperature on the tissues. By far the 
largest number of those who succumb to typhoid fever die from the effect directly or 
indirectly of the fever heat. Out of 210 fatal cases that occurred in a large 
hospital during a certain period eighty-six were due to the direct influence of the 



540 THE TREATMENT OP DISEASES. " 

elevated temperature, and in the remainder the same influence had a large share in 
producing the complications or bringing about the fatal result. 

It is obviously a matter of the utmost importance to consider what means are at 
our disposal for the reduction of the temperature of the body. In Germany cold 
baths are extensively used for this purpose. This is a method of treatment which 
has as yet been little employed in this country for typhoid fever, but the results 
have been so eminently satisfactory that it undoubtedly demands our best attention 
and consideration. 

Our ancestors were very fond of taking patients suffering from high fever to 
the nearest river, and giving them a dip, and it must be confessed that viewed by 
the light of modern science, their treatment was not by any means bad. The cold 
bath treatment, as used in Germany, is very simple. For adults the full-length cold 
bath, at a temperature of about 68° Fahr., is used. The patient is lifted out of bed in 
a sheet, and then carefully lowered, sheet and all, into the bath. The teeth usually 
chatter a little at first, but the patient does not mind it so much as one might sup- 
pose. The duration of the bath should be about ten minutes, but for feeble persons 
it may be reduced to seven, or even live minutes. Directly the time is up, the 
patient is taken out of the bath, rapidly dried with hot towels, wrapped in a warm 
sheet, put to bed, given a glass of wine, and made to keep quiet. Sometimes the 
patient is put in the bath at a temperature of 95°, and the water is quickly reduced 
by the addition of lumps of ice to a temperature of 72° or lower. This latter 
method is less efficacious than that of which we have already spoken. The cold 
bath treatment should be commenced when the temperature in the rectum reaches 
103°, or, in the case of children, 104° Fahr. The baths, to do any good, must be 
given frequently. Sometimes, in very severe cases, the bath may have to be given 
every two hours, and by these means many lives have been saved which with less 
energetic treatment must have been sacrificed. In the majority of cases, however, 
from five to eight baths per diem will suffice, the aggregate number during the whole 
course of the disease amounting to forty or fifty. 

It will probably be thought that there must be many objections to this metn^d 
of treatment, but in reality there are not. Perhaps it will be said that it must be 
a great shock to the system. Practically this is not found to be the case, it reduces 
the temperature, and those who have had most experience in this method of treats 
ment are the most enthusiastic in its praise. It may be said, but surely it will 
drive the disease inwards. This is a purely theoretical objection, for of course the 
whole body is affected with the disease, the patient is ill, and not any particular 
part of him. But will it not set up inflammation ? No, on the contrary, it is 
shown by statistics that patients treated with cold baths get inflammation of the 
lungs far less frequently than those treated by other methods. The trouble given 
to the attendants is in reality very little. The bath may be used for the same 
patient over and over again. If placed in the room, or, better still, by the bedside, 
it will always be ready for use. The patient does not find the cold bath so dis- 
agreeable as we should at first sight imagine. We have frequently seen patients 
with very high temperatures placed in a cold bath, and they rarely gave any indica- 
tion of discomfort. 



TYPHUS FEVER. 541 



Cold packs are sometimes substituted for baths, and they are nearly always 
used in the case of children. A course of four consecutive packs of from ten to 
twenty minutes' duration apiece is about equivalent in effect to a cold bath of ten 
minutes. 

Quinine is a drug which is very commonly used for reducing the temperature 
in typhoid fever. It does very little good when administered in ordinary five- 
grain doses. From twenty to forty grains must be given to produce any very 
marked effects. This quantity must positively be taken within the space of half 
an hour, or at the most an hour. The sulphate of quinine must be administered 
in powder in seven-grain doses every ten minutes. It is useless to expect much 
benefit if the dose is divided and the administration extended over a long period. 

Liebermeister, of whom we have already spoken as an authority on typhoid fever, 
says : — 

" There are still a good many physicians who have a sort of dread of these large 
doses of quinine. Where a dose of thirty grains is indicated, they give fifteen, and 
then try to make up the deficiency by repeating it oftener, say every day or twice a 
day. No sufficient and satisfactory result need be looked for from such a method. 
I have given quinine in large doses to at least 1,500 typhoid fever patients, besides 
hundreds of patients with pneumonia and other diseases. The number of single 
doses, of one scruple (twenty grains) to forty-five grains, which I have ordered in 
hospital and private practice, probably amounts to 10,000. And in no single 
instance have I seen any permanent injury follow which I could attribute to the 
action of the quinine." 

These full doses of quinine usually produce a loud ringing or roaring in the ears, 
and partial deafness. In rare cases they may even bring about a state similar to 
that of drunkenness, with unsteadiness of motion, weakness in the legs, and a 
decided feeling of discomfort. The temperature of the body falls materially, some- 
times even to the normal standard, and soon all the symptoms dependent on the ex- 
cessive fever are modified. The decline of temperature usually begins in a few 
hours after taking the medicine, and reaches its maximum in from six to twelve 
hours after. The first administration of forty grains within the hour should be made 
in the evening, so that its effects may coincide with the natural daily variation in 
temperature. It should never be repeated within twenty-four hours, and, as a rule, 
it should not be given again under two days. Quinine proves as successful in chil- 
dren as in adults. For children under two years old, ten to fifteen grains are 
required ; for those between the ages of three and five, fifteen grains ; for those 
between six and ten years of age, fifteen to twenty-three grains ; and for those 
between eleven and fifteen, twenty-three to thirty-one grains. The use of quinine 
may be advantageously combined with the cold water treatment. 

Sometimes large doses of digitalis are used for the reduction of the temperature, 
but this method of treatment is not altogether free from danger. 

We must now pass on to the consideration of other symptoms which may require 
treatment. If the bowels remain obstinately confined, a small dose of castor oil 
may be given. Of course, constipation is an exception, and there is usually diar- 
rhoea If the purging is moderate, it requires no treatment. Should there be more 



542 THE TREATMENT OF DISEASES. 

than three or four motions daily, the acetate of lead mixture (Pr. 30), to each dose 
of which ten drops of solution of acetate of morphia may be added, will be found of 
use, or a starch and opium injection — twenty drops of laudanum to four ounces 
of starch water — may be employed. Sulphate of copper and nitrate of silver some- 
times prove of service in obstinate cases. 

When there is frequent copious diarrhoea, with the passage, at times involuntary, 
of drab or ochre-coloured evacuations, associated with enlargement and tenderness 
of the abdomen, excessive prostration and thirst, and a nearly imperceptible pulse, 
arsenic, in the form of the arsenic mixture (Pr. 40), may be employed with advantage. 
When there is a bitter taste in the mouth, a brown-coated, rough tongue, a 
stupefying headache and cough, tincture of bryony will usually do good (Pr. 49). 

Bleeding from the bowel is a symptom which sometimes requires treatment. 
When the quantity is very small it will do no harm, but should as much as a table- 
spoonful appear in the motions, at one time it is well to endeavour to check it. A 
bladder or india-rubber bag containing ice should be placed on the abdomen. 
Twenty drops of the tincture of perchloride of iron may be given every alternate 
hour in a glass of water, or a tea-spoonful of the ipecacuanha mixture (Pr. 50) may 
be given every ten minutes for the first hour, and subsequently hourly. When the 
bleeding from the bowel is accompanied by suppression of the urine, drop doses of 
turpentine may be employed. 

When there is much pain in the abdomen poultices or hot fomentations are 
admissible. 

When perforation of the intestine takes place the only hope of a favourable 
issue lies in securing complete rest of the intestines for a considerable time. Opium 
should be administered in doses of a grain every hour, until the patient falls 
asleep. A grain of opium is contained in fourteen minims of laudanum, but it is 
better to use solid opium made up into little pills. The patient should be kept as 
constantly as possible under the influence of the drug. At first no nourishment of 
any kind must be given, nothing but a little ice to suck to allay the thirst, and for 
a long time only the most easily digestible food should be given, and that in the 
fluid form. The object is to get the opening in the bowel to heal, and this 
will never take place if food is constantly passing out through it. Under no 
circumstances must purgatives be given. 

To allay the excessive hunger from which many patients suffer during con- 
valescence, and before it is safe to give any solid food, drop doses of tincture of 
cinchona given hourly may be used with advantage. It does not matter how 
earnestly the patient may pray for something to eat, he must have no solid food 
until the evening temperature has been normal, ie., as low as 98*4° Fahr., for 
several consecutive days. This rule must be strictly and literally observed. Its 
infringement would, almost to a certainty, be attended with the most disastrous 
consequences. 

Typhus Fever is a contagious disease lasting from two to three weeks, and 
characterised by a rash which appears between the third and sixth days. It has 
received a multitude of names, almost every epidemic resulting in some addition to 



TYPHUS FEVER. 543 



the list. It is most commonly known as " spotted fever," w epidemic," or " con- 
tagious fever," and " camp fever," or " gaol fever." The terms " malignant fever " 
or " putrid fever " have been sometimes applied to severe cases. 

Typhus attacks people of all ages and both sexes indiscriminately. If we were 
to rely solely on evidence obtained from death registers and hospital statistics we 
might imagine that it was very uncommon in children, but this is readily explained 
if we remember that typhus seldom proves fatal to children, and that in Baany of 
our large hospitals people under fifteen are not admitted. 

Depressing mental emotions, over-work, and anxiety, by undermining the general 
health, render the system more susceptible to attacks of the disease. It is supposed 
by many that during the prevalence of an epidemic the fear of catching the fever, 
and the consequent depression which it produces, may act as a powerful predisposing 
cause. 

Persons who are under-fed, or who live upon food of an inferior quality, are 
especially liable to suffer from typhus. Typhus is by no means an aristocratic disease. 
It seldom attacks the rich and well-to-do, but prefers to associate with paupers and 
those but little removed from the level of pauperism. It delights in dirt and 
squalor, and is never so happy as when it can obtain admission to a gaol or work- 
house. It often breaks out, and always attains it greatest severity, when people are 
worse off and more badly fed than usual. It is almost always an accompaniment of 
war and commercial distress, and often follows in the wake of strikes. In Ireland, 
during the potato famines of 1818 and 1847, typhus raged with the greatest severity, 
and it is estimated that on each of those occasions more than one-eighth of the 
entire population was attacked. 

Over-crowding is a very favourable condition both for the production and propo- 
gation of typhus. Some of our most fatal epidemics have occurred in Liverpool, 
where in many parts the houses are built back to back in narrow unventilated courts. 
In Glasgow the mortality from typhus fever in different parts of the town corresponds 
so exactly with the degree of density of the population that there can be very little 
doubt that they stand in the relation of cause and effect. 

Typhus is essentially a disease of cold and temperate climates, and there is no 
sufficient evidence to show that it ever occurs within the tropics. Great Britain and 
Ireland are, and ever have been, the chief seats of the disease. It is most common 
during the last two months of the year, probably because at that time the poorer 
classes suffer more from want of food, and display a greater aversion than usual to 
proper ventilation. 

Typhus fever is a distinctly contagious disease, but at the same time tolerably 
close communication with the sufferer is necessary for its transmission from person 
to person. For instance, the extension of typhus fever from a hospital to the 
adjacent houses seldom or never occurs, and in this respect it differs from small-pox 
and many other diseases of this class. Casual visitors to fever wards are rarely 
attacked, but nurses, who in the discharge of their duties are brought in very much 
closer contact with the patients, seldom escape. Doctors in charge of fever patients 
nearly always catch typhus sooner or later, though, as a rule, much less quickly than 
nurses. It would appear that dilution with air in a great measure destroys the 



544 THE TREATMENT OF DISEASES. 

activity of the typhus poison. Persons who have once suffered from typhus art 
rarely attacked a second time. Typhoid fever neither protects from nor predisposes 
to typhus. 

People so seldom fall ill of this fever after only a single contact with a case of 
tho disease that some diificulty has been experienced in determining the time during 
which the poison may remain latent in the system without making its effects mani- 
fest. The period of incubation is probably variable, and is supposed to range from 
a few hours to several days. 

Typhus fever usually begins with headache, loss of appetite, and general malaise. 
The patient is dull, and out of sorts, and, in spite of a feeling of extreme fatigue, is 
unable to sleep, and is restless at night. For the first day or two it is often very 
difficult to say what is the matter with the patient, or to form any idea of what he 
is about to suffer from. Sometimes the disease begins suddenly with a shivering 
fit, but this symptom is far less common than at the onset of small-pox and some 
other acute diseases. For three or four days these general symptoms increase in 
severity, and are accompanied by thirst, heat of skin, and very great prostration. 
Typhus patients are usually knocked over by the disease far more quickly than 
sufferers from typhoid fever or small-pox. A man who has typhus can seldom keep 
about after the third day, and is only too glad to take to his bed. 

As the fever increases in severity the skin becomes hot and slightly reddened, 
especially about the head and face, and noises in the ears are not uncommon. 
Sometimes there are symptoms of a cold in the head, and the patient may suffei 
from sneezing and a slight sore throat. 

The appearance of a typhus patient is very peculiar, and is to a practised eye 
eminently characteristic. The sufferer lies prostrate on his back, with a weary, dull, 
heavy, absent expression. In fact, he looks very much like a man who has made 
himself stupid with drink, and is just beginning to recover from the effects of the 
debauch. In the advanced stages of a severe attack, the patient sinks down in bed, 
lying on his back, with his eyes shut or half-shut, moaning and too prostrate to 
answer questions, to protrude his tongue, or make the slightest voluntary move- 
ment. Despite this apparent quiet, he passes restless, uncomfortable nights, often 
broken by delirium. From the very beginning of the fever the torque is coated, at 
the onset with a white, and later with a thicker yellow fur, which exhibits a strong 
tendency to become dry. Thirst is a very constant symptom, so that in many cases 
the only thing that is really relished is plain cold water. The condition of the 
bowels varies with different patients, for there may be either diarrhoea or constipa- 
tion. Even when diarrhoea is present the stools are not at all like those we have 
described as being met with in the course of typhoid fever. 

The rash which is peculiar to and distinctive of typhus fever is known as the 
mulberry rash. It usually make its appearance on the fourth or fifth aay, but some- 
times later and occasionally earlier. It comes out first on the backs of the wrists, 
and about the armpits and navel, but in many cases it covers the whole trunk, and 
frequently the arms and legs as well. Sometimes in the case of children it appears 
on the face so copiously as to be mistaken for measles. The rash is usually 
described as consisting of two portions, between which every conceivable connecting- 



TTPHUS FEVEB. 545 



link may be found. One is a faint irregular dusky-red fine mottling which looks as 
if it had its seat some distance below the surface; the other is formed of separate 
spots of small size and purplish colour scattered over the mottled surface, and look- 
ing more or less superficial. These spots are irregularly roundish in shape, and at 
their first appearance are slightly elevated above the skin. The mottling often 
exists without the distinct spots, but the spots very seldom without the mottling. 
From the first to the third day after the appearance of the rash no fresh spots are 
seen, but each spot, although it becomes less elevated and more dark and dingy, 
continues visible till the whole rash disappears. During the first three days, typhus 
spots temporarily disappear under the pressure of the finger, but after that time they 
remain unaltered by pressure. They usually subside between the fourteenth and 
twenty-first days, but in fatal cases they remain after death. 

It will be important to consider the course of the temperature in this disease. 
On the evening of the first day of the fever the temperature may be as high as 
103° Fahr., and it continues rising until the third day, when it often reaches 
106° Fahr., or more. The difference between the morning and evening temperature 
is less marked than in typhoid fever, it seldom amounting to much more than a 
degree. The highest temperature is usually reached on or about the fourth day, 
and then a slight fall takes place. On the seventh day there is commonly a more 
marked fall, but in severe cases this may be indicated only by the absence of the 
usual evening rise, or it may even be totally absent. During the second week the 
temperature rises again, but only for a day or two, and it is rarely so high as in the 
first week. On or about the fourteenth day there is usually a considerable fall in 
the temperature, and this occurs even in those severe cases in which there was no 
fall on the seventh day. In favourable cases the temperature becomes normal about 
the end of the first half of the third week. The suddenness with which the fever 
leaves the patient is very characteristic of this disease, the temperature not un- 
frequently falling as much as three or four degrees in the course of a night. In 
cases which are about to terminate fatally the temperature remains high, about 
105° Fahr., until the last, and very frequently there is a very rapid rise a few hours 
before death closes the scene. 

The duration of an uncomplicated case of typhus fever varies from twelve to 
twenty-one days. It is extremely uncommon for a relapse to occur. The greatest 
Clanger is usually during the second week of the illness, death seldom ensuing before 
the seventh day. The recovery from typhus is usually very rapid, a wonderful 
change in the condition of the patient often occurring in twenty-four or forty-eight 
hours. The sequeke of this disease are very few, especially when compared with 
typhoid or scarlet fever, and an attack seldom results in any permanent injury to 
the health. 

The mortality in typhus fever, taking the average of all cases, is about ten per 
cent. In children it is as low as five per cent, but in elderly people it rises to fifty 
or sixty per cent., or upwards. Bulky, fat people are found to bear the disease 
badly, and previous habits of intemperance add very greatly to the gravity of the 
attack Although people in the upper classes of society seldom catch typhus, yet 
when they do have it they are said to suffer much more than their poorer brethren. 
35 



546 THE TREATMENT OF DISEASES. 

At the commencement of an attack of typhus fever, a difficulty is sometimes 
experienced in recognising the exact nature of the complaint, and this difficulty is 
not always removed even when the rash makes its appearance. The eruption is 
sometimes, though not commonly, a good deal like that of measles. They both 
appear about the same day after the commencement of the illness ; and in children 
especially it is often no easy matter to say from which of the two diseases the 
patient is suffering. The eruption of typhus is of a smaller pattern than in measles, 
and it seldom assumes a crescentic arrangement. When the rash is much elevated 
above the skin this is a point in favour of measles, and the same may be said when 
a cold in the head is a prominent symptom. 

There is usually very little difficulty in distinguishing typhoid fever from typhus 
fever, but as these two diseases were formerly confounded, it may not be uninterest- 
ing to compare their most prominent features in a tabular form : — 

Typhus and Typhoid Fevers Compabed. 

Typhus Fever. Typhoid Fever. 

I, Age. — May occur at any age. Bare in old people. 

2 Social condition. — Oceurs chiefly among the Occurs as frequently among the rich as the 
lower classes of society. poor. • 

3. Contagiousness. — Very contagious. Not contagious. 

4. Onset. — Well marked. Often insidious. 

5. General appearance. — Very dull ; pupils of Less apathetic ; pupils of eyes usually dilated. 

eyes usually contracted. 

6. Bleeding from nose. — Rare. Not uncommon at onset. 

7. Eruption. — Appears before the seventh day; Does not appear till seventh day ; comes out in 

comes out in a single crop ; spots at first successive crops ; spots elevated, and dis- 

not elevated, and may not disappear on appear on pressure. 

pressure. 

8. Diarrhoea. — Not common ; stools natural or Common ; stools yellow like pea-soup, 

dark in colour, if loose, of a muddy consis- 
tence. 

9. Tongue. — Nearly always dry. May be moist. 

10. Duration. — On an average fourteen days; On an average twenty-two days; may prove 
in fatal cases death always ensues before fatal after the twentieth day. 

the twentieth day. 

II. Relapses. —Rare. Not uncommon. 
12, Convtlescenee. — Rapid. Slow. 

Practically one would not need to compare all these different points to 
distinguish between the two diseases. Usually it is important to consider the 
nature of the fever prevailing in the town or neighbourhood, and to inquire care- 
fully as to the possibility of the patient's exposure to any source of infection. 

At present we know of no means either of curing or shortening the duration of 
typhus. The symptoms may be advantageously treated, and the patient's strength 
may be supported through the time of the fever, but we have no means at our 
disposal for arresting the progress of the disease. It is almost needless to say that 



TTPHUS FEVfcB. 547 



the attendance of a doctor is necessary. The general treatment is not esseniiaHjr 
different from that we have already adopted in other fevers. 

It is very necessary that the patient should be placed under the best possible 
hygienic conditions. He should be placed in a large room, with an ample supply of 
fresh air at a moderate temperature. Cleanliness is absolutely essential, and 
frequent change of both personal and bed linen is most desirable. The services of 
a couple of experienced nurses should be obtained. In the case of poor people, 
living in close crowded rooms, removal to a hospital should be insisted on both for 
the sake of the patient and his neighbours. Quiet and freedom from anxiety greatly 
add not only to the patient's comfort but to his chances of recovery. It is a good 
plan to carefully sponge over the whole body several times a day ; and, in many 
cases, the employment of the wet pack proves beneficial. 

In a disease of this severity it is very essential that the patient's strength should 
be supported by every means in our power. In the early stages of the fever, as 
long as the appetite remains good the diet need not be restricted, and the patient 
may have anything he chooses if it is not positively noxious. Soon, however, all 
relish for food is lost, and the patient will take nothing but liquids and sick-room 
delicacies. Sometimes the dislike for food is so great that it has to be administered 
just as if it were so much medicine. The digestive functions are so greatly impaired 
that only the most nutritious substances should be administered. Beef-tea, mutton- 
broth, chicken or veal broth, milk, eggs, arrowroot, jellies, and other similar articles 
will be found useful. A good nourishing soup is made as follows : — Stew two 
ounces of the best well-washed pearl sago in a pint of water till it is quite tender 
and very thick, and then mix it with half a pint of good boiling cream and the 
yolks of two fresh eggs. Blend the whole with a quart of beef essence made by 
cutting up in small pieces four pounds of lean beef from the sirloin or rump, 
placing it in a covered saucepan with a quart of cold water by the side of a fire for 
four or five hours, and then allowing it to simmer gently for two hours. It 
must be skimmed well, and the mixtures are to be mixed when both are 
hot. So little is usually taken at a time, that it is necessary to administer some- 
thing every two hours ; and the fact of the patient being drowsy or sleepy shouM 
not prevent this from being done. The patient usually suffers greatly from thirst, 
and he should have plenty of water, lemonade, soda water, cold weak tea, or any 
other beverage he may fancy. Iced drinks often prove very grateful and 
refreshing. 

The administration of the proper amount of alcohol is a point which requires 
some judgment. Children rarely require stimulants of any kind, and many adults 
do very well without them. Alcohol may be advantageously administered in 
the case of old people, or when the patient has been long accustomed to the free 
use' of stimulants. Its employment is especially indicated when there is great pros- 
tration with low delirium and drowsiness, and in cases in which the pulse is weak, 
or the extremities are cold and blue. It is rarely required before the appearance of 
the eruption, and proves most useful during the second and third weeks of the 
disease. In cases in which stimulants are required, a daily allowance of a bottle of 
good claret, or half a bottle of sherry, would not be excessive for an adult. In 



548 THE TREATMENT OP DISEASES. 



severe cases large doses of brandy may have to be administered. Should the patient 
take a fancy to beer there is no objection to his having it in moderation When the 
food or drink cannot be swallowed, or is rejected by vomiting, it may have to be 
administered in the form of an injection- 
Much may be done to add to the comfort of the patient by treating the most 
prominent and distressing symptoms. The thirst may often be relieved by the use 
of acid drinks, such, for instance, as the gentian and acid mixture (Pr. 15) diluted 
with water. A weak infusion of cascarilla or orange peel, slightly acidulated with 
hydrochloric acid, may be used for the same purpose. Raspberry vinegar, too, is a 
useful drink. Sweet fruits, although at first agreeable and refreshing, should be 
taken only in moderation, for they are apt to give rise to a disagreeable taste in the 
mouth, or may even produce flatulence or diarrhoea. There is no advantage in curtailing 
the amount of water taken by the patient. Small pieces of ice to suck often prove 
very gratef uL The headache, sleeplessness, and delirium are often relieved by small 
doses of opium — for example, five drops of laudanum in a little water every 
four hours. When the delirium is very violent, mechanical restraint may have to be 
resorted to, but this should be avoided if possible. Furious delirium, accompanied 
by confusion of ideas, throbbing of the temples, aud great thirst, is often controlled 
by the belladonna mixture (Pr. 39) given in tea-spoonful doses, every ten minutes for 
the first hour, and subsequently hourly. Shaving the head, and the applications of 
cold lotions, or of a pocket handkerchief moistened with aromatic vinegar-and-water, to 
the scalp and forehead will often allay the violent and distressing headacns. The 
bowels should be opened daily, but only the very mildest laxatives should be used, 
as purgatives often set up diarrhoea. Should the bowels be open too freely, some o£ 
the remedies of which we have spoken in the treatment of diarrhoea should be 
employed. Vomiting may be checked by ice, lime-water, drop doses of ipecacuanha 
wine given hourly (Pr. 50), or perhaps by a blister or mustard poultice applied to 
the pit of the stomach. The condition of the bladder should be carefully attended 
to, for in diseases in which the patient is unable to pass his water the use of the 
catheter may be necessary. 

To avoid infection fresh air, efficient ventilation, and cleanliness, are of para- 
mount importance. The attendants on the sick should, as far as possible, avoid 
inhaling the breath of, or the exhalations from the body of, the patient. Disinfec- 
tants, such as chloride of lime, carbolic acid, and Condy's fluid should be constantly 
employed in the sick-room, but should never be regarded as substitutes for fresh air. 
At the termination of the illness the room should be thoroughly fumigated, and 
then whitewashed and re-papered. 

Simple Fever, or Febricula. — Occasionally a person may be slightly feverish, and 
the most careful examination may fail to detect the presence of any other symptom. 
We speak of these as being cases of simple continued fever or febricula, and when 
the complaint is very transitory we sometimes call it ephemeral fever. It is a very 
trifling complaint, and may be produced by almost any combination of circum- 
stances which lowers the general tone of the system. In delicate susceptible people 
it may be caused by sudden atmospheric changes, or the prevalence of an unusually 



SIMPLE FEVER, OR FEBRICULA. 549 

high or low temperature. It may be the result of getting wet through, of exposure 
to the heat of the sun, of sleeping in damp sheets, or of living in a cold draughty 
house. Errors in diet, whether in the form of under-feeding, or what is far more 
common, over-feeding, play a prominent part as exciting causes. Many people suffer 
from a poor and insufficient diet, but a still larger number owe their temporary 
ailments to a too free indulgence in the pleasures of the table. Excessive bodily 
fatigue, excitement, anxiety, and possibly over-work, may produce a transient' febrile 
condition. In the majority of cases febricula is associated with, if not dependent on, 
some slight functional disturbance of the stomach or chest. 

The symptoms of simple continued fever are chiefly those which we have already 
enumerated as together constituting that condition which we call fever. The 
complaint is commonly ushered in by a little chilliness, or by chills accompanied by 
flushes, and this is followed by burning heat and dryness of the skin, a full, quick 
pulse, a coated tongue, thirst, loss of appetite, high-coloured scanty urine, and 
constipation. The temperature often rises very rapidly, and may reach 102° or 103° 
in the course of a few hours. Sometimes there is headache, pain in the loins, or a 
condition of considerable prostration. These symptoms usually last only a few 
hours, or at the utmost a day or two, and then rapidly decline, leaving the patient 
weak but otherwise well Convalescence may be ushered in by bleeding from the 
nose, a copious discharge of urine, or even by the breaking out of a few spots at the 
corners of the mouth. 

The treatment of simple continued fever is of the simplest possible description, 
The patient should keep quite quiet indoors, and should take a thorough rest until 
Ms indisposition has passed off. It is not absolutely necessary that he should stay 
in bed, for he may be on the sofa in his own room covered over with a rug, and pass 
the time away in reading his favourite authors or skimming through the pages of 
the last new noveL He should abstain from solid food until his temperature has 
returned to the normal, and should subsist chiefly on milk, or iced milk and 
soda water, with an occasional sponge cake or a biscuit or two. Stimulants are not 
usually necessary, but when the patient is much prostrated, as the result of previous 
fatigue or anxiety, a couple of glasses of port wine may be allowed in the course 
of the day. At the commencement of the attack a hot foot-bath, or the wet pack 
will often do good. Yery little medicine is as a rule required. Three or four tea- 
spoonfuls of solution of acetate of ammonia (Mindererus's spirit) may be taken every 
four hours to favour perspiration, and promote the action of the kidneys. 

The drug on which we are accustomed to place the greatest reliance is aconite. 
The earlier it is given the better. The dose of the aconite mixture (Pr. 38) is a tea- 
spoonful every ten minutes for the first hour, and subsequently hourly. It quickly 
reduces the intensity of the fever, a fact easily shown by the frequent employment of 
the thermometer. When there is redness of the face, violent headache, confusion 
of ideas, throbbing of the temples, and wakefulness, belladonna should be given. 
The dose and mode of administration of the belladonna mixture (Pr. 39) are the 
same as for the aconite mixture. In some cases it will be found advantageous to 
give a dose of the aconite mixture and the belladonna mixture alternately. Thej 
should not be mixed, or given at the same time. 



550 THE TREATMENT OP DISEASES. 

When the fever is unusually severe or prolonged, and there is much prostration, 
a half tea-spoonful dose of the arsenic mixture (Pr. 40) given every hour for six or 
eight hours will be found serviceable. 

When the prominent symptoms are stupefying headache, aggravated by move* 
ment, shooting pains in the limbs, a cough, yellow coated tongue, nausea, and 
constipation, the best remedy is tincture of bryony, given according to Pr. 49. 

Remittent Fever, like ague, is due to the action of malaria on the system. A 
larger dose of the poison is required to produce a " remittent " than an " intermit- 
tent " fever. We have already explained the technical use of these terms. In 
intermittent fevers, as we have seen, the patient is at some portion of the day quite 
free from fever, but in remittent fever such is not the case ; the fever is sometimes 
less but the patient is never quite free from it. An ague may be converted into 
remittent fever by continued exposure to the action of malaria, and on the other 
hand as a patient is recovering from remittent fever the complaint often assumes an 
intermittent form. 

The disease of which we are now speaking is sometimes known as bilious fever, 
or bilious remittent fever, or as jungle fever. In England it is met with usually 
in a very mild form, but it is a formidable disease in many parts of the world. It 
prevails with great intensity on the western shores of Africa, in the East Indies, in 
many parts of North and South America, and in the West India Islands. 

We need not discuss its mode of causation, as what we have said respecting the 
origin of ague is, in a great measure, applicable to this disease. 

The fit, as in ague, consists of three stages, but here the cold stage is less severe 
and of shorter duration, and in some of the worst cases it may be altogether absent. 
The patient usually at first experiences a sensation of nausea with weariness, languor, 
and lassitude, and complains of oppression at the pit of the stomach. He then feels 
a certain amount of chilliness, which gradually passes off. The hot stage then com- 
mences, the countenance is flushed, the patient complains of rending headache, with 
excruciating pains in the limbs and loins, the skin is burning hot, and the unfor 
tunate sufferer is restless, and tosses about in bed in the vain search for an easy 
posture. Vomiting soon begins, and often continues through the disease a distressing 
and embarrassing symptom. It usually fails to relieve the sense of fulness and 
oppression at the pit of the stomach, although the amount of fluid evacuated is often 
very great. When the hot stage has lasted from six to twelve hours, a little mois- 
ture breaks out on the brow and neck, and gradually spreads over the body ; the 
pulse gets slower, the skin is cooler, the headache is less, vomiting ceases, and the 
patient obtains some sleep. There is always a remission every morning, but in bad 
cases this is the only one that can be distinguished, so slight is the abatement. The 
disease varies in duration from five to fourteen days. Death rarely occurs before 
the eighth day, and in most cases under judicious treatment a favourable termination 
may be hoped for. 

This is a disease in which a medical man should be sent for without delay. As, 
however, it may in many cases be impossible to obtain professional assistance, we 
will indicate the line of treatment to be pursued. At the commencement of the 



REMITTENT FEVER. 551 



attack a purgative pill (Pr. 60) should be given with the view of thoroughly clearing 
out the bowels. During the cold stage no special treatment is required. If the hot 
stage be mild, without much headache or heat of skin, no interference is necessary 
beyond giving the patient iced water, or lemonade, or soda water to drink, or, better 
still, a little ice to suck. 

If, however, the skin is very hot, the headache and pains in the limbs and loins 
severe, or the patient very restless, cold towels may be applied to the head, and the sur- 
face of the body sponged with tepid water. The vomiting is not only very distressing, 
but rapidly induces exhaustion. Sometimes it may be combated by sucking little 
lumps of ice, or by the application of a mustard poultice, or a pad of lint sprinkled 
with chloroform, and covered with oil silk, to the pit of the stomach. A still better 
plan is to give drop doses of ipecacuanha wine every ten minutes for the first hour, 
and subsequently hourly, in a tea-spoonful of water. During its employment other 
medicines and methods of treatment should be suspended. 

Directly the remission sets in — that is to say, as soon as moisture appears on 
the skin, and the pulse is reduced in frequency, a ten-grain dose of quinine (four 
table-spoonfuls of Pr. 10) should be given. This should be repeated every second 
hour until thirty grains have been given, or until its administration is interrupted 
by the access of another fit. If the stomach refuses to retain the quinine, a twenty- 
grain dose must be injected into the bowel in beef -tea or any bland fluid. It is a 
golden rule that by some means or other thirty grains of quinine must be taken into 
the system between the termination of one fit and the commencement of the next. 
In some very bad cases, it may even be advisable to give quinine at once, and not to 
wait for the remission ; but it is better not to do this unless it is absolutely neces- 
sary. The patient's strength must be supported by nutritious food and a judicious 
administration of stimulants. 

How to avoid Fever ts Hot Climates. 
The following simple rules will, we trust, be of use to emigrants and others living 
in tropical climates. They are, with a few minor alterations, identical with those 
drawn up for the guidance of the soldiers serving on the Gold Coast in 1873 : — 

1. Avoid needless exposure to the sun, ndn, night-dews, and fogs. 

2. After "being exposed to the sun, bathe the head and face, and if possible the whole body. 
If wet, change your clothes with the least practicable delay, and rub yourself with a rough towel. 
If exposed to dews or fogs, take a cup of hot coffee or soup, or a little quinine wine. 

3. Avoid stagnant water or such as contains " bush " plants, whether they be dead or living. 
When possible, use only water which has been filtered or otherwise purified. When at work, cold 
tea is the best beverage. Rinse out the mouth before swallowing the first draught, and take only- 
two or three mouthfuls at a time. This will relieve thirst as effectually as a longer draught. 

4. Avoid all spirits, or other drink offered by natives. All of them are more or less un 
wholesome to Europeans, and they may be absolutely poisonous. 

5. The moderate use of tobacco in smoking may be of use during the prevalence of damp, 
malarious fogs. In excess, however, it does more harm than good. In no other form than 
smoking has it any good effect whatever. 

6. In regard to food, the more you restrict yourself to a plain, substantial diet, the better it 
will be for you. If in the bush, carry with you a small supply of pepper, mustard, salt, and an 
ouion. These may often be the means of furnishing you with a savoury repast. 



552 THE TREATMENT OP DISEASES. 

7. To guard against the bites of insects, apply a little lime-juice to the hands and face. 

8. In the bush, beware of unknown fruit. Some kinds, tempting in appearance, are poisonous 
in reality. 

9. Cleanliness of person and clothing should be as far as possible observed. The daily use 
of a tooth-brush and powdered charcoal for the teeth is enjoined. The under-clothing should be 
changed as often as possible, or if it cannot from any cause be washed, it should be hung up in 
the sun and well shaken. 

10. A respirator, or veil of thin linen, or cotton gauze, worn over the face, may act as a guard 
against malaria in the bush. 

11. Never lie down upon the bare ground, and never in thick grass. In the former case you 
run the risk of an attack of fever or dysentery, and in the latter of being bitten by snakes, &c. 
Avoid remaining in the vicinity of newly turned-up soil. 

12. Do not believe that you are in any way "proof" against the climate. To believe this 
will sooner or later prove delusive. You can lessen the risks of illness by due care and pre- 
caution, but the attempt to brave those risks will surely and speedily end in your own prostration. 

13. The sooner, on being attacked with illness, you can obtain medical treatment, the greater 
your chances of recovery. If you suffer from headache, dislike to food, chilliness and pains in 
the back, or from gnawing pain in the stomach and looseness of the bowels, get advice if you 
possibly can. 

Yellow Fever. — This is a disease which is seldom seen in this country, but is 
habitually present in the seaport towns of the West India Islands, in Africa, and 
some parts of the coast of North and South America. It seldom occurs at a greater 
elevation than 2,500 feet above the level of the sea, and whilst it may cause the 
greatest devastation in plains and valleys, the inhabitants of elevated regions enjoy 
almost complete immunity from its effects. It is essentially a disease of warm 
climates, an average temperature for some weeks of at least 72° Fahr. being 
necessary for its production. The places in Europe most liable to be affected are 
the southern ports of Spain. 

It usually has its origin in regions which are capable of producing ague. It 
differs from this disease in many respects, but in none more strikingly than in the 
fact that it is infectious, and is capable of being communicated from one person to 
another. 

Yellow fever is generally said to consist of a single paroxysm. There are certain 
premonitory symptoms, consisting usually of loss of appetite, of flatulence, and a 
peculiar watery look about the eyes. There are, as a rule, no distinct rigors, but 
chills alternating with flushes of heat. The patient complains of headache and vio- 
lent pains in the back, and suffers greatly from nausea and tenderness at the pit of 
the stomach. This usually lasts for a day or two, and then vomiting commences. 
Everything is at once rejected, usually without any effort, and the vomited matter 
will be found on examination to be tinged with bile or blood — " black vomit." The 
pain in the abdomen is increased, the urine becomes scanty, and the bowels are 
obstinately confined. The patient is often very restless, and exhibits an evident 
derangement of intellect, although he may answer questions coherently. This con- 
dition may last from a few hours to two or three days, and is followed by a state of 
remission. The patient feels much relieved, the irritability of the stomach abates, 
the skin becomes moist, and the bowels are freely open. In favourable cases 
this is an indication of convalescence, but too frequently the improvement is of short 



ULCER OF THE STOMACH. 053 



duration. A yellow tinge makes its appearance on the forehead, and rapidly 
spreads downwards over the face, back, and chest, and then involves the whole body. 
After a few hours the black vomit returns, the pain at the pit of the stomach 
is aggravated, the patient refuses all medicine and food, complains of excruciating 
pain in the calves of the legs, and finally becomes delirious. 

The usual duration of the fever is from three days to a week, although in some 
cases death may ensue in a few hours. When the sixth day elapses without the 
occurrence of black vomit, or suppression of the urine, there is great hope of recovery, 
but even if all the other symptoms be absent, and only one of these two present, 
the indications are unfavourable. In many epidemics the mortality is as high as 
one in three. 

In so serious a disease as this, the attendance of a doctor is of course essential, 
but considering the frequency with which it occurs in places where medical aid is 
not obtainable, we will briefly indicate the line of treatment to be adopted. 

The disease cannot be cured, and all we can hope to do is to guide the patient 
safely through it. There is little to be done, except to treat the most urgent 
symptoms as they arise. Quinine, which does so much good in ague, is here useless. 
Removal from the infected locality is often followed by a marked amelioration of 
the symptoms. Nothing so quickly and so effectually arrests yellow fever on board 
ship as running into a cold latitude. The greatest attention should be paid to 
cleanliness, and during the whole of his illness the patient should be in a large, well- 
ventilated room. As the bowels are generally confined, a calomel purge (Pr. 61)* 
may be given at the onset of the disease. Drop doses of ipecacuanha, given 
frequently, will usually check the vomiting, but should this fail, recourse must be 
had to chloroform, given internally, or to milk and lime-water. Every effort 
must be made to support the strength by the administration of milk and strong 
beef-tea, and there should be no hesitation in giving plenty of stimulant, especially 
champagne, if obtainable. 



ULCER OP THE STOMACH. 

Ulcer of the stomach probably occurs far more frequently than is usually 
supposed. It so frequently heals spontaneously, and the patient recovers so quickly, 
that the true nature of the illness is not even suspected. In post-mortem 
examinations scars of old ulcers are frequently met with on the inner wall of the 
stomach. The disease occurs more frequently in women than in men. The 
majority of cases occur between the ages of twenty and thirty, but the liability to 
the disease increases as age advances. These statements may at first sight appear to 
be contradictory, but they are in reality not so, for it must be remembered that 
there are far fewer people living between the ages of say sixty and seventy, than 
between twenty and thirty. Allowing for the number of persons living at different 
ages the preponderance of the disease in the later periods of life is very considerable. 
The disease is more common among the poorer classes of society, and it occurs most 
frequently in servant-girls, and pale, anaemic, half-starved, needlewomen. It has 
been supposed that there is a connection between ulcer of the stomach and arrest of 



554 THE TREATMENT OP DISEASES. r 

the menstrual function, although there seems to be some doubt on this point. Cases 
are indeed recorded of suppression of the menses through cold having been 
immediately followed by symptoms of ulceration of the stomach. Respecting the 
causes of ulcer of the stomach we know very little. Many theories have been 
advanced, but as there is none which is universally accepted, it is needless to enter 
into a discussion of the subject. It has been thought that moral emotions, bad or 
insufficient food, excessive indulgence in spirituous drinks, and exposure to extreme 
cold may act as exciting causes, but this, to say the least, is problematic. 

The ulcer is rarely smaller than a ten cent-piece or larger than a dollar ; its 
shape is usually circular or slightly oval, and the edges are often sharp, as if a piece 
of the tissue had been punched out. Usually there is only one ulcer, but 
occasionally there are two, three, or even more. These facts are, of course, ascer- 
tainable only by a post-mortem examination, for as these ulcers are actually in the 
stomach, and not on the surface of the body, we have no means by which we could 
see them during life. 

We must now consider the symptoms to which ulcer of the stomach gives rise. 
None is so constant as pain, and this, unfortunately, is only in very exceptional 
cases absent. It varies considerably in character and intensity, but possesses no 
distinctive character. It is usually experienced from a few minutes to a quarter of 
an hour after eating, and is especially apt to occur after taking indigestible food. 
It does not cease until digestion is completed, or until the food is rejected by 
vomiting. It may also be excited by exposure to cold, mental excitement, or 
severe bodily exertion, and is usually increased by external pressure and by tight 
clothing. The pain is often felt at the pit of the stomach, or a point a little above 
this, or it may even be experienced in the middle of the back. 

Another symptom is vomiting, which is absent in very few cases. It is almost 
always accompanied or preceded by pain in the stomach, which is relieved by 
the vomiting. The vomit usually consists of food in different stages of digestion. 
Hsematemesis is much less common, but when blood is thrown up in large 
quantities mixed with food, it is, with certain limitations, indicative of the 
complaint now under consideration. Slight bleeding often escapes notice, because 
the effused blood does not induce vomiting, but passes off in the stools, which are 
scarcely ever examined unless there is some special reason for so doing. In copious 
haemorrhage a portion of the blood always escapes by the bowels as a blackish 
tarry-looking substance. When hsematemesis has once occurred it nearly always 
returns, either because the clot which is formed is dissolved out by the gastric 
juice, or forced out by the movements of the stomach, or because fresh tissue 
is opened up by the extension of the ulcer. Small bleedings do not materially 
disturb the general health, but a copious haemorrhage may produce fainting, or 
even death. Nothing is more likely to favour bleeding than the congestion of 
the stomach, resulting from over-indulgence in food, or some other similar cause. 

Dyspepsia, or difficult digestion, as shown by lack or perversion of the appetite, 
by increased thirst, unpleasant taste in the mouth, weight at the pit of the 
stomach, flatulence, and eructation of acid fluids, is very common. Notwith- 
standing these digestive derangements, the nutrition is by no means always 



ULCER OF THE STOMACH. 555 



impaired, and the sufferer may for a long time remain fat and plump, so that 
the serious nature of the illness is apt to be overlooked. When, however, 
these symptoms go on uninterruptedly for years, as they are apt to do, the 
sufferer gradually loses flesh and strength, and becomes more and more pale 
and wasted. 

Gastric ulcer is almost invariably accompanied by a confined state of the 
bowels. It would seem, probably, that there is a kind of sympathy between 
the stomach and bowels, and that the sluggishness of the latter is induced 
by the condition of the former. There is often considerable mental depression ; 
in fact, in a disease which usually lasts for months or years, which at every 
meal reminds the patient of his condition, which is constantly exhausting his 
strength, causing him violent pain, and disturbing his rest, it is but natural 
that there should be some depression of spirits. 

There are certain complications of ulcer of the stomach which merit a brief 
consideration. In the first place the ulcer may eat its way right through the walls 
of the stomach and allow the contents to be poured out into the abdominal cavity. 
Under these circumstances death nearly always occurs in two or three days from 
shock. Sometimes by good fortune the ulcer may have become adherent to some 
other organ, as the liver or spleen, so that when perforation occurs the fluid is 
prevented from being poured out, and no great damage is done. In exceptional 
cases perforation is the first indication of the existence of the hitherto latent disease. 
The occurrence of this condition, is indicated by the onset of severe pain at the pit 
of the stomach, which soon spreads over the whole belly ; the abdomen becomes 
swollen, and there is great anxiety, with rapidly increasing prostration. These 
indications of the giving way of the coats of the stomach usually occur after a full 
meal, or perhaps from some sudden exertion, as that produced by vomiting, 
coughing, sneezing, &c. Another complication is the occurrence of consumption. 
People who have ulcer of the stomach sometimes become consumptive, but whether 
these two conditions stand in the relation of cause and effect, we cannot say. 

It must be admitted that it is not always an easy matter to distinguish ulcer of 
the stomach from other diseases. In many cases the nature of the complaint is 
perfectly clear, but in others it is far from being so. One often meets with pale 
sickly girls or women who complain of menstrual disorders, and have indigestion, 
and pain, and tenderness at the pit of the stomach. The great problem to be solved 
is whether they have ulcer of the stomach, or are only fanciful and hysterical. In 
any doubtful case it is much better to act upon the supposition that they have the 
more serious disease — ulcer. This is perfectly justifiable, because in the morbid 
conditions which are liable to be mistaken for gastric ulcer, the strict diet, and other 
measures adopted for its treatment are likely to prove, on the whole, beneficial. It 
is often extremely difficult to distinguish between ulcer and cancer of the stomach ; 
we have considered the chief points of difference between them when speaking of 
the latter disease. (See Cancer of the Stomach.) 

Ulcer of the stomach is undoubtedly a serious complaint, but the large majority 
of patients completely recover. It is probable, as we have said, that many cases 
never come under the care of the physician at all, and that healing occurs 



556 *HK TREATMENT OF DISEASES. 

spontaneously. When there is copious bleeding the disease mast have progressed 
deeply, and we consequently feel less sanguine as to the result. The loss of blood 
is dangerous, moreover, on account of the exhaustion it produces. When per- 
foration occurs we must fear the worst, although the case is by no means 
hopeless. Severe persistent vomiting, and long tormenting pain are unfavourable 
signs; they ultimately exhaust the strength, and so impair the prospect of 
recovery. 

We have no specific remedy for ulcer of the stomach. We can no more cure an 
ulcer by the administration of any one particular medicine than we can mend a 
broken leg by the same means. The only way in which we can effect a cure is to 
follow a rational and systematic course of treatment. It must always be remembered 
that the ulcer will heal by itself, unless prevented from so doing by external causes, 
and our endeavour should be to place the diseased organ under such conditions that 
all causes which interrupt the curative process are as far as possible eliminated. This 
fundamental law of treatment is, however, always violated, unless we make it our 
first rule to allow no solid food to be taken, or at least none which cannot by masti- 
cation be converted into a soft pulpy mass. One of the best articles of diet in these 
cases is milk. It contains in itself all that is necessary for the nutrition of the 
body, and has, moreover, the special advantage in the treatment of ulcer of the 
stomach, that the soft clot which it forms is far less irritating to the ulcerated 
surface than are other substances, such as hard-boiled eggs, pieces of meat, bread, 
cabbage, potato, &c. The success which attends the practice of restricting the 
patient to >an exclusively milk diet is very great. The milk should be given in 
small quantities, rarely exceeding a tea-cupful at intervals of two hours, and in 
severe cases, where there is frequent vomiting, the amount must be restricted to 
table, dessert, or even tea-spoonfula Long fasting is undesirable, and it is 
advisable that the patient, if awake, should take the milk at intervals during the 
night. The milk is often better borne when mixed with a little well-boiled arrow- 
root or biscuit powder, since its coagulation in the stomach in masses is thereby 
prevented. The milk should not be taken too hot, but there is no objection to its 
being tepid, unless, indeed, there is a tendency to bleeding, when of course everything 
must be cold. Butter-milk may be used as a substitute for milk when it in its 
ordinary form appears to disagree, or it may be diluted with water, or with soda 
water which has been allowed to stand till the greater part of the effervescence has 
subsided. In certain cases the milk is not easily digested, but gives rise to 
flatulence, acidity, increased pain, and even vomiting. In elderly people milk 
occasionally fails to nourish, and unless a different diet be adopted emaciation and 
loss of strength are apt to ensue. 

There is another article of diet which is even less likely than milk to inflict 
injury on the stomach, and that is essence of beef. We append several formulae for 
the preparation of this substance. 

Essence of Beef, No. 1. — Take one pound of fresh beef, free from fat, and pour 
over it half a pint of soft water, or rather less • add five or six drops of pure hydro- 
chloric acid, obtained from the chemist's, and half a teaspoonful of common salt- 
Stir it well, and leave it for three hours in a cool place. Then pass the fluid through 



TTLCER OF THE STOMACB. 557 



a hair sieve, pressing the meat slightly, and adding gradually towards the end of the 
straining a little more water. The liquid thus obtained is of a red colour, possessing 
the taste of soup. It should be taken cold, a tea-cupful at a time. If preferred warm, 
it must not be put on the fire, but heated in a covered vessel placed in hot water. 

Essence of Beef , No. 2. — Take one pound of gravy beef, free from fat and skin, 
chop it up very fine, add a little salt, and put it into an earthen jar with a lid, 
fasten up the edges with thick paste, such as is used for roasting venison, and place 
the jar in an oven for three or four hours. Strain through a coarse sieve, and give 
the patient two or three teaspoonfuls at a time. 

Essence of Beef No. 3. — Cut up in small pieces one pound of lean beef from 
the sirloin or rump, and place it in a covered saucepan, with half a pint of cold 
water, by the side of the fire for four or five hours, then allow it to simmer gently 
for two hours. Skim it well, and serve. 

These are formulae on which implicit reliance may be placed, but as it is always 
desirable in these cases to have a variety, we give two others. It must be remem- 
bered that even a slight change in the mode of preparation affords appreciable 
difference in the taste. 

Beef Essence, No. 4. — Take one pound of rump steak, mince it like sausage-meat, 
and mix it with one pint of cold water. Place it in a pot at the side of the fire to 
heat very slowly. It may stand two or three hours before it is allowed to simmer, 
and then let it boil gently for fifteen minutes. Skim and serve. The addition of a 
small table-spoonful of cream to a tea-cupful of this beef tea renders it richer and 
more nourishing. Sometimes it may be thickened with a little flour or arrowroot, 
but only in exceptional cases, and when the patient is on the high road to recovery. 
Beef Essence, No. 5. — Take one pound of gravy beef, free from skin and fat, 
chop it up as fine as mincemeat, pound it in a mortar with three table-spoonfuls of 
soft water, and let it soak for two hours. Then put in a covered earthen jar with a 
little salt, cementing the edges of the cover with pudding paste, and tying a piece 
of cloth over the top. Place the jar in a pot half full of boiling water, and keep 
the pot on the fire four or five hours. Strain off through a coarse sieve (so as to 
allow the smaller particles of meat to pass) the essence, which will then amount to 
about a quarter of a pint. Give two or more table-spoonfuls occasionally. 

These preparations are well borne, because they make but slight demand on the 
functional activity of the stomach. We usually commence with Formula I. 

"With the exception of the essence of beef or milk, and perhaps a little soup con- 
taining the white of eggs, or barley water, nothing else should be taken, at least, in 
the beginning of the treatment. Vegetables, fruits, brown bread, and oatmeal 
gruel are especially injurious in ulcer of the stomach ; we draw especial attention to 
this fact, because they are often supposed to be perfectly innocuous. 

It may be desirable in cases in which the symptoms are severe to give the 
stomach an entire absolute rest, and to feed the patient solely by injections. The 
best injection to use for this purpose is what is known as the meat-pancreas injec- 
tion. It is made as follows : — Take about five ounces of finely-scraped meat, chop 
it still finer, add to it five and a half ounces of finely-choppecl sweetbread free from 
fat, then add about three ounces of lukewarm water, and stir to the consistence of 



558 THE TREATMENT OF DISEASES. 

a thick pulp. This is given as an enema, care having been taken to wash out the 
bowel with water about an hour before. In explanation of the name it should be 
stated that the sweetbread is known technically as the pancreas. By the use of 
this injection a person can be nourished for a long time without experiencing any 
sensation of hunger. This somewhat disagreeable mode of treatment has for- 
tunately to be resorted to only in severe cases, although the results are highly 
satisfactory. 

Besides resting the stomach it is very desirable to prevent by every means in 
our power the long-continued collection of acids in the stomach. This object is 
usually effected by the administration of Carlsbad salt, which consists chiefly of 
common salt, carbonate of soda, and sulphate of soda or Glauber's salts. Common 
salt promotes digestion, carbonate of soda diminishes the excess of acidity of the 
contents of the stomach, and sulphate of soda aids in their expulsion from the 
stomach into the intestines. The natural or artificial Carlsbad salt is obtainable 
from any chemist, and in these cases is best used every morning as follows : — One 
table-spoonful of the salt is dissolved in a pint of lukewarm water, and of this 
the patient drinks, fasting, about a fourth part, and repeats this quantity every ten 
minutes, so as to be about three-quarters of an hour in taking the whole amount. 
Then he is to wait half an hour longer before he takes his breakfast, which is usually 
followed by one or two watery discharges. If he have more than two, or none at all, 
the quantity of salts taken the next day must be regulated accordingly, but the 
amount of water in which the salt is dissolved is to remain the same — one pint. 

For how long should this restricted diet be resorted to ? One cannot lay down 
any absolute rule as regards time, and one has to be guided entirely by the condition 
of the patient. After a few days the pain and vomiting usually cease, and the 
healing of the ulcer advances so rapidly that after two or three weeks the patient 
may gradually return to a more solid diet. At first the greatest care should be taken 
that the convalescent's stomach is not taxed with the digestion of any food which is 
not easily assimilable. The following mode of treatment is largely adopted in 
Germany, and is in strict conformity with the rules already laid down. The patient 
is confined to bed during the whole course of treatment, and active movements of 
the body are avoided as much as possible. Hot poultices are applied to the abdomen, 
or if there is any tendency to haemorrhage, a bag of ice. During the first few days 
the Carlsbad salts (a table-spoonful in a pint of lukewarm water) are given every 
morning. The diet consists entirely of milk and extract of beef, with the exception 
of a few pieces of rusk, which must not be swallowed until they have become 
thoroughly softened and masticated. All the food should have a lukewarm 
temperature unless there are signs of bleeding, when everything must be cold. 
After from two to three weeks the patient is placed on a light diet, consisting of 
pigeon, chicken, puree of potatoes, soups, wheat bread, &c., and after eight days 
longer anything may be taken which is not absolutely indigestible or injurious. 

Perhaps it may be thought that we ought to say something with regard to medi- 
cinal treatment of this complaint, but if the foregoing directions are carried out in 
their integrity no medicine will be required. In some cases benefit is derived from 
die administration of arsenic according to Pr. 40. We would advise our readers 



VOMITING. 559 



to study carefully the case of vomiting quoted from William Hunter. (See 
Vomiting.) Directions for treating medicinally many of the most troublesome 
symptoms of gastric ulcer, such as vomiting (see Vomiting) and hsematemesis (see 
Bleeding from the Stomach), have already been given 

When perforation occurs — that most disastrous event in the course of gastric 
ulcer — the measures consist in the administration of large doses of opium (fifteen 
drops of laudanum in a little beef tea as an enema every three hours) or hypodermic 
injections of morphia, so as to keep the patient constantly drowsy, absolute rest, ab- 
stinence from all food, and hot fomentations, or ice-cold compresses to the abdomen. 
Under these distressing circumstances the highest possible medical skill should be 
obtained. Give nothing whatever by the mouth — not even a drop of water — and 
remember that these cases are not absolutely hopeless, and that whilst there is life 
there is hope. Should the patient rally, the strength will have to be supported by 
enemata. The following is a good formula for an injection : — Mix four ounces of 
extra strong beef-tea, one ounce of cream, and half an ounce of brandy or an ounce 
of port wine. 

Even when the ulcer has entirely healed the patient may require treatment for 
various sequelae dependent for their production on the contraction of the scar, or 
other damage the stomach may have sustained They will usually be found to 
assume the form of indigestion, and are best treated by the remedies indicated whilst 
speaking of that complaint. The patient should be kept upon a light, easily 
digestible diet for some time afte? the beginning of the convalescence, the main 
object being to avoid taxing the powers of the stomach more than is absolutely 
necessary. It must not be forgotten that relapses in this disease are not infrequent, 
and caution in the use of food is imperative, even after complete recovery. 

People who are supposed to be liable to the formation of ulcer in the stomach 
would do well to be very careful with regard to what they eat and drink. Pale, 
sickly young women, who are supposed to have a tendency this way, must avoid 
taking acids and irritating food, especially when the stomach is empty. They 
should always restrain powerful and prolonged acts of vomiting, and must by every 
means in their power endeavour to improve the general condition of the health. 



vomiting. 

Vomiting, as we have already seen, is often one of the most distressing symptoms 
of dyspepsia. It is not unfrequently a concomitant of some of the most serious 
disorders of the stomach, such as ulcer and cancer. It occurs moreover as a 
symptom of many other disorders besides those of the stomach. Thus it not 
uncommonly marks the onset of some of the fevers, such as measles" or scarlet fever, 
and is not unfrequently the first indication of the approaching illness. It is a 
constant and important feature in inflammation of the brain. It is important to be 
able to distinguish vomiting arising from disease of the brain from the sickness 
which accompanies stomach disorder, or we may be in danger of confounding a very 
grave disease with a mere temporary indisposition. To facilitate the diagnosis we 



580 



THE TR ATMENT OF DISEASES. 



have arranged the peculfe-Ities which characterise these two forms of vomiting side 
by side in parallel <• m ns. 

Brain Vomiting. Stomach Vomiting. 

1. There is little or no nausea, and the vomit- 1. The nausea is relieved, at all events tem- 

ing continues in spite of the discharge of porarily, by the discharge. It returns 

the contents of the stomach. directly food is taken. 

2. There is no tenderness over the stomach, 2. There is tenderness over the stomach, and 

and pressure is borne without inconveni- pressure induces an inclination to retch. 

ence. 
8. The tongue is clean, the breath sweet, and 8. The tongue is dirty, the breath offensive, 
the bowels obstinately confined. and there are griping pains in the stomach 

with diarrhoea. 

4. Headache comes on early, and is a promi- 4. Headache comes on after the other symp- 

nent symptom. toms. 

5. The stomach is emptied without effort. 5. The vomiting is preceded by retching. 
«. There is no disgust for food. 6. There is complete disgust for food. 

These statements must, of course, be taken with a certain amount of qualification, 
but, speaking generally, they are correct. We give the rule, but disregard the 
exceptions. 

Vomiting, and especially morning vomiting, is of frequent occurrence in those 
who habitually indulge to excess in alcoholic liquors. In the victims of chronic 
alcoholism, or, to use less refined phraseology, in drunkards, the vomiting usually 
occurs before breakfast, and is often excited by the act of cleaning the teeth. In 
women, a common cause of morning vomiting is pregnancy, or some disorder of the 
womb. In some cases it occurs only in the morning, and is excited by the first 
waking movements ; in others, the vomiting occurs not only in the morning, but 
frequently during the day, returning whenever food is taken. It may be so severe 
that the stomach rejects all nourishment, and the patient is quickly reduced to a 
very critical condition. Sometimes the vomiting is absent in the morning, but 
comes on later in the day, and increases towards evening. Many women are 
troubled with nausea and vomiting during the whole time they are suckling. Cases 
of vomiting are occasionally met with for which no adequate cause can be detected ; 
the food is rejected without pain and without nausea, and sometimes so suddenly 
that the patient has hardly time to escape from the table. 

Next as to the treatment of vomiting. Of late years no remedy has been more 
extensively employed in the treatment of this complaint than ipecacuanha wine. 
It should be given in drop doses in a little water three times a day or every hour, 
according to the urgency of the symptoms. A tea-spoonful of the mixture (Pr. 
50) contains a drop of ipecacuanha wine. It is essential that it should be given 
in the manner here indicated. It often aggravates the mischief if given in 
larger doses, and seldom succeeds if given with other drugs, or in any other vehicle 
than water. Ipecacuanha wine is not to be used indiscriminately in the treatment 
of vomiting ; there are some forms in which it acts like a charm, and there are 
others in which it does little or no good. Fortunately the indications for the 
use of ipecacuanha in vomiting are perfectly well understood, and for the accuracy 



vomiting. 561 



of our knowledge of this subject we are indebted to the untiring industry of one 
of our most distinguished hospital physicians. In the vomiting of pregnancy 
ipecacuanha wine is undoubtedly by far the best remedy. When the sickness 
occurs the first thing in the morning, a dose of the medicine should be given on 
awaking, and before the patient makes even the slightest movement. When 
the vomiting is most severe towards evening, ipecacuanha occasionally fails, and 
then mix vomica (Pr. 44) may be employed with advantage. The mix vomica and 
ipecacuanha are occasionally given in alternate doses. In obstinate cases bella- 
donna sometimes succeeds. Twenty or thirty drops of the tincture should be 
administered in water every three or four hours. In the vomiting occurring during 
suckling, ipecacuanha usually acts like a charm. This mode of treatment naturally 
fails to give relief when the symptoms are due to displacement of the womb, and 
then usually nothing but local measures will prove of avaiL Morning vomiting 
sometimes accompanies general weakness, and is met with in convalescents from 
acute illnesses. This form is readily controlled by ipecacuanha. 

The ipecacuanha proves of equal value in many forms of children's vomiting. 
Thus it will usually remove or lessen the vomiting of whooping-cough, when it is 
due to the violence of the cough. Sometimes in children the vomited matter is 
composed of large hard lumps of curdled milk; ipecacuanha does little good in 
these cases. If diarrhoea is present, one-third of lime-water mixed with the milk 
is the best remedy ; but if the child is constipated, half a tea-spoonful of bicarbonate 
of soda to a pint of milk will do more good. Should both the lime-water and the 
bicarbonate of soda fail to afford relief, it may be necessary to withhold milk for a 
time, and to feed the child exclusively on sopped bread, water gruel, and chicken 
or veal broth. Young children, often only a few weeks old, suffer from a form of 
vomiting, the characteristic feature of which is the suddenness of its occurrence. 
No sooner is the milk swallowed than without any effort on the part of the child 
it is forcibly expelled, being sometimes shot out through both the nose and mouth. 
Diarrhoea may co-exist, but more frequently there is constipation. The child may 
be reduced almost to a skeleton by the continuous vomiting. The best remedy for 
this complaint is one of the sugar and grey powders (Pr. 71) given every two or 
three hours. 

In children brought up by hand, attention to feeding will often do more than 
anything to check vomiting. The great point is to dilute the milk. For a child a 
month old the milk should be mixed with an equal quantity of water. Of this, from 
a pint to a pint and a half should be taken in the twenty-four hours. As the child 
grows older, rather less water should be added. The following food will be found 
useful for children whose digestive powers are weak, or who are suffering from 
persistent vomiting. Soak a scruple of gelatine in a little cold water for a short 
time, and then boil it in half a pint of water till it is dissolved ; this usually takes 
from ten to fifteen minutes. Just before finishing the boiling, add milk, with some 
arrowroot made into paste with cold water, and afterwards some cream. The 
proportion of milk, cream, and arrowroot will depend on the age of the child. For 
an infant less than a month old, three or four ounces of milk, a tea-spoonful of 
arrowroot, and half an ounce of cream, to half a pint of gelatine- water, would be 
36 



562 THE TREATMENT OF DISEASES. 

al*>ut right ; for older children the milk may be increased to a half or two-thirds. 
(Should even this fail, and the vomiting continue, one might try milk diluted with 
three or even four times its quantity of very thin arrowroot-water ; or the child 
might be fed on cream and water only — one part of cream to three or four of water. 

In the distressing morning vomiting of drunkards, arsenic will effect a cure 
with almost unfailing certainty, and will simultaneously improve the state of the 
stomach, and restore both appetite and digestion. The vomit in these cases is 
generally intensely bitter and sour, and of a green colour. It is usually accom- 
panied by great straining and distress, and generally very little or nothing is 
ejected, and then it is called "dry vomiting." The arsenic mixture (Pr. 40) may 
be employed, a tea-spoonful being taken four times a day, and the first dose 
half an hour before rising. Ipecacuanha will sometimes succeed in these cases, 
but arsenic acts far more certainly. 

In that form of vomiting to which we have referred as coming on suddenly and 
without pain or nausea, arsenic employed as above will nearly always succeed; 
ipecacuanha will prove almost equally efficacious. Should there be constipation it 
will be as well to get the bowels thoroughly open by some mild aperient before com- 
mencing treatment. 

The vomiting of cancer and ulcer of the stomach may yield to ipecacuanha, but 
sometimes this fails, and then arsenic may be employed. Sometimes the arsenic 
mixture (Pr. 40) succeeds when almost everything else has been employed in vain. 

Alum in from six to ten grain doses, dissolved in half an ounce of water, somo 
times checks obstinate vomiting occurring in consumptive patients, especially when 
it is brought on by the cough. 

We have by no means exhausted our list of remedies for vomiting. In the 
treatment of this complaint bismuth has long enjoyed a deservedly high reputation. 
It is commonly given in combination with hydrocyanic acid ; three drops of dilute 
hydrocyanic acid may be added to each dose of the bismuth mixture (Pr. 18). We 
have already insisted on the necessity of giving bismuth before meals and not after. 
Chloroform may be used for the same purpose, two or three drops being given in a 
wine-glassful of water. Creasote will sometimes succeed when other remedies have 
failed. The dose is three drops, which any chemifet will make into a pill for you 
It should be given either three times a day or every four hours, about half an hour 
before meals. Often enough ten drops of laudanum in a little water, or a hypo- 
dermic injection of morphia, will succeed better than anything. Sometimes an 
effervescing mixture will speedily allay the irritability of the stomach. In many 
oases simple soda-water, with or without brandy, answers admirably. A bag of ice 
or a blister applied to the pit of the stomach often succeeds, and small pieces of ice 
slowly swallowed are useful The spinal ice-bag does good in sea-sickness (see Sea- 
sickness), and might be used in other forms of vomiting, as, for example, the 
vomiting of pregnancy. Dry champagne is often retained when everything else is 
rejected. 

But after all the regulation of the diet, both as regards quantity and quality, is 
the great thing to be aimed at. In illustration of this fact we cannot do better 
than quote a most striking and instructive case recorded by the celebrated Dr. 



YOMITING. 063 



William Hunter. " Many years ago," lie says, " a gentleman came to me from the 
eastern part of the city with his son, about eight or nine years old, to ask my advice 
for him. The complaint was great pain in the stomach, frequent and violent 
vomiting, great weakness, and wasting of flesh. I think I hardly ever saw a 
human creature more emaciated or with a look more expressive of being near the 
end of all the miseries of life. The disorder was of some months' standing, and 
from the beginning to that time had been daily growing more desperate. He was 
at school when first taken ill, and concealed his disorder for some time ; but grow- 
ing much worse he was compelled to complain, and was brought home to be more 
carefully attended. From his sickly look, his total loss of appetite, besides what he 
said of the pain which he suffered, but especially from his vomiting up almost every- 
thing which he swallowed, it was evident that his disorder was very serious. 

" Three of the most eminent physicians of the time attended him in succession, 
and tried a variety of medicines without the least good. They had all, as 
the father told me, after sufficient trial, given the patient up, having nothing 
further to propose. The last prescription was a pill of solid opium, for in 
the fluid state, though at first the opiate had stayed some time upon his stomach, 
end brought a temporary relief, it failed at length, and, like food, drink, 
and every medicine which had been given, was presently brought up again by 
vomiting. The opiate pill was therefore given in hopes that it would elude 
the expulsive efforts of the stomach. It did so for a time, but after a little 
use, that likewise brought on vomiting. Then it was that his physician was 
consulted for the last time, who said that he had nothing further to propose. 

"Though at first the boy professed that he could assign no cause for his 
complaint, being strictly interrogated by his father if he had ever swallowed 
anything that could hurt his stomach, or received any injury by a blow or 
otherwise, he confessed that the usher in the school had grasped him by the 
waistcoat at the pit of the stomach, in a peevish fit, and shaken him rudely, 
for not having come up to the usher's expectation in a school exercise; that, 
though it was not very painful at the time, the disorder came on soon after. 
This account disposed the father to suspect that the rude grasp and shake 
had hurt the stomach. With that idea he brought him to me, as an anatomist, 
that an accurate examination might, if possible, discover the cause or nature 
of the disorder. 

" He was stripped before the fire, and examined with attention in various 
situations and postures, but no fulness, hardness, or tumour whatever could 
be discovered ; on the contrary, he appeared everywhere like a skeleton covered 
with a mere skin, and the abdomen was as flat, or rather as much drawn inwards, 
as if it had not contained half the usual quantity of bowels. 

" Having received all the information I could expect, and reflected some little 
time upon the case, I wished to speak with the father in another room, and, to 
give my patient some employment as well as refreshment, asked him to take a little 
milk in the meantime. But his father begged that taking anything into his 
stomach might be put off till he got home, because he was certain that it would 
make him sick. * Just before we set out,' said he, * I gave him a little milk, but 



564 THE TREATMENT OF DISEASES. 

he was sick and brought it all up in the coach, before we had got many paces 
from the house/ 

" In the adjacent room I said to the father, * This case, sir, appears to me so 
desperate that I could not tell you my thoughts before your son. I think it 
most probable, no doubt, that he will sink under it ; I believe that no human 
sagacity or experience could pretend to ascertain the cause of his complaint, 
and without supposing a particular or specific cause, there is hardly anything 
to be aimed at in the way of a cure. Yet, dreadful as this language must be 
to your ear, I think you are not to be without hope. As we do not know 
the cause, it may happen to be of a temporary nature, and may of itself take 
a favourable turn; we see such wonderful changes every day in cases that 
appear the most desperate, and especially in young people. In them the resources 
of nature are astonishing.' 

" Then he asked me if I could communicate any rules or directions for giving 
him a better chance of getting that cure from nature which he saw he must 
despair of from art. 

"I told him that there were two things which I would recommend. The 
first was not so important, indeed, yet I thought it might be useful, and certainly 
could do no harm. It was to have his son well rubbed for half an hour 
together with warm oil and a warm hand, before a fire, over and all round 
his stomach, every morning and evening. The oil, perhaps, would do little 
more than make the friction harmless, as well as easy, and the friction would 
both soothe pain, and be a healthful exercise to a weak body. 

" The second thing I had to propose I imagined to be of the utmost consequence. 
It was something which I had particularly attended to in the disorders of the 
stomach, especially vomitings. It was carefully to avoid offending a very weak 
stomach, either with the quantity or quality, of what is taken down, and yet to get 
enough retained for supporting life. * I need not tell you, sir,' said I, ' that your son 
cannot live long without taking some nourishment ; he must be supported to allow 
of any chance in his favour. You think that for some time he has kept nothing of 
what he swallowed, but a small part must have remained, else he could not have 
lived till now. Do you not think, then, that it would have been better for him if 
he had only taken the very small quantity which remained with him, and was con- 
verted to nourishment ? It would have answered the end of supporting life as well, 
and perhaps have saved him such constant distress of being sick, and of vomiting. 
The nourishment which he takes should not only be in very small quantity at a time, 
but in quality the most inoffensive to a weak stomach that can be found. Milk is 
that kind of nourishment ; it is what Providence has contrived for supporting 
animals in the most tender stage of life. Take your son home, and as soon as he 
has rested a little, give him one spoonful of milk ; if he keeps it some time without 
sickness or vomiting, repeat the meal, and so on. If he vomits it, after a little rest 
try him with a small quantity, viz., with a dessert or even a tea-spoonful. If he 
can but bear the smallest quantity you will be sure of being able to give him 
nourishment. Let it be the sole business of one person to feed him. If you succeed 
in the beginning, persevere with great caution, and proceed very gradually to ft 



WARTS. 565 



greater quantity, and to other fluid food, especially to what his own fancy may in- 
vite him, such as smooth gruel or panada, milk boiled with a little flour of wheat or 
rice, thin chocolate and milk, any broth without fat or with a little jelly or rice or 
barley in it, <fcc. &c.' We then went in to our patient again, and that he might be 
encouraged with hope and act his part with resolution, I repeated the directions 
with an air of being confident of success. The plan was simple, and perfectly 
understood. They left me. I heard nothing of the case till, I believe, between 
two and three months after. His father came to me with a most joyful countenance, 
and with kind expressions of gratitude told me that the plan had been pursued with 
scrupulous exactness, and with astonishing success ; that his son had never vomited 
since I had seen him ; that he was daily gaining flesh, and strength, and colour, and 
spirits, and now grew very importunate to have more substantial food. I recom- 
mended a change to be made by degrees. He recovered completely, and many yean 
ago he was a healthy and very strong young man." 



WARTS. 

Warts are closely allied to corns. They occur most frequently on the hands or 

fingers of young people. They may be met with either singly or in large numbers. 
They are occasionally hereditary, and in these cases they not uncommonly correspond 
in number and position with those existing in one of the parents. In the majority 
of cases, however, warts exhibit a considerable degree of capriciousness in their 
appearance, period of duration, and disappearance. From their frequent occurrence 
on the hands of those often engaged in the examination of dead bodies, it would 
seem probable that the poison of decomposing animal matter is, under certain 
circumstances, capable of favouring their growth. 

It is a common belief that the blood from a wart is capable of producing other 
warts on people with whose skin it may happen to come in contact ; but the evidence 
on this point is, to say the least, inconclusive. It is even doubtful whether the 
ordinary warts which occur on the hands can be inoculated. 

The arsenic treatment, to which we referred when speaking of corns, is well 
adapted for warts. The top of the wart should either be sliced off with a sharp 
knife, cut off with a pair of scissors, or destroyed with a drop of some caustic, such 
as nitric acid. It is then to be painted with the arsenic solution two or three times 
a day. In a short time it undergoes a change, and appears to break up into a 
number of pieces. It may then be removed or turned out without the slightest 
pain or difficulty. 

There are several other means of getting rid of warts. Their vitality is low, 
and they are usually readily destroyed by the application of a caustic or astringent. 
The strong acetic acid known as the " glacial " acetic acid is often used for this pur- 
pose. It should be applied with a glass rod until the wart is pretty well sodden 
with the acid. It may have to be applied more than once, and care should be 
taken to prevent it from coming in contact with the surrounding skin, or it may 
cause a blister. Small warts occurring in numbers may usually be got rid of cer- 
tainly and painlessly by keeping them constantly moist with a lotion made by adding 



566 THE TREATMENT OP DISEASES. 



two drachms of dilute nitric acid to a pint of water. Lunar caustic is sometimes 
used for warts, but its action is, as a rule, too superficial to be of much service. 

When warts or warty growths occur on the nose, lips, or any part besides the 
hands, chromic acid may be used. The solution is made by dissolving a hundred 
grains of crystallised chromic acid in an ounce of water. The solution is best 
applied by the aid of a pointed glass rod, or when a large quantity is required by 
means of a small glass tube drawn to a point. Only so much should be applied as 
will saturate the diseased growth, and it should not be brought in contact with the 
surrounding tissues. Any superfluous acid is to be removed by a piece of blotting- 
paper or wet lint. The application usually produces only a little temporary 
smarting, unless indeed, the part is ulcerated, when the pain is more severe and of 
longer duration. After the application of the chromic acid, it is a good plan to dress 
the part with lint dipped in lead lotion, as it relieves the soreness and restrains the 
inflammation. Under the influence of this treatment the growth usually rapidly 
wastes, in some cases being thrown off altogether, and in others undergoing a 
partial though distinct diminution in size. In the majority of cases one application 
suffices, the cure being complete in from four to eight days. When, however, the 
warts are very large, repeated applications may be necessary. 

The application of a few drops of tincture of steel daily for several days will 
often cure a wart. It is best adapted to those forms which are moist and secreting. 

Thuja occidentals, a product of the evergreen known as arbor vitce, is a good 
remedy for warts. Each wart should be painted three or four times a day with the 
tincture of thuja, small doses being also given internally. 

When warts are provided with a little stalk or peduncle, as they are sometimes, 
they may be removed by the application of an elastic ligature. A small elastic 
ring, or a thin india-rubber thread such as may be drawn out of an old brace, may 
be applied to the base of the growth so as to constrict it pretty tightly, though not 
painfully. The continuous constriction will, in a few days, cause the wart to dry 
up and fall off. 

WASTING PALSY — PROGRESSIVE MUSCULAR ATROPHY. 

This curious disorder has only been recognised as a distinct affection since the 
year 1853. It is essentially characterised by a wasting of the muscles, there being no 
diminution of intelligence or of the sensibility of any part of the body. It occurs 
most frequently in young adults, and in middle-aged individuals, but even children 
are sometimes attacked. Men are more liable to it than women, and this probably 
depends on the greater and more sustained muscular exertion which men's 
occupations demand, and on their more frequent exposure to cold and wet. The 
influence of consanguinity in the production of this complaint is often well marked. 
In many instances the subjects of wasting palsy have been persons of good physical 
development, and not unfrequently they have been remarkable for their strength 
and activity. In the majority of cases the immediate cause of the disease is either 
excessive muscular exertion or exposure to cold. Many patients have attributed 
the onset of their symptoms to wearing damp apparel, to the immersion of the 



WASTING PALSY — PROGRESSIVE MUSCULAR ATROPHY. 567 

limbs in cold water, to standing or sitting in a draught when hot, or to exposure to 
inclement weather. Particular sets of muscles which are of necessity in long 
continued action in persons following certain mechanical trades, as, for example, 
masons, milliners, shoemakers, and smiths, are those which are most frequently 
involved, and in these cases the wasting may be permanently limited to these parts. 
It has occassionally happened that the disease has followed a severe blow on the 
back, or some injury to the spine. Thus in the case of a boy of fifteen wasting of 
the muscles of the trunk and upper limbs followed a playful blow with the fist of 
one of his companions between the shoulders. In another instance the first 
symptoms of wasting of the muscles of the ball of the thumb occurred six months 
after the fall of a bale of cotton cloth on the nape of the neck. A curious case is 
recorded of a gentleman aged fifty-four, who suffered what he considered a slight 
injury. In jumping across a flower-bed for a wager, he came down heavily on 
his heels, and then fell backwards on his head. He was stunned for a time, 
but gradually recovered, and after some days' confinement to his bed appeared to be 
quite well again. It was, however, soon perceived that a great change had taken 
place in his habits. Having been extremely fond of manly sports and exercises — 
rowing, cricketing, riding, and the like — he discontinued to take part in any of 
these, although he continued to go every autumn to the Scotch moors for the 
purpose of shooting grouse. Five years after the accident, whilst engaged in the 
last-named sport, he perceived that his right leg had lost a part of its usual strength, 
and from that time the ordinary symptoms of wasting palsy developed themselves. 

The symptoms generally come on very gradually. The tailor finds that he 
cannot hold his needle, the shoemaker cannot thrust his awl, the mason fails to 
wield his hammer, the gentleman experiences a difficulty in writing, in taking out 
his pocket-handkerchief, or putting on his hat. Some such incident directs attention 
to the affected limb, which is then discovered to be wasted and shrunken. In most 
cases the change begins in the upper limbs, most frequently of all in the hand, in 
the ball of the thumb especially, and in the ball of the right much oftener than in 
that of the left thumb. Next to those of the hand, the muscles of the shoulders are 
apt to be the earliest affected ; sometimes those of the neck and face ; less often some 
of the muscles of the lower limbs are the first to suffer. There seems to be a kind 
of caprice as regards the starting-point, but the muscles of which we have just been 
speaking are those which are ordinarily most employed by working men — a fact 
in favour of the theory that the disorder is sometimes the result of over-work. As 
the disease progresses the natural rounded contour of the limbs is replaced by an 
unsightly flattening, the bones stand out with unnatural prominence, giving the 
member the appearance of a skeleton clothed in skin. This may be carried to such 
an extent that the hand looks more like a claw than anything else. When the 
shoulder is affected the whole limb dangles powerlessly at the side. Sometimes, as 
we have seen, the disease extends to other parts of the body, and when the face is 
involved it is veiled, as it were, by an impenetrable mask, no emotion changes its 
unvarying aspect, and the expression is always solemn, stolid, and immovable. 
Sometimes the muscles of the mouth and cheeks waste away, and then the saliva 
ribbles out over the lips. The complaint sometimes induces a change in the voice, 



568 THE TREATMENT OP DISEASES. 

which loses its register, and is finally reduced to a monotone. In extreme cases 
absolute immobility of the limbs or affected parts may result, but more commonly 
the various movements are still capable of being performed, though with greatly 
diminished force. Occasionally during the progress of the disease the wasted 
muscles exhibit curious flickering or tremulous movements, which can be seen going 
on under the skin. They are not sufficiently powerful to move the limb, and they 
commonly pass unnoticed by the patient himself. They afford a pre of that the 
muscle is not yet dead. In some cases the progress of the disease is accompanied 
by a good deal of pain of a neuralgic character. In a few instances agonising pain 
has been a marked feature of the case. The general health remains unaffected, the 
intelligence is unimpaired, and the ordinary functions are usually performed with 
their accustomed regularity. 

"With the view of conveying a clearer idea of this terrible, though interesting 
malady, we give an abstract of one of the earliest recorded cases. The patient was 
a mountebank, aged thirty-two. From his own account it appears that one cold 
September night he slept on the muddy pavement of the streets, and in the 
morning on awaking found his right side quite benumbed. The warmth of a 
tavern fire soon restored both sensation and motion, but three weeks afterwards he 
noticed a weakness of the right hand, and from that time was no longer able to 
play the cornet-a-piston. For a year the weakness was confined to the muscles of the 
hand ; he then passed another night in the cold and wet, and from that time felt a 
great weakness in his legs. This gradually progressed, and about a year later he 
was so weak that he had to come to the hospital. At the time of admission he 
could dress himself and walk, though with trouble, and could feed himself, and talk 
without difficulty. Speaking of his own condition, he said, " I am not ill, but ray 
strength is gone, and my weakness increases daily. There is a feeling of great 
lassitude in my limbs, which torments me every hour, but especially on awaking 
from sleep." Still another year later and the unfortunate patient could not 
walk at all, neither had he the power to change his position without help. His food 
was given him^and he had to be put to bed just like a little child. His appetite 
was voracious, but he had the greatest difficulty in swallowing, and twice he was 
nearly choked by pieces of vegetable sticking in the throat. The only way to feed 
him was to place a spoon containing food right at the back of the throat ; consider- 
able efforts at swallowing on the spoon and its contents ^ ere then made, and the 
former beinsr withdrawn, the food was in time swallowed. The saliva could not be 
got rid of, and constantly ran from the mouth. In t^ing to swallow liquids, 
the greater part was always returned. The power of Articulation being lost, 
the wants were made known by nods, by the eyes, and by guttural, nasal sounds. 
The respiration was very incomplete, so that it seemed certain that the unhappy 
man, whose intelligence was unimpaired, was menaced every moment with suffoca- 
tion Finally he was seized with the then prevailing influenza, and being unable 
to expectorate the phlegm, was one morning found quite dead. This, it must be 
remembered, was an unusually severe case. 

The course of this disease is essentially chronic, and its duration uncertain. It 
often happens that after destroying a group of muscles, its course 1? vennan entry 



worms. 569 



arrested. Even when progressive, its advance is seldom continuous, but is marked 
by repeated pauses and recommencements, and the pauses may last for months or 
years at a time. Cases which can be traced to the effects of over-exercise usually 
do well. 

"Wasting palsy is not likely to be mistaken for any other complaint. Almost the 
only thing with which it could be confounded is the palsy resulting from lead- 
poisoning. In lead palsy, however, there is a comparatively sudden invasion ; in a 
few days, or at the outside weeks, the disease is at its height, whereas in wasting 
palsy the loss of power is very slow. Morover, in lead palsy some of the other 
■ymptoms of poisoning by that metal would be sure to be present. 

Wasting palsy requires the attendance of a doctor, if not constantly at all event* 
occasionally. The usual treatment consists of galvanism, aided by gentle frictioiL 
warm baths, and methodical exercise. Iron and quinine are often given with a view 
of improving the general condition of the health, although it is but rarely affected. 
We should recommend a course of phosphorus as being very likely to do good. Two 
drops of either the phosphorated oil or the saturated solution of phosphorus in 
ethsr (Pr. 53) should be given every four hours. The improvement would of necessity 
be slow, and the medicine might have to be taken for some weeks, or even months, 
before any marked change was observed. The treatment of these chronic cases neces- 
sitates a great deal of patience. Should this fail, pilules containing each one thirty- 
second of a grain of extract of physostigma might be tried. One should be taken five 
or six times a day for some months. 



WORMS. 

It is necessary that we should say a few words on this somewhat repulsive sub- 
ject, for worms, not content with feeding on our bodies when we are dead, sometimes 
take up their abode in our interiors during life. In fact, man, like other animals, is 
infested with numerous parasites. In the classified list issued by the Royal College 
of Physicians, over fifty varieties are enumerated. Some are animals, and others — 
for example, the fungus which is the cause of ring- worm — are plants. They crawl 
over us, burrow beneath our skin, nestle in our entrails, and propagate their kind 
in every corner of our frame. In fact, there is scarcely a tissue or organ that may 
not be profaned by their inroads. We have no intention of entering into the 
subject of parasitic disease generally, but will confine our remarks to the subject of 
worms. 

The round-worm is the commonest form from which man suffers. It is very like an 
earth-worm, for which in former times it was generally mistaken. It is usually some 
five or six inches long, and is lighter in colour and more pointed at the extremities 
than the earth-worm. Sometimes young ones are met with measuring not more 
than an inch or an inch and a half. These worms occur most frequently in young 
people. They live in the bowels, but sometimes make their way into the stomach, 
and are then usually quickly got rid of by vomiting. As a rule, there are only one 
or two, but occasionally large numbers are met with. A girl only eight years old 



570 THE TREATMENT OP DISEASES. 




voided upwards of 200 in the course of a week, and the case is recorded of a 
soldier who passed 367 in six days. In another instance the patient got rid of 460 
in a fortnight This, however, is quite exceptional. The round- worm is met with 

all the world over, but is more common in some 
countries than in others. In the Southern 
States of North America it attacks almost every- 
one, young or old, and especially the negroes. In 
the West India Islands, Brazil, Finland, Green- 
land, in parts of Holland, Germany, and France, 
it is also very common The rural population 

Fig. 10.— BOUND-WORM. • . ., , . .,, . , , ,-, 

(a) a mouth enlarged. suffer more than the dwellers in towns, and the 

inhabitants of low and damp localities more than 
those who enjoy higher and drier abodes. The symptoms to which these worms 
give rise are, as a rule, not very decided ; often enough there are no discoverable 
symptoms. When large numbers occur in a person of delicate constitution they may 
cause thirst, disturbed sleep, with grinding of the teeth, moroseness, with low spirits, 
pallid countenance, fetid breath, swelling of the belly, shrunken limbs, depressed 
appetite, slimy stools, itching of the nose, straining, and irritation of the back 
passage. It must be understood that the occurrence of such marked symptoms is 
exceptional. 

The indications for treatment are to relieve the irritation of the bowels when 
present, to improve the general nutrition where that has suffered, but above all to 
expel the worms. The best remedy for getting rid of the worm is santonine, the 
active principle of wormseed. From two to four grains of the santonine, according 
to age, are to be mixed with a tea-spoonful or more of castor oil, and taken early in 
the morning before breakfast, repeating the dose two or three mornings successively. 
Every stool should be examined for worms. As soon as the intruders are got rid 
of, attention should be directed to the improvement of the general health. Iron 
(1 l-3. 3 and 4), quinine (Pr. 9), and cod-liver oil are likely to prove of advantage. 
Parrish's Chemical Food is useful. Plenty of out-door exercise, with, if possible, 
change of air, is likely to do good. 

We cannot speak very confidently of the prevention of round-worm, because we 
are not certain how it enters our bodies. Probably, however, the careful cooking of 
all our food would prove a good safeguard, even in those countries and districts 
where the pest most abounds. 

Tape-worm occurs most frequently where much pigs' flesh is consumed, and indi- 
viduals who do not eat this meat are peculiarly exempt from the complaint. It is 
frequently observed among those who in their occupations are in the habit of putting 
knives used for cutting raw meat into their mouths ; also among those who indulge 
in raw or very under-done meat. There can be no doubt that in this country tape- 
worm is often communicated by eating raw or imperfectly cooked beef. We need 
not enter into any detailed description of the tape-worm, for it is not likely to be 
mistaken for any other kind. It may vary in length from a yard to twenty feet. 
The head is at the part that tapers to a point Usually small pieces or joints an 
inch or so in length are passed in the motions. 



WORMS. 



571 



There can be no question that a large proportion of persons infested with tape- 
worm are unconscious of any departure from the state of perfect health, but there 
is as little doubt that in some instances func- 
tional derangements occur which are referable to 
the irritation it produces. Such are various 
uncomfortable sensations in the abdomen ; pains 
resembling colic, sometimes felt when the 
stomach is empty, at others after certain articles 
of food; variable appetite, now excessive, now 
failing entirely ; slight diarrhoea or constipation, 
and so on. Sometimes there is a constant 
craving for food, debility, irritability of the 
bladder, giddiness, noises in the ears, attacks of 
faintness, restlessness, wasting, and itching at 
the nose and back passage. This somewhat 
grave list of symptoms really contains nothing 
that is at all characteristic, and the only positive 
proof of the existence of the worm is the pas- 
sage of the joints. 

We will now consider the different remedies 
that may be employed for the expulsion of the 
worm. 

The male shield-fern (Aspidium felix mas) 
is perhaps the oldest and most widely-known 
vermifuge. The patient must eat a very light 
tea, but no supper, and just before bed- 
time should swallow two table-spoonfuls of 
morning after the oil has acted he is to take either Pr. 35 or a tea-spoonful of the 
liquid extract of male shield-fern in a little milk. No food is to be taken until 
the bowels have freely acted, when the worm is usually expelled. The head should 
be carefully looked for. 

The bark of the pomegranate root (Punica granatum) is also an ancient and 
extensively used remedy. Two ounces of the bruised bark, of the fresh root if 
possible, are to be macerated for twenty-four hours in two pints of water, to be then 
boiled down to a half, strained, and divided into three doses, one of which is to be 
taken at half-hourly intervals. The medicine is to be taken on an empty stomach, and 
must be repeated daily for four or five days. It is very desirable that the root from 
which the bark is obtained should be fresh. 

Kousso — the flowers and tops of a plant known as Brayera anthelmintica — is a 
quick and good vermifuge, an especial favourite in Abyssinia, where tape- worm is very 
prevalent. The dose is half an ounce suspended in water, and it must be taken 
fasting. An objection to its use is that it is somewhat costly, but it might be tried 
in obstinate cases when other measures have failed. 

It must be admitted that in some cases tape-worm proves extremely obstinate, 
but still persistence in treatment nearly always succeeds in getting rid of it at last 




Fig. 11.— JOINTS OF TAPE-WORM. 

A. Head (a), and a number of joints of body. 

B. Microscopical structure of portions of thre* 
joints. 



castor oil. On the following 




572 THE TREATMENT OF DISEASES. 

It is sometimes a good plan to give ten-drop doses of the liquid extract of male shield- 
fern three or four times a day for a week or more. 

The best way of avoiding tape-worm is to make sure that your meat is always 
well done. Pork infested with " measles " should never be sold for food. Cooks and 
butchers should learn not to put their knives in their mouths, for it is a dangerous 
practice in more ways than one. Every one suffering from tape-worm — and for the 
matter of that any kind of worm — should disinfect every motion as soon as it is 
passed by pouring over it strong carbolic acid. This should be done not only for his 
own sake, but for the safety of others. 

Thread-worms are of very common occurrence in children. They are little 
things looking just like a thread. They not unfrequently occur in immense numbers. 
They reside in quite the lower part of the bowel, from which circumstance they are 

often known as seat-worms. When only a few 
are present, they give rise to no inconvenience, 
and are usually only accidentally discovered in 
the stools. When they are numerous, they often 
cause itching or tickling of the back passage, 
which is sometimes very distressing, especially 
towards night. 

A capital mode of treatment is to inject into 

Fig. 12. — THREAD-WORMS. ,1 i i . , » i , , . • • 

(a) a mouth eniar ed. back passage a pint ot cold water containing 

a table-spoonful of tincture of steel. This may 
be repeated once or twice a day until the worms have disappeared. An injection 
$f infusion of quassia, or of salt and water, answers equally well. It is very desirable 
to pay attention to the general heaUh, and steel wine, Parrish's Chemical Food, or 
cod-liver oil may be advantageously administered. 

The patient should avoid touching the neighbourhood of the back passage, and 
should be scrupulously clean in person and clothing. The common Hindoo custom 
of washing after every act of defecation should be adopted. People suffering from 
worms should sleep alone. The food Lhould be well cooked, and the hands should 
be thoroughly washed before and aftei every meal 



The term writers' cramp is not a hi ppy one, for the affection is by no means 
confined to those who wield the pen. It — or a practically identical disorder — may 
be found in the artist, and may prevent him from painting in oils; or it may 
occur in the violinist or the pianist, and hinder the musical performances of either ; 
it may be met with in the seamstress, or the smith, or the milkmaid, and may limit 
or destroy their powers of work. In fact, analogous conditions occur in almost all 
avocations. Of late years it has been met with in those female stage-dancers who 
are accustomed to balance themselves on the tips of their toes. 

It is usually a chronic and slowly-developed disease. A difficulty is experienced 
in executing a particular movement, such as that of writing, or playing on a musical 



writers' cramp. 573 



instrument, other movements of the same limb being perfectly easy of performance. 
The patient experiences at first a sense of stiffness or weariness after unusually pro- 
longed exertion. The author or copyist finds that his pen no longer readily obeys 
the mandates of the will, it will not move as it ought to, and the writing is altered 
in character and looks unnatural. The pianist makes blunders in striking the 
chords, the fingers falling on the keys they were intended to avoid. The move- 
ments, which from years of constant practice had become almost involuntary — a kind 
of second nature — are now performed with effort and difficulty. The violinist can 
no longer control the movements of his left hand, and his fingers feel cramped and 
stiff. The poor needlewoman can no longer ply her needle, she pricks her fingers 
in her now bungling efforts, and the stitches are irregular and the work badly done. 
The premiere danseuse is seized with severe pain or cramp in the calves of her legs, 
and is temporarily obliged to desist from her efibrts. 

The disturbances of movement which render writing or similar acts difficult or 
impracticable are highly characteristic. Such disturbances are in the first instance 
slight, and are only perceived when the effort has been long continued, being then 
felt as a sensation of extreme weariness. By degrees the symptoms become more 
and more marked, and make their appearance very soon after the commence- 
ment of the exertion, and ultimately directly the pen is taken in the hand, or even 
when the hand is merely placed in the required position At first the difficulty 
may be overcome by a vigorous effort, but soon no amount of determination will 
enable the sufferer to perform the desired act. Other things are done without 
trouble, but that combination of movements, the performance of which is necessary 
for the patient to obtain a livelihood, resists every effort. In a fully developed case 
of writers' cramp*, the patient may be unable to write a dozen lines to save his life, 
and yet he may be able to paint, or play the pianoforte, or carve without the 
slightest difficulty. So long as he refrains from attempting to perform the special 
act, whatever it may be, he differs in no respect from a healthy man ; immediately 
he attempts to follow his pursuit he is reduced to a condition of perfect helplessness. 
The moment he abandons his effort and desists from the attempt he is all right 
again, and feels nothing abnormal. After a time, prolonged effort to perform the 
desired act brings on distinct cramp, or a jerking or shaking of the part. The 
cramp movements, which are at first limited to the thumb and fingers, are some- 
times temporarily avoided by the writer, who adopts some mechanical device which 
leaves them at rest. The positions assumed by the patient in order to facilitate his 
writing, and the means he employs to prevent the occurrence of the spasm, are 
often very curious. One man will rest only the wrist on the paper, raising the 
elbow in the air ; another supports the arm on the elbow, and writes with the wrist 
raised and free ; a third steadies the right hand with the left ; whilst a fourth takes 
the pen between the index and middle finger, or sticks it into a cork which he 
seizes with his whole hand. As a rule, no sooner has the patient trained himself 
to write in some such awkward manner, than the muscles of the forearm become 
subject to spasm, and he is no better off than before. Sometimes the sufferer 
succeeds with infinite trouble in learning to write with his left hand, but no sooner 
have his efforts been crowned with success than that hand too becomes affected. 



574 THE TREATMENT OF DISEASES. 

All his labour is thus thrown away, and his condition is, if anything, worse than 
before. 

It is instructive to notice the changes that occur in the handwriting consequent 
on the disease, and a comparison may.be instituted with letters formerly written in 
health ; it is often quite altered in character, because the patient has adopted a new 
method of using the pen when writing is possible. The strokes are coarse, im- 
perfect, and unequal, and numerous irregularities and false strokes are to be 
observed ; in the highest degree of the affection, after a few scarcely legible words, 
the writing becomes a mass of irregular strokes and curves, whilst in other instances 
the letters are mere trembling, undulating, or zigzag strokes. 

In some instances the attempt to perform the special act produces spasm, not 
only in the muscles brought into action, but also in other parts. For instance, the 
attempt to write may bring on spasm, not only in the affected hand, but also in 
the face or neck. As a rule, the general health in no way suffers, and the phy- 
sical strength may be equal to or even beyond the average. A man may be the 
victim of writers' cramp, and yet be apparently a perfect model of health 

The affection we have been considering seldom occurs before the age of thirty. 
As a rule, men suffer more frequently than women, but pianoforte-players' 
cramp is more often met with in females. It is said, too, that the male 
dancer never suffers from dancers' cramp. The principal cause of the disease is 
usually supposed to be excessive writing, or playing, or what not ; but it must be 
remembered that it is of not unfrequent occurrence in those who have never 
over-exerted themselves in any way. It is most frequently observed in writers, 
secretaries, clerks, merchants, and savants ; but it occurs also in those who write 
but little, and who think they have done wonders if they have signed a score of 
business letters. The spasm is said occasionally to arise from exposure to cold, 
but this is very doubtful. It is obvious that inconvenient tables, a bad position 
in writing, tight sleeves, and especially hard and pointed pens must favour the 
development of the disease, since they all increase the demands made upon the 
muscles and nerves employed in writing. It is certain, however, that steel pens 
are not exclusively to blame for producing this form of spasm, since it was known 
before they were invented, and occurs in those who use only quill pens. 

In cases where the symptoms have existed for only a short time, relief may be 
confidently expected, provided that rest can be taken. If the symptoms have existed 
for many months, or if rest be impossible, our opinion will be more or less unfavour- 
able. Many who were seriously threatened with writers' cramp are now free 
from the malady, because they rested ; many who could not or did not rest have 
progressed from bad to worse. 

The treatment consists primarily in attention to the removal of the cause. The 
discontinuance of all writing, playing, sewing, dancing, or whatever else may have 
led to the occurrence of the disease, or at least the limitation of such occupations 
to the greatest possible extent, is of vital importance. In recent and slight cases 
this alone will often effect a cure in a month or two. In severe cases absolute ces- 
sation from writing must positively be insisted on, and often enough nothing but a 
long rest, say of six months, or even a year, will effect a cure. Something may 



writers' cramp. 575 



perhaps be attempted before resorting to this serious measure in the way of assisting 
the patient by getting him to use good soft pens, and large cork pen-holders that 
may be grasped by the whole hand. We may mention incidentally that thick cork 
holders are a great convenience in writing even in health. 

Electricity undoubtedly does good in some cases, but the exact form in which it 
should be employed — if at all — is a point that can be determined only by a medical 
consultation. Gymnastics, shampooing, tonics, and cold-water bathing may do good, 
In Vienna the following mode of treating dancers' cramp is adopted by the ballet- 
master : he either ties a handkerchief tightly above the ankle, or has the sufferer 
placed on a wooden cylinder, which she rolls backwards and forwards, whilst the 
whole weight of her body is supported on it. In this way the pain is relieved so 
that dancing can be resumed, but its return is not prevented. 

A case is recorded of writers' cramp being cured by extract of physostigma. 
The patient was a clerk, aged thirty, intelligent and well educated. He had been 
ill three months, and was rapidly growing worse. Both hands were affected — the 
right most, though the left was first attacked. After writing a short time the 
fingers would be drawn up and cramped so that he could not use them, and his 
hand would start so that the pen would sometimes fly out of his fingers. - His 
writing, which was formerly very good, had become so altered that his friends 
scarcely recognised it. The fingers of both hands trembled a great deal, just as they 
would in shaking palsy. He complained of severe numb and shooting pain in 
both hands, which he compared to neuralgia; it was most severe in the index-finger, 
and often kept him awake at night. The tip of the index-finger was very tender, 
and the pressure of the pen caused great pain. The hands perspired most profusely. 
He was ordered a thirtieth of a grain of extract of physostigma, to be taken every 
two hours in the form of a pill. He quickly improved. At the end of a fortnight 
his most distressing symptoms were relieved. The tenderness at the tips of the 
fingers was less, and he wrote better, for the effort caused less cramp and starting 
of the hand. In a few weeks the tremulousness, with the cramps and startings of 
his fingers and hands, left him, so that his writing gradually improved till it became 
as good as ever. In a little over two months he was cured. Till he took the phy- 
sostigma he was daily growing worse, and from the time of beginning it he iteadilj 
%ad co**fcinuously improved. 



PRESCRIPTIONS. 

In dispensing, solids are weighed and liquids measured. Any of these prescrip- 
tions copied out and sent to a chemist would be made up without difficulty. Pill* 
or powders, and small bottles if securely packed, can be conveniently sent by post. 
The quantities here given are for adults. In the case of children a proportionately 
smaller dose must be administered, according to age. Although the quantities 
indicated are those usually employed, it may be necessary in special instances or 
in certain diseases to depart from the ordinary custom. These cases are pointed 
out in the text Should any difficulty be experienced in taking the pills they should 
be silvered or varnished. 



1. — Iron Mixture. 
Tincture of perchloride of iron, two drachms. 
Chloric ether, one drachm. 
Glycerine, one drachm. 
Water, to eight ounces. 

Mix. Two table-spoonfuls to be taken three 
times a day. 

2. — Iron and Quassia Mixture. 
Tincture of perchloride of iron, half an ounce. 
Chloric ether, forty minims. 
Infusion of quassia, to eight ounces. 
Mix. Two table-spoonfuls to be taken three 
times a day. 

3.— Citrate of Iron Mixture. 
Citrate of iron and ammonia, two drachms. 
Syrup of orange-peel, half an ounce. 
Water, to eight ounces. 

Mix. Two table-spoonfuls to be taken three 
times a day. 

4. — Iodide of Iron Mixture. 
Syrup of iodide of iron, half an ounce. 
Syrup of phosphate of iron, two ounces. 
Water, to eight ounces. 

Mix. Two table-spoonfuls to be taken three 
times a day. 

6. — Aperient Iron Mixture. 
Sulphate of magnesia, one ounce. 
Sulphate of iron, half a drachm. 
Dilute sulphuric acid, one and a half drachms. 
Peppermint water, to eight ounces. 
Mix. Two table-spoonfuls three times a day. 
87 



%.—8alim Irm Mixture 
Citrate of potash, three drachms. 
Tincture of perchloride of iron, three 
Chloric ether, one drachm. 
Water, to eight ounces. 

Mix. Two table-spoonfuls to be taken three 
times a day. 

7. — Effervescing Iron Mixture* 
Citrate of iron and quinine, a drachm. 
Sulphate of quinine, eight grains. 
Citric acid, eighty grains. 
Water, to eight ounces. 
Mix. Two table- spoonfuls to be taken every 

four hours, with one table-spoonful of the 

following : — 
Bicarbonate of soda, eighty grains. 
Water, four ounces. Mix. 

8. — Iron and Digitalis Mixture. 
Tincture of perchloride of iron, one drachm. 
Tn fusion of digitalis, half an ounce. 
Dilute phosphoric acid, one drachm. 
Water, to eight ounces. 

Mix. Two table-spoonfuls to be taken three 
times a day. 

9. — Tonic Quinine Mixture, 
Sulphate of quinine, sixteen grains. 
Dilute sulphuric acid, half a drachm. 
Water, to eight ounces. 

Mix. Two table-spoonfuls to be taken tans 
times a day before meals. 



678 



PRESCRIPTIONS. 



10. — Strong Quinine Mixture. 
Sulphate of quinine, forty grains. 
Dilute sulphuric acid, half a drachm. 
Water, to eight ounces. 

Mix. Two table-spoonful* or more every four 
hours. 

11. — Quinine and Iron Mixture, 
Sulphate of quinine, eight grains. 
Sulphate of iron, sixteen grains. 
Dilute sulphuric acid, eight minims. 
Water, to eight ounces. 

Dissolve and mix. Two table-spoonfuls three 
times a day. 

12. — Salieine Mixture. 
Salicine, four drachms. 
Hot water, eight ounces. 
Dissolve. When cold, an eighth part to be 
taken every two hours. 

13. — Ammonia and Bark Mixture. 
Carbonate of ammonia, forty grains. 
Liquid extract of bark, one ounce. 
Chloric ether, eighty minims. 
Syrup of orange-peel, one ounce. 
Decoction of bark, to eight ounces. 
Mix. Two table-spoonfuls every four hours. 

14. — Gentian and Soda Mixture. 
Bicarbonate of soda, two drachms. 
Dilute hydrocyanio acid, twenty-four minims. 
Compound infusion of gentian, to eight ounces. 
Mix. Two table-spoonfuls three times a day. 

15. — Gentian and Acid Mixture. 
Dilute hydrochloric acid, two drachms. 
Dilute hydrocyanic acid, twenty -four minims. 
Compound infusion of gentian, to eight ounces. 
Mix. Two table-spoonfuls three times a day. 

16. — Gentian and Senna Mixture. 
Compound infusion of gentian, four ounces. 
Infusion of senna, four ounces. 
Mix. Two table-spoonfuls three times a day. 

17. — Carminative Mixture. 
Powdered rhubarb, forty grains. 
Powdered ginger, forty grains. 
Bicarbonate of soda, eighty grains. 
Aromatic spirits of ammonia, two and a half 

drachms. 
Cinnamon water, to eight ounces. 
Mix. Two table-spoonfuls every four hours, or 

a single dose may be given. 



18. — Bismuth Mixture. 
Carbonate of bismuth, one and a half drachms. 
Carbonate of magnesia, one and a half drachms. 
Mucilage of tragacanth, one and a half ounces. 
Water, to eight ounces. 

Mix. Two table-spoonfuls every four hours, 
a quarter of an hour before meals. 

19. — Paregoric Mixture. 
Compound tincture of camphor, two drachms. 
Ipecacuanha wine, twenty -four minims. 
Tincture of henbane, one and a half drachms. 
Water, to eight ounces. 
Mix. Two table-spoonfuls every four hours. 

20. — Ipecacuanha and Squill Mixture. 
Ipecacuanha wine, two drachms. 
Tincture of squills, one drachm, 
Laudanum, half a drachm. 
Treacle, half an ounce. 
Water, to eight ounces. 
Mix. Two table-spoonfuls every four hour*. 

21. — Carbonate of Ammonia Mixture. 
Carbonate of ammonia, forty grains. 
Chloric ether, two and a half drachms. 
Mucilage of acacia, two ounces. 
Water, to eight ounces. 
Mix. Two table-spoonfuls every four hours. 

22. — Ammonia and Senega Mixture. 
Carbonate of ammonia, half a drachm. 
Spirit of chloroform, one and a half drachms. 
Infusion of senega, to eight ounces. 
Mix. Two table-spoonfuls every four hours. 

23. — Creasote Mixture with Opium. 
Creasote, eight minims. 
Tincture of opium, sixteen minims. 
Spirit of chloroform, two drachms. 
Glycerine, one ounce. 
Water, to eight ounces. 
Mix. Two table- spoonfuls every four hours. 

24. — Mouse Mixture. 
Sulphate of magnesia, two ounces. 
Powdered rhubarb, one drachm. 
Jalap, one drachm. 
Peppermint water, seven ounces. 
Mix. A sixth part for a dose. 
This " House Fhysic," or a similar preparation. 

is kept in the wards of nearly every hospital 

and infirmary. 



DRAUGHTS AND MIXTURES. 



579 



25. — Saline or Purgative White Mixture. 

Epsom salts, one and a half ounces. 

Carbonate of magnesia, one drachm. 

Peppermint water, to eight ounces. 

Mix. Dose, an eighth part or two table- 
spoonfuls. 

26. — Pochette Draught. 
Eochelle salt, half an ounce. 
Syrup of ginger, a tea-spoonful. 
Lemon-juice, two table -spoonfuls. 
Water, four table-spoonfuls. 
Mix and drink. 

27. — Emetic Draught. 
Sulphate of zinc, twenty grains. 
Ipecacuanha wine, half an ounce. 
"Water, one ounce. 
Mix. To be taken immediately. Its action 

may be aided by the free administration of 

warm water. 

28. — Diarrhoea Mixture. 
Dilute sulphuric acid, two drachms. 
Tincture of opium, one drachm. 
Spirit of chloroform, one and a half drachms. 
Water, to eight ounces. 
Mix. Two table-spoonfuls every four hours. 

29. — Astringent Mixture. 
Gallic acid, two drachms. 
Dilute sulphuric acid, two drachms. 
Water, to eight ounces. 
Mix. Two table-spoonfuls every four hours. 

30. — Acetate of Lead Mixture. 
Acetate of lead, forty grains. 
Dilute acetic acid, four drachms. 
Cinnamon water, to eight ounces. 
Mix. Two table-spoonfuls every four hours. 

31. — Bromide of Potassium Mixture. 
Bromide of potassium, two drachms. 
Syrup of orange-peel, one ounce. 
Water, to eight ounces. 
Mix. Two table-spoonfuls three times a day. 

32. — Iodide of Potassium Mixture. 
Iodide of potassium, half a drachm. 
Syrup of orange-peel, one ounce. 
Water, to eight ounces. 
Mix. Two table- spoonfuls three times a day. 



33. — Colehicum Mixture 

Bicarbonate of soda, one drachm. 

Colehicum wine, three drachms. 

Water, to eight ounces. 

Mix. Two table-spoonfuls three times a day. 

34. — Sulphuric Acid Mixture. 

Epsom salts, four ounces. 
Dilute sulphuric acid, two drachms. 
Peppermint water, to eight ounces. 
Mix. Two table-spoonfuls three or four times 
a day. 

35. — Tape-worm Draught. 

Liquid extract of fern-root, one drachm. 
Syrup of ginger, one drachm. 
Water, to one ounce. 
To be taken fasting. 



36. — Sal Ammoniac Mixture. 

Sal ammoniac, eighty grains. 

Carbonate of ammonia, forty grains. 

Camphor water, to eight ounces. 

Mix. Two table- spoonfuls every four hours. 



37. — Sedative Draught. 

Bromide of potassium, twenty grains. 

Syrup of chloral, one drachm. 

Water, to one ounce. 

Mix. The draught to be taken at bed-time. 

38. — Aconite Mixture. 

Tincture of aconite, one drachm. 

Water, to eight ounces. 

Mix. A tea-spoonful to be taken every ten 
minutes for the first hour, and subsequently 
hourly for six or eight hours, or longer if 



39. — Belladonna Mixture. 

Tincture of belladonna, one drachm. 

Water, to eight ounces. 

Mix. A tea-spoonful to be taken every quarter 

of an hour for the first hour and subsequently 

hourly. 

40. — Arsenic Mixture. 
Liquor arsenicalis, one drachm. 
Water, to half a pint. 
Mix. A tea-spoonful every three or four hours. 



680 



PRESCRIPTIONS. 



41. — Gelseminum Mixture. 

Tincture of gelseminum, eighty minima. 

Water, to eight ounces. 

Mix. Two table-spoonfuls every four hours. 
To be taken cautiously, and the effects 
carefully watched. If dimness of vision 
or unsteadiness of gait ensue, the dose 
to be reduced by a third, or the intervals 
prolonged to six hours. 

42. — Arnica Mixture. 
Tincture of arnica, one drachm. 
Water, to eight ounces. 

Mix. A tea-spoonful every ten minutes for the 
first hour, and subsequently hourly. 

43. — Pulsatilla Mixture. 
Tincture of Pulsatilla, one drachm. 
Water, to eight ounces. 

Mix. A tea-spoonful every ten minutes for 
the first hour, and subsequently hourly. 

44. — Nux Vomica Mixture. 
Tincture of nux vomica, one drachm. 
Water, to eight ounces. 

Mix. A tea-spoonful every quarter of an hour 
for the first hour, and subsequently hourly. 

45. — Hamamelis Mixture. 
Tincture of hamamelis virginica, one drachm. 
Water, to eight ounces. 
Mix. A tea-spoonful every hour for the first 

six or eight hours, and subsequently every 

three or four hours. 

46. — Tartarated Antimony Mixture. 
Tartarated antimony, one grain. 
Water, half a pint. 

Dissolve. A tea-spoonful every quarter of an 
hour for the first hour ; afterwards hourly. 

47. — Cantharides Mixture. 
Tincture of cantharides, one drachm. 
Water, to eight ounces. 
Mix. A tea-spoonful every two or three hours. 

48. — Corrosive Sublimate Mixture. 
Corrosive sublimate, one grain. 
Water, half a pint. 
Mix. A tea-spoonful hourly. 

49.— Bryony Mixture. 
Tincture of bryony, one drachm. 
Water, to eight ounces. 
Mix. A tea-spoonful every hour. 



50. — Ipecacuanha Mixture. 
Ipecacuanha wine, one drachm. 
Water, to eight ounces. 
Mix. A tea-spoonful every hour. 

51. — Podophyllin Solution. 
Podophyllin (the resin), one grain. 
Rectified spirit, two drachms. 
Dissolve. Two or three drops on sugar every 
three hours, 

52.— Nitrite of Amyl Drop*. 
Nitrite of amyl, eight minims. 
Rectified spirit, half an ounce. 
Mix. Three to five drops on sugar every three 
hours or oftener. 

63. — Phosphorus Solution. 
A saturated solution of phosphorus in ether. 
Five drops in half a wine-glassful of water four 
times a day. 

54. — Phosphorus Capsules. 
Each containing one-thirtieth of a grain of 
phosphorus. One to be taken every three 
or four hours. 

55. — Eypophosphite of Lime Mixture. 
Hypophosphite of lime, one drachm. 
Syrup, one ounce. 
Water, to eight ounces. 

Mix. One or two tea-gpoonfuls three times a 
day. 

66. — Morphia Linctus. 
Solution of morphia, one and a half drachms. 
Chloric ether, one and a half drachms. 
Syrup of lemon, to four ounces. 
A tea-spoonful occasionally when the cough is 
troublesome. 

67. — Squill and Opium Linctus. 
Oxymel of squill, ten drachms. 
Compound tincture of camphor, five drachms. 
Ipecacuanha wine, two and a half drachms. 
Mucilage of acacia, to four ounces. 
Mix. A tea-spoonful occasionally when the 
cough is troublesome. 

58. — Creosote Linctus. 
Creasote, four minims. 
Glycerine, half an ounce. 
Water, to four ounces. 
Mix. A tea-spoonful when the oonfSk is troaklfr 



PILLS AND POWDERS. 



581 



69. — Confection of Sulphur and Senn*. 
Confection of senna, ten drachms. 
Sublimed sulphur, two drachms. 
Mix. One or two tea-spoonfuls occasionally. 

60.— Aperient Pill. 
Compound colocynth pill, two grains. 
Blue pill, one and a half grains. 
Extract of henbane, one grain. 
Powdered ipecacuanha, one third of a grain. 
One pill to be taken at bed-time. 8end a 
dozen. 

61.— Calomel PiU. 
Calomel, three grains. 
Extract of henbane, a sufficient quantity. 
Make a pill. To be taken at bed-time. 

62.— Blue Pill with Opium. 
Blue pill, twenty-four grains. 
Opium, two grains. 

Divide into twelve pills. One to be taken three 
times a day. 

63.— Sulphate of Iron Pills. 
Dried sulphate of iron, one drachm. 
Syrup, twelve drops. 

Make twelve pills. One to be taken three times 
a day. 

64. — Iron and Aloes Pills. 

Sulphate of iron, forty-eight grains. 

Watery extract of aloes, twenty-four grains. 

To make twenty-four pills. One to be taken 
three times a day for four days, then one 
twice a day for four days, and then one a 
day for another four days. 

65. — Dinner Pills. 
Extract of Barbadoes aloes, two grains. 
Extract of nux vomica, half a grain. 
Extract of gentian, one grain and a half. 
Make a pill. One to be taken once or twice a 

day, half an hour before meals. Send a 

dozen. 

66. — Oxide of Zine Pills. 
Oxide of zinc, two and a half grains. 
Extract of liquorice, a sufficient quantity. 
Make a pill. One or two every night at bed- 
time. Send a dozen. 

67. — Indian Hemp Pills. 
Extract of Indian hemp, half a grain. 
Make a pill. One to be taken three times a 
day. 



68. — Sulphide of Calcium Pilules. 
Sulphide of calcium, two grains. 
Sugar of milk, forty grains. 
To make twenty pilules. One to be taken 
every two hours. 

69. — Lozenge Pills. 
Hydrochlorate of morphia, one thirty-sixth of 

a grain. 
Extract of liquorice, three grains. 
Compound powder of tragacanth, five grains. 
To make a lozenge pill. One to be placed in 

the mouth and allowed to dissolve slowly 

when the cough is troublesome. 

70.— Tar Pills. 
Tar (Pix Liquida), two grains. 
Lycopodium, one grain. 
Make a pill. One every four hours, 

71. — Sugar and Grey Powden. 
Grey powder, two grains. 
Powdered sugar, one drachm. 
Divide into twelve powders. One four times a 
day. 



72.— Orey Powder and Mubark 
Grey powder, three grains. 
Rhubarb in powder, six grains. 
Make a powder. To be taken at bed-1 



73. — Calomel and Sugar Powders. 
Calomel, two grains. 
Sugar, one drachm. 

Divide into twelve powders. One •rery three 
or four hours. 

74. — Digestive Powders. 
Bicarbonate of potash, ten grains. 
Bicarbonate of soda, ten grains. 
Ginger, five grains. 
Caluruba in powder, five grains. 
Mix. One three times a day, half an hour 
before meals. 

76. — Bismuth and Charcoal Powders, 
Carbonate of bismuth, ten grains. 
Wood charcoal, ten grains. 
Bicarbonate of soda, five grains. 
Mix. To be taken three times a day, half an 
hour before meals. 



582 



PRESCRIPTIONS. 



76. — Iron Powders. 
Reduced iron, seventy-two grains. 
White sugar, a drachm. 
Mix, and divide into twelve powders, 
three times a day. 



One 



77. — Phosphate of Lime and Iron Powder*. 
Phosphate of lime, one grain. 
Phosphate of iron, one grain. 
Saccharated carbonate of iron, one grain. 
White sugar, five grains. 
Mix. One three times a day. Send two dozen. 

78. — Sulphide of Calcium Powders. 

Sulphide of calcium, twenty-four grains. 

Sugar of milk, half an ounce. 

Thoroughly «iix, and keep in a well-stoppered 
bottle. Dose, five grains, or as much as 
will cover a sixpence, every four hours. 

79. — Santonin Powders. 
Santonin in powder, three grains. 
Sugar in powder, twelve grains. 
Mix. One at bed-time for a child from two to 
ten years of age ; for an adult, two. 

80. — Busting Powder. 
Oxide of zinc, one part. 
Powdered starch, two parts. 
Mix. For external application only. 

81. — Alum GargU. 
Alum, two and a half drachms. 
Honey, an ounce. - 
Rose water, half a pint. 
Mix. To be used three or four times a day. 

82. — Tannic Acid Gargle. 
Glycerine of tannic acid, ten drachms. 
Water, to half a pint. 
Mix. To be used three or four times a day. 

83. — Borax Gargle. 
Borax, two and a half drachms. 
Water, half a pint. 
Mix. To be used three or four times a day. 

84. — Cayenne Pepper Gargle. 
Tincture of capsicum, one hundred ininims. 
Dilute acetic acid, fifty niinims. 
Water, to half a pint. 
Mix. To be used two or three times a day. 



85. — Turpentine and Ammonia Liniment. 

Liniment of turpentine, one and a half ounces. 
Solution of ammonia, one and a half ounces. 
Oil of cajeput, half a drachm. 
Olive oil, to four ounces. 

Mix. To be rubbed into the chest every night 
at bed-time. 

86. — Neuralgia Liniment. 

Aconite liniment, two parts. 

Chloroform liniment, one part. 

Mix and label " Poison — not to be taken." To 
be lightly painted over the painful part with 
a small brush. The application may be re- 
newed several times in the course of the 
day. Care must be taken not to get it into 
cracks or cuts, and not to drop it into the 
eye. 

87. — Belladonna and Chloroform Liniment. 

Belladonna liniment, one part. 
Chloroform liniment, two parts. 
Mix. The liniment to be used once or twioe ft 
day. 

88.— Calomel Ointment. 

Calomel, one drachm. 
Lard, one ounce. Mix. 

89.— Bilute White Precipitate Ointment. 

White precipitate, five grains. 
Lard, one ounce. Mix. 

90. — Alkaline Lotion. 
Carbonate of soda, one tea-spoonful. 
Water, one pint. Dissolve. 

91. — Sulphur Lotion. 

Flowers of sulphur, one tea-spoonfuL 
Glycerine, two table-spoonfuls. 
Rose water, half a pint. Mix. 

92. — Evaporating Lotion. 
Rectified spirit, two and a half ounoem, 
Water, to half a pint. Mix. 

93.— Red Wash. 

Sulphate of zinc, twenty grains. 

Compound tincture of lavender, Wo drachma. 

Water, to half a pint. Mix. 



LOTIONS, &C. 



583 



94. — Amies Lotion. 
May be made by adding twenty drops of the 
tincture of arnica to half a cupful of water. 

95. — Hamamelis Lotion. 
Tincture of hamamelis, three drachm*. 
Water, to half a pint. Mix. 

96. — Hydrastis Lotion. 
Muriate of Hydrastin, three grains. 
Distilled water, three ounces. Dissolve. 

97. — CaUnduU Lotion. 
Add a tea-spoonful of tincture of calendula to 

half a cupful of water. 



98. — Compound Jalap and Bitartrate of Potash 

Powders. 
Compound jalap powder, twenty grains. 
Bitartrate of potash, ten grains. 
Mix to make a powder. One to be taken every 
alternate morning. Send three. 

99. — Effervescing Ammonia Mixture, 

Carbonate of ammonia, two drachms. 

Water, eight ounces. 

Two table-spoonfuls, with one table-spoonful 

of the following, to be taken every four 

hours, whilst effervescing : — 
Citric acid, one hundred and thirty-six grains, 
Water, four ounces. Mix. 




V) 


« ■'■ . 


z 


< 


— 


(0 


5 


-1 


o 


< 


Q 


4 

til 


< 


zi 


(0 


3. 1 


13 




h- 




o 




UI 




DC 


. *"•% 




umb i.f^r 4u s 



rt 






PATENT APPLIED FOFt. 



COPYRIGHTED 1884 BY L .W. YAGGY, CH ICAGO- 




PATENT APPLIED FOF*. 



COPYRIGHTED 1884 BY L .W. YAGGY, CH ICAGO- 




YAGGY, CHICAGO- 




PATENT APPLIED FOR 



84 BY L.W. YAGGY, CHICAGO. 



INDICATION OF DISEASE. 

TEMPERATURE AND THE CLINICAL THERMOMETER. 

It would be difficult to over-estimate the value of the information afforded by the 
clinical thermometer as a guide to the detection and treatment of disease. This 
little instrument is so simple in structure, and its use is so easily acquired, that it 
should be in the hands of every one who aspires, in however humble a degree, to 
relieve the sufferings of his fellow-creatures. Every mother should at once get a 
thermometer, and learn how to take the temperature of her children. A single 
observation may remove the most distressing anxiety as to the nature of a temporary 
indisposition, and show the absence of grounds for alarm. It will serve to indicate 
the existence of many maladies in their very earliest stages, and point out the 
necessity for treatment at the time when it is most likely to prove of avail. 
Elevation of temperature is in itself a distinct indication for the administration of 
certain remedies, the success of which depends upon their being given at once. 

"We have no hesitation in saying that the thermometer has done more than 
anything to render accurate our knowledge of the nature of disease, and to advance 
the art of treatment It is now in daily, nay hourly, use in every hospital in 
America, and ranks in importance with the stethoscope. A doctor without his 
thermometer is like a sailor without his compass. No one should undertake any 
ease of fever who has not at his disposal the means of obtaining a systematic record 
of the temperature. The man who attempts to treat a case of scarlet or typhoid 
fever without a knowledge of the temperature is doing justice neither to himself 
nor to his patient ; he is simply groping in the dark. No amount of practical 
knowledge, and no amount of experience will enable a man to dispense with the 
information afforded by this little instrument. Of course the actual work of 
temperature-taking must be performed by those who have immediate charge of the 
patient, just as to them is entrusted the administration of the medicines. In many 
cases it is necessary that the temperature should be taken six times in the twenty- 
four hours, and it is obviously impossible that a doctor in active practice could do 
this himself. In the case of children and young people there is no one so fitted to 
perform this duty as their mother. Every mother should love, study, and trust the 
thermometer, the little magician, who like the little finger in the fairy tale, tells 
things that no one else could tell With it she will give the doctor a trusty 
account of the condition of his patient. During his absence her hand will be his 
hand, her eye his eye, and more than that, seeing a sudden rise or fall of temperature 
when he is away, she foresees the peril that thermometry predicts several hours in 
advance, as the barometer does the storm, her mind becomes his mind, she hastens 
his return, and enables him to ward off a deadly exacerbation or collapse, trulj 
herself saving the life of the patient. 



586 INDICATION OF DISEASE. 



The clinical thermometer does not differ essentially from an ordinary garden 
thermometer. It is, of course, smaller, and more accurate, and more delicate, and 
it is not supported in a frame. The figures are engraved on the glass itself, and it 
is usually graduated from 95° to 112°. Either the Fahrenheit or Centigrade scale 
may be used, but in this country the former is nearly always employed. The 
thermometer is what is called " self-registering," that is, you can take a temperature 
with it, lay it aside, and read it off at your leisure. At the top of the ordinary 
column of mercury there is a little piece which has been purposely detached to serve 
as an index. Before taking a temperature this is shaken down to about 96°, and 
then, when the mercury rises, it drives the index before it, and leaves it at the highest 
point it has reached. The object of the constriction is to prevent the index from 
being accidentally shaken down into the bulb and lost. It should be noted that it is 
the upper end of the index, i.e., the end farthest from the bulb, which indicates the 
correct temperature. The mode of graduation is perfectly simple. Each of the big 
lines indicates a degree, although, as a matter of convenience, only every fifth degree 
is numbered. Each degree is divided by the smaller lines into fifths. For example, 
if, after making an observation, the lower end of the index stood at the point 
marked a in the figure, we should say the temperature was 97°, if it stood at b 
we should say it was 100° and -f, and if at c 103° and -§•. As a matter of 



lllllllllllllllll^lllllllllltllllllllllllllllllllllllllllllllllllfllllllllllllllilllll 

96 100 105 110 

Fig. 13. — Thermometer Scale Enlarged. 

convenience we always write the tomperature in figures, and express the fraction in 
decimals or tenths of a degree. Thus f we write as *4, that is, T %, and f as '8, or ^. 
Thus we write down our first temperature, that at a, as 97*0°, that at b as 1004°, 
and that at c as 103 -8°. Yery often the letter F., indicating Fahrenheit, is put 
after the figure, as 101*6° F.; but this is not necessary. We must now explain 
what the little arrow at 98*4° means. This indicates the normal or natural tem- 
perature of the body, and if you take your own temperature you will find that that 
is about what it comes to. A little variation on one side or other of this point is 
of no importance, and is quite compatible with health. 

Clinical thermometers can be bought at any instrument maker's, or your chemist 
will get you one. They are advertised in the medical journals, and can be sent 
by post, so there is never any difficulty in obtaining them. What you Want is a 
" clinical self-registering thermometer." They are made of all sizes, but you will 
find the 4-inch the most convenient. They are supplied in a little metal or box-wood 
case, and with care they will last for almost any length of time, although they, of 
course, will not stand rough usage. The price varies at different stores from three 
to five dollars. Do not be persuaded to purchase ornamental cases or anything of 
that kind. What you want is a plain serviceable instrument, and the simpler the 



HOW TO TAKE THE TEMPERATURE. 587 

better. In shaking down the index be careful not to shake it right down into 
the bulb, or you will never get it up again. Hold the thermometer firmly in your 
right hand, and then tap that hand against the other till you gradually shake the 
index down to well below normal. You will find that in course of time, with con- 
stant washing, the black will come off the figures, and they will be less easily read. 
You can easily restore that by rubbing them with a little heel-ball obtained from the 
cobbler's. 

We must now explain the mode of taking the temperature. There are three 
regions in which the temperature may be conveniently taken — the bowel, the arm- 
pit, and under the tongue. In the case of children, in whom a knowledge of the 
temperature is always very important, the bowel is undoubtedly the most con- 
venient, and is in every way preferable. The child is not frightened by seeing the 
instrument, and but little care is required to maintain it in position. The observation 
is quickly made, and its accuracy is not influenced by the restlessness of the patient. 
With adults the temperature is less frequently taken in the bowel, but in cases of 
high fever treated by cold baths, it must of necessity be taken in this region — for 
the arm-pits are under water, and the chattering of the teeth would prevent an ob- 
servation from being made in the mouth. It may be asked is there no fear of the 
thermometer being broken in the bowel 1 The risk of accident is extremely small, 
supposing the slightest care to be taken. In the case of a child a little gentle 
restraint will obviate any danger, whilst an adult with a thermometer in his rectum 
readily appreciates the necessity for remaining quiet. For some years past the 
temperature of every patient in the children's wards of one of the best governed 
hospitals has been uniformly taken in the bowel, six times a day, without the 
occurrence of any accident. In adults the temperature is ordinarily taken in the 
arm-pit or under the tongue. The temperature under the tongue is more readily 
and quickly ascertained, and particularly in the case of patients not confined to bed. 
is more reliable than when taken in the arm-pit. Under certain circumstances the 
temperature must be taken in the mouth, as when the patient is in a vapour bath 
or " wet-pack," and in some cases of rheumatic fever, where the slightest movement 
of the limbs causes the most exquisite pain. In other instances the temperature 
cannot be taken in the mouth, as when the patient is unable from constant cough 
or shortness of breath to retain the instrument long enough for a satisfactory 
reading to be obtained. In cases of St Yitus's dance the force and frequency of 
the involuntary movements may not only put difficulties in the way of making an 
observation, but it may jeopardise the safety of the instrument. When from any 
reason the temperature cannot be taken in the mouth, recourse must be had to the 
arm-pit. The chief objections to arm-pit temperature are the length of time taken 
for the mercury to become stationary, and the difficulty experienced with people who 
are thin in approximating the arm sufficiently to the body. Arm-pit temperatures 
in cases of consumption are on this account usually untrustworthy. 

The temperature of the extremities may be ascertained by holding the thermo- 
meter in the closed fist, or by inserting the bulb between the clefts of the fingers or 
toes. The latter method is especially useful in cases of supposed injury to the local 
nervous supply, as when one of the nerves of the limb has been accidentally injured. 



588 INDICATION OF DISEASE. 



In diseases of the nervous system it is occasionally necessary to ascertain the 
temperature of the surface of the body, a knowledge of the differential 
temperature of corresponding parts on opposite sides often proving in obscure case* 
an assistance in forming an opinion as to the nature of the complaint 

The following is the method of taking the temperature in the arm-pit : — 

1. The index should be shaken down and the thermometer warmed by holding 
It for a few minutes in the hand. 

2. The patient, if lying on the side, should be turned over, and the observation 
made in what was the dependent arm-pit. 

3. The bulb of the instrument should be placed between the anterior and 
posterior folds of the arm-pit, and care should be taken that it is actually in contact 
with the skin all round, and not with the night-dress. 

4. The patient should be made to lie in such a position that the fore-arm falls 
naturally across the chest, and by its weight converts the arm-pit into a closed cavity. 

5. The thermometer should be retained in position for five minutes. 

The object of taking the temperature in the dependent arm-pit is that it will 
have been less exposed, and its temperature will consequently more quickly indicate 
the true temperature of the body. It is a matter of indifference whether the 
temperature be taken in the right or left arm-pit In cases where the patient is 
restless or delirious it may be necessary to hold the thermometer in position, and see 
that the arm is actually kept in contact with the body. Temperatures ta«.en in the 
arm-pit in the cases of people not in bed are seldom trustworthy. 

The following is the method of taking the temperature under the tongue : — 

1. The index should be shaken down, and the thermometer warmed by holding 
*'t in the hand, as before directed. 

2. The bulb of the thermometer should be placed as far back under the tongue 
as possible. 

3. The mouth should be closed and respiration carried on entirely through the 
nose. 

4. The thermometer should be kept in position for three minutes. 

In taking temperatures in the mouth it is essential to ascertain that the bulb of 
the thermometer is actually under the tongue. It has been found experimentally 
that the temperature recorded by a thermometer placed between the inside of the 
cheek and the gums is considerably below that of the real temperature of the body, 
the actual difference depending on the temperature of the external air. 

The following is the mode of taking the temperature in the bowel : — 

1. If the patient is an adult he should lie on one side with his knees well drawn 
up ; a child may be placed on his chest across his mother's knees or, what is better, 
the legs may be simply held up and slightly separated so as to expose the part. 

2. The index having been shaken down in the usual way and the thermometer 
dipped in olive oil, the bulb should be passed for a distance of about two inches 
through the anus into the bowel. The whole of the thermometer is not to be 
introduced. 

3. The contraction of the muscle of the orifice will probably retain it in position, 
but it is better to hold it in case it should be shot out by a sudden expulsive effort 



WHEN TO TAKE THE TEMPERATURE. 589 

4. The observation should be made for three minutes. In the case of adults 
the temperature can be readily taken beneath the sheet, without any exposure. 
The introduction of the instrument causes no pain, unless the patient happen 
to be suffering from piles. It is quite possible, if thought desirable, to take the 
temperature in this way during sleep. 

It will be seen that the time required for thermometrical observations varies 
with the different regions in which they are taken. Thus the time required for an 
observation in the bowel, or under the tongue, is three minutes, and in the arm-pit, 
previously covered up, five minutes. 

It may not be superfluous to point out the necessity for washing the instrument 
after each observation. In the case of contagious diseases, the thermometer should 
always be disinfected in weak carbolic acid, or Tilden's fluid, after being used. It is 
advisable to make it a rule to wash the instrument in the presence of the patient 
both before and after taking the temperature. 

How often should the temperature be taken 1 This must depend on the nature 
and urgency of the case. In many chronic illnesses a morning and evening 
observation amply suffices. In acute cases, such as the different fevers, six obser- 
vations in the twenty-four hours should, if possible, be made. In cases of very high 
temperature — hyperpyrexia— whore the danger is imminent, it may be necessary to 
take the temperature every half -hour, or even oftener. 

"When should the temperature be taken 1 When only two observations are made 
in the day, one should be about 8 in the morning, and the other about the same 
hour in the evening. When the observations are made three times a day, the 
temperature may in addition be taken at 2 p.m. When six observations are made 
in the course of the twenty-four hours, the most convenient hours are 3, 
7, and 11, night and day. Should there be reason to suspect that a rise of 
temperature occurs at other times, or should any special change be noticed in 
the condition of the patient, this would of course be an indication for taking 
the temperature. It is seldom necessary to wake the patient at night to take the 
temperature, the thermometer can easily be slipped into the arm-pit, or in the case 
of a child into the bowel, without causing any disturbance. The temperature 
should in the same case be always taken in the same region — for example, if you 
begin with the bowel you should go on with it. 

It is very essential not only that the temperature should be carefully taken, but 
that it should be systematically recorded. It will not do to trust to your memory, 
You should have a form on which to put down the figures at once. We append 
an example (see Chart). 

These forms can readily be drawn out with pen and ink, but for schools, where 
there is much sickness, and for those who visit the sick poor, it would be advisable 
to get them already printed. They are in constant use in all the metropolitan 
hospitals, and can be obtained at a trifling expense where you purchased vour 
thermometer. They serve not only as a record of the temperature, but also of the 
pulse and respiration. Under the heading of remarks you may enter the state of 
the bowels, or any other fact that may strike you as being of importance. Our 
example is taken from an actual case of rheumatic fever, although, of course, the name 



690 



INDICATION OF DISEASE. 



Temperature taken (under the tongue). 
Name. — Reginald Vernon, Esq., Richfield Springs, N.Y. 

Illness. — Rheumatic Fever : taken ill on the 8tk. 



Date. 


HOTJE. 


Temp. 


Pulse. 


Eesp. 


Remarks. 


1877. 












July 9th .. .. 


11.30 a.m. 


102-4 


118 


40 


No medicine. 




11.30 p.m. 


102-8 


116 


50 






To take 30 


grains of 


salicine 


every hour. 




n 10th .. .. 


11.30 a.m. 


102-4 


120 


40 






11.30 p.m. 


99-4 


94 


44 




w 11th .. .. 


11.0 a.m. 


100-4 


104 


46 






11.30 p.m. 


98-2 


100 


32 






To take the 


salicine every 


alternate 


hour. 




„ 12th .. .. 


11.0 a.m. 


98-0 


— 


— 






11.0 p.m. 


97-6 


84 


32 




„ 13th .. .. 


11.30 a.m. 


98-0 


— 


— 






11.30 p.m. 


97-2 


80 


26 






Salicine 


discontinued 


— last dose 


at 11 p.m. 




„ Hth .. .. 


11.30 a.m. 


98-2 












11.30 p.m. 


98-8 


82 


24 




n 15th .. .. 


11.30 a.m. 


986 


— 


— 






11.30 p.m. 


98*4 


78 


24 




„ 16th . . •• 


11.30 a.m. 


98-2 


— 


— 






11.0 p.m. 


986 


76 


20 




„ 17th .. .. 


11.0 a.m. 


98-4 


— 


— 





of the patient is fictitious. It will be seen that the temperature was taken only twice 
a day, and that is hardly sufficient. The fact is, the patient was a bachelor, living in 
rooms, and had no skilled assistance in the shape of a trained nurse. He was 
unable to take the temperature himself, as the pain in the joints was very great, and 
the slightest movement increased it. In spite of the small number of observations, 
the temperature afforded valuable information as to his progress, and served to 
relieve his medical attendant of much anxiety. 

Sometimes it is desirable to record the temperature on a chart. This graphic 
method is so commonly adopted for illustrating the variations in the height of 
the barometer that it must be familiar to most of our readers. A glance at the 
accompanying chart will serve to explain the system. 

At the top you record the name, age, and the nature of the illness of the patient. 
Then in the first column, extending from side to side, you put the day of the month, 
and the initial of the day of the week above it if you like. Then in the next 
horizontal column you write the day of the illness, generally in Roman figures. 
For instance, in this case — which is the same as that referred to on the sheet — the 
patient was quite well on the 7th, on the 8th he felt hot and feverish, and had pains 
in his joints, and on the 9th he sent for his doctor. Here the 9th was clearly 
enough the second day of the illness. Sometimes, especially in typhoid fever, you 
may be unable to determine with accuracy the day of onset of the illness, and you 
may have to leave this line blank. In chronic cases, when the patient has been ill 



HOW TO RECORD THE TEMPERATURE. 



591 



Name.— Reginald Vernon, Esq., Richfield Springs, N.Y. Age— 23. Illness— Rheumatic Fever. 


JULY 


9* 


10* 


ll 4 - h 


lP 


13 l - h 


14* 


.15* 


th 
16- 


17* 
















-42° 


Day 

of Illness 


II 


III 


IV 


V 


VI 


VII 


VIII 


IX 


X 
















Time 


M 


E 


M 


E 


M 


E 


M 


E 


M 


E 


M 


E 


M 


E 


M 


E 


M 


E 


M 


E 


iyi 


E 


M 


E 


M 


E 


M 


E 


M 


E 


M 


E 


" £\° 




































































































































































































































































































































JLUO 




, 
































































-o- 






























































































































»> 


























































































































104.°- 




J- 
































































Og 
































































-5- 
























































































































































































AC\" 


103°- 
J 109°. 




*a 






























































40 


























































































































































































o 




























































' 
























































A 








t 






















































/ 




\ 






r 


























































1 




























































"^Q*! 












~r 






















































: £ 

1 


*S ±V4- 
1 

| i(rf- 

1 

1 inn°- 












s> 


























































































< 






































































































o» 
































































• i; 
































































-*r 






































































«.. 














































fc 












«3 








s 














































^ft°S 










A 


4 








43 














































- 1 










\ 










S 
















































oq°_ 








\ 




r* 








H 




















































\l 










ft 




















































V 










s 
































































CO 














































- 
































































Normal \ 

Temperat-l 

ofbodyC 

Qft- 
































































' V7° 












1 












/s 






























































/ 




X 






A 
























































/ 






V 


s/ 














































lK v 










/ 












































07°- 














\ 




A 






























































v 


\ 


/ 


































































\ 


































































V 














































qft° 


































































VI 



































































































































































































































































































































Fig. 14 .— TEMPERATURE CHART. 

for weeks and months, it is never necessary to fill it in. The big letters M and E 
in the next line mean morning and evening. This chart is intended to record only 
two temperatures a day, but when an observation is made oftener, say six times in 
the twenty-four hours, you draw a larger number of columns for the day, and put 
the hour, a.m. or p.m., at the top of each. The black lines running from side to side 
with the figures attached correspond to the scale of the thermometer. Thus a 
temperature of 100° Fahr. would be indicated by a dot placed on the line marked 
on your left with 100, in the morning or evening column as the case might be. The 
faint dotted lines between and parallel with these black lines indicate divisions of 
a degree, just as do the smaller marks on the thermometer scale. For example, 
the temperature of our patient on the morning of the 9th was 102° and two-fifths. 



592 INDICATION OP DISEASE. 



that is 102° and four-tenths, or 102*4°, so -we put a dot on the second faint line 
above the 102. The space between each degree is divided into ten equal parts, but 
as a matter of convenience only five of the faint lines are drawn, so that each of 
them represent two-tenths of a degree. Thus the first faint line above 102° is 
102-2°, the next is 102-4°, and so on, and the same with the other degrees. The 
thick black line opposite 98*4° Fahr. is the normal temperature of the body, and 
corresponds to the little arrow on the thermometer. The figures on your right hand, 
ranging from 36 to 42, are the corresponding figures on the Centigrade scale. You 
need not trouble about them unless you are abroad and can get nothing but a 
Centigrade thermometer, when you will find them useful. 

All this looks a little bit complicated at first sight, but it is not so in reality. 
It is as easy as A B C when you just get over the first difficulty, and it is almost 
impossible for you to make any mistake. The object of joining the ^dots by lines 
is that you can see at a glance the course of the temperature. For instance, in 
this case salicine was given, and the fall in the temperature which it caused is very 
obvious. The drop on the third day of illness is entirely due to the treatment, and 
would not have occurred in the natural course of the disease. The fever was cut 
short by the salicine, for after the fourth day the temperature practically never 
rose above the normal, and all cause for anxiety was at an end. 

As we have seen, the normal temperature of the body — the point at which the 
arrow is placed on our clinical thermometers — is 9 4 -4° F. ; but the temperature at 
different periods of the day, and under the diverse conditions to which we are ex- 
posed, may, and ordinarily does, range somewhat on either side of that point without 
indicating any departure from health. There is, in fact, a diurnal range of tempera* 
ture. The temperature reaches its highest point about 9 a.m., and continues much 
the same during the chief part of the day ; whilst in the evening it uniformly and 
gently falls, and remains at its lowest depression during several hours of the night ; 
but subsequently, in the early morning hours, it again uniformly and quickly rises. 
This is well illustrated by the accompanying chart of the temperature of a healthy 
boy, taken at hourly or half-hourly intervals for a period of two days. 




Mmger and Stuart.] [Proceedings ofths Royal Socisty, 1877. 

Fig. 15.— THB DITONAL RANGE OF TEHPEBATUBB IS HEALTH; 

This diurnal rise and fall constitutes the only great variation. In young people 
the evening fall usually begins between 5 and 7 p.m., but exceptions sometimes occur, 
for the evening fall may begin either before or after the time stated. The fall, 



THE TEMPERATURE IN HEALTH. 593 

however, happens more frequently before this time than after. The morning rise 
usually begins between 3 and 7 a.m., and is completed by 9 a.m. After this hour the 
temperature usually remains at much the same height until the evening fall begins. 
The daily variation in old people is considerably less than that of young people ; in 
fact, the variation in persons over forty is only half that of persons under twenty-five 
years. But the difference is not merely in the amount of depression, but in the 
manner of its occurrence. In young people there is in the evening a very rapid fall, 
and the minimum temperature of the day is quickly reached, often, indeed, in three 
or four hours. In persons over forty so rapid a fall rarely occurs ; but the tempera- 
ture usually declines very slowly, and as soon as the minimum is reached it again 
begins to rise, so that not only is the amount of the evening fall less in these older 
persons, but the period of the depression is also shorter, generally very much shorter. 
On some days, curiously enough, no diurnal variation occurs in persons over forty 
years of age. In middle-aged adults, apparently the diurnal fall does not observe 
any particular time; but occurs sometimes in the middle of the night, and at other 
times in the morning, about 9 a.m. It may be taken as a rule that the older the 
person the later in the day the diurnal fall begins; thus, in a child aged five it 
began between 2 and 3 p.m. ; in two boys aged eleven, between 4 and 7 p.m. ; in 
two men, aged fifty-five and sixty-eight, between 9 and 11 p.m. Respecting the 
cause of this diurnal rise and fall we know little. It is easy to theorise, but difficult 
to arrive at any definite conclusion, or to obtain trustworthy evidence on the subject. 
It has been clearly shown by keeping people in the dark that it is not due to the 
action of light. It has, moreover, been proved that it is not due either to food or 
exercise. 

Food has little or no influence on the temperature of healthy people. When the 
morning rise of temperature has been delayed by long abstinence from food, break- 
fast, by restoring the tone of the system, will enable this to take place, but this is 
all that it can do. If you take your temperature just before a mid-day dinner, and 
just after, you will find that there is very little, if any, variation. To establish thi» 
point you would, of course, have to make the observation on several occasions. 
A cup of hot tea will temporarily raise the temperature taken under the tongue 
by a degree or more. Alcohol distinctly depresses the temperature. When you 
take a glasr of spirits, you do not keep out the cold, but, on the contrary, let 
it in. 

Exercise elevates the temperature slightly. Thus an observer took his tem- 
perature at 3.30 o.m.. and found that it was 98*6° F. He then walked to the top 
of a very high hill, a distance of some five miles, and found that his temperatuiw 
was 99° F. 

It is greatly to be regretted that our knowledge of the course of the temperature 
in health is so meagre. Any one — man or woman — who would take his own tem- 
perature several times a day at definite hours for a period of six months, and would 
publish his results, would be conferring a great benefit on science. It would be 
especially important to work out fully the influence of food, exercise, <fec, on the 
healthy temperature. Work of this kind is readily accepted by the various 
medic I societies. As a model for work, Ogle " On the Diurnal Variations of the 
38 



594 INDICATION OF DISEASE. 



Temperature of the Human Body," St George's Hospital Reports, 1866, vol. L, may 
be consulted. 

It has been stated that the temperature is slightly higher in women than in 
men, but it must be admitted that on this point we have no information that can 
for one moment be regarded as conclusive. Mental exertion, such as literary 
composition or reading a work of exciting interest, is said to cause a slight elevation 
of temperature, the mean of a number of observations made under these circum- 
stances being slightly higher than the mean of an equal number made at the same 
period of the twenty-four hours, when the attention was not roused, as when reading 
an uninteresting book, or when engaged in the mechanical process of copying 
manuscript. During sleep, however, when it may be supposed that there is a total 
absence of mental exertion, there is no fall of temperature. The fall that takes 
place at night is due to the diurnal range of temperature, and occurs with equal 
regularity sleeping or waking. 

The temperature of the body is, to a certain extent, influenced by the tem- 
perature of the external medium. The variations that occur in the temperature of 
the air are ordinarily too slight to affect it to any appreciable extent In the 
Turkish bath, with the temperature at 130° F. or thereabouts, there is usually an 
elevation of 2° or 3° in the temperature of the body. In a hot-water bath the 
temperature may be raised from 1° to 4°, the amount of elevation being dependent 
on the temperature and duration of the bath. In baths of a moderate heat — 
101° to 102° — the temperature of the body rapidly assumes that of the surrounding 
medium, and there can be but little doubt that the same accordance would be 
observed at still higher temperatures, were it not for the impossibility of any one 
remaining in a very hot bath for more than a few minutes. Hot vapour baths 
are equally efficacious in raising the temperature, an elevation of from 2° to 3" being 
readily obtainable. The rapidity with which the temperature falls on removal from 
the bath is very remarkable, a degree being sometimes lost in less than five minutes. 
Cold baths exert a powerful influence in lowering not only the surface heat, but 
also the temperature of the interior of the body. It is possible by means of the 
cold bath to reduce the temperature to 87° F., but so great a depression as this 
occurs only when the water is very cold and the bath is continued for a considerable 
time — for from a quarter to half an hour. Sometimes the maximum depression is 
not obtained during the continuance of the bath, the temperature of the body falling 
for some time after. 

Menstruation occurring normally in healthy young women usually produces no 
disturbance of the temperature, but occasionally there is, without any apparent 
cause, a slight elevation at these times. The uniform occurrence of a febrile 
condition at the monthly periods may be regarded as an indication of the existence 
of a morbid condition of the parts concerned in producing the menstrual flow. 

It is by the thermometer alone that we can determine with accuracy the tem- 
perature of the body. The significance of abnormal temperature as an indication 
of disease has long been recognised. For more than 2,000 years it has been known 
that elevation of temperature is a pathognomonic symptom of fever, and thus 
fever and preternatural heat of the body have come to be regarded as synonymouj 



WHY TO TAKE THE TEMPERATURE. 595 



terms. Before the invention of the clinical thermometer it was customary to rely 
chiefly on the state of the pulse and the heat of the skin, as estimated by the hand. 
for the detection of fever. The hand is quite untrustworthy as a test or measure of 
temperature, and consequently of the existence of febrile disturbance. A dry skin 
may readily be mistaken by the hand for fever, whilst similarly a moist skin may 
mask the presence of elevation of temperature. The hand, even if sufficiently 
sensitive, could do no more than estimate the temperature of the surface of the 
body ; the thermometer indicates the heat of the interior. A relationship, it is 
true, ordinarily exists between the pulse-rate and the temperature, but this is so 
prone to disturbance from trivial causes as to render it unreliable as an indication 
of the existence of fever. We will refer to this at greater length when speaking of 
the pulse. 

The thermometer is of the utmost value as a guide to diagnosis. By its use we 
are enabled, by a single observation, to distinguish between diseases the symptoms 
of which are so similar that without its aid our skill would be baffled, and our 
treatment of necessity postponed. In the diagnosis of typhoid fever the thermometer 
is all-important. Hear what a learned physician says on this subject : — " There is 
a form of typhoid fever," he says, " with which we are all familiar, that has been 
termed latent typhoid fever — a form in which the patient is from the commencement 
to the termination of the disease able to walk about, and even to follow his 
ordinary occupations. This is a form of the disease in which the patient not very 
unfrequently dies from perforation of his bowel, or from intestinal haemorrhage, even 
though, as is usual, the evidences of bowel irritation have been trifling. The 
diagnosis of this practically important variety of typhoid fever is often all but 
impossible without the use of the thermometer ; with its aid it is comparatively, 
and it may be absolutely, easy. The thermometer, in this case, enables the prac- 
titioner not only to satisfy himself, but also to satisfy the patient and his friends 
that he is really ill, that he is the subject of fever, not merely out of sorts — poorly. 
Accuracy in our diagnosis in this class of cases is all -important, for by it we are led 
to avoid the treatment which some of the symptoms may seem to demand — treatment 
which perchance might lead, as it often has led, to a fatal result ; while, by the 
ocular demonstration of the existence of the fever which we can give to the patient, 
we can induce him to take those hygienic precautions so important for his safe 
passage through the ailment. How often have we all known in times past a drastic 
purge — administered by the physician to remove the disordered secretions, and 
injudicious diet taken by the patient to remove the weakness — lead to death ! " 

In some cases it would be absolutely impossible to distinguish between pleurisy 
and mere muscular pain in the side without the thermometer ; the importance of 
making the diagnosis is self-evident. A young man comes complaining of darting 
pain in the side which suddenly seized him a few days ago, and " catches " him 
whenever he gives a cough or takes a breath. His faces wears an expression of 
illness, and his pulse is quick and feeble. He cannot sleep at night, and has, he 
says, quite gone off his appetite. He has had a little cough all the winter, but does 
not spit much. It is impossible to learn anything from an examination of his chest. 
for he is very tender, and the pain is so great that he cannot take a deep breath, 



596 INDICATION OP DISEASE. 



Is this pleurisy t — or only muscular pain ; pleurodynia ? The symptoms are readily 
explicable on either supposition. The pain is in itself sufficient to have caused the 
sleeplessness, and the want of sleep may have impaired the appetite and given rise 
to the other general symptoms. The cough may be nothing more than a common 
cold, and the condition of the pulse may be due to the pain, or may be the result of 
nervousness. How is the diagnosis to be made 1 By taking the temperature. If 
the patient is suffering from pleurisy the temperature will be 101° F. or more, and 
if from pleurodynia it will be normal. 

Oases of hysteria are frequently met with, which so closely simulate other 
diseases that without the help of the thermometer a diagnosis would have to be 
postponed. The facilities which it affords for the detection of feigned disease are 
great. The thermometer will often indicate the occurrence of some complication in 
the course of a disease which might otherwise have passed unobserved until too late 
for treatment. It should not, however, be trusted too implicitly for this purpose, 
for serious complications may occur without any indication from the course of the 
temperature. The return of the temperature to the normal is an indication of the 
termination of the illness and the commencement of convalescence. 

Many fevers have typical ranges of temperature, so that an inspection of the 
temperature sheet may, if the disease conform to its type, enable the physician, 
without ever seeing the patient, to say what is the matter with him. Valuable as is 
the knowledge gained by the use of the thermometer, it must be remembered that 
the temperature is but one of a number of symptoms which together constitute the 
disease, and that the information thus obtained by no means justifies him in 
disregarding other methods of examination. 

In some cases the temperature is the only true guide to the progress of the 
complaint. A patient comes to us suffering from ague. Under the influence of 
quinine the symptoms in a few days entirely disappear, and the patient is convinced 
that he is perfectly well, and is anxious to resume his employment By the use of 
the thermometer we find the temperature rises periodically, and reaches a point 
equal to that attained when the fits occurred in all their severity. We thus 
ascertain the necessity for keeping the patient still longer under treatment, and are 
enabled to prevent him from taking a step which would inevitably produce a 
relapse. 

This dissociation of the other symptoms from the disease whilst the elevation of 
temperature still continues is not unfrequently observed in cases of ague. In many 
diseases the persistence of a temperature slightly above the normal, after the 
apparent establishment of convalescence, is the only sign of an incomplete recovery, 
or of the existence of some later or hitherto unsuspected mischief. 

The temperature typical of a disease may be altered by an attack of bleeding, 
by constipation, or other similar causes, but such disturbing processes are usually of 
short duration, and the course of the disease in a few hours resumes its normal 
character. A marked or permanent alteration in the range of temperature often 
affords the earliest indication of the existence of some complication, of the extension 
of the disease, or of the lighting up of mischief in some previously unaffected region. 
The daily fluctuations in the temperature are much greater in disease than in health, 



HIGH AND LOW TEMPERATURES. 597 

a variation of from eight to ten degrees in the twenty-four hours being not uncom- 
monly met with in some acute illnesses. 

We have seen that the normal temperature of the body is 98*4°, but varies 
somewhat in different individuals and under the diverse circumstances in which we 
are placed. This variation is never very great practically, as shown by frequently 
taking the temperature in healthy people ; it does not amount to more than between 
two and three degrees. Any elevation above 99*5° F., or any fall below 97°, must, 
except under exceptional circumstances, be regarded with considerable suspicion, if 
not absolutely as a sign of ill-health. At the same time it must be admitted that 
there are persons, both children and adults, who occasionally, whilst exhibiting all 
other conditions of perfect health, have a temperature as low as 96° F. Although 
any departure from that range of temperature which we have agreed to be the 
normal range of temperature is to be taken as an indication of disease, however 
slight, the converse proposition is not true. A normal temperature is no indication 
of the freedom of the patient from disease — in fact in the majority of chronic 
illnesses there is no elevation of temperatura Whenever the temperature reaches 
100° F. the patient is ill, and if it is persistent he should obtain medical advice. 
The temperature runs up much more readily, and from a slighter cause, in children 
than in adults. Diarrhcea or stomach disturbance will send the temperature of a 
child up two or three degrees, and this may be perfectly transitory ; nevertheless, 
such cases should be carefully watched, for it may indicate the onset of some acute 
disease. 

In the great majority of febrile diseases, the temperature does not rise above 
106° F. It has been laid down as a rule that in fever a temperature of 108° 
F. is incompatible with life, even for a day, but this, like most rules, has 
its exceptions. Very low temperatures are occasionally met with in cholera 
and some other diseases. Loss of blood, whether it be from the nose, lungs, 
stomach, or womb, reduces the temperature in direct proportion to the quantity lost. 
The loss of blood in ordinary bleeding irom the nose is seldom sufficiently great 
to exert any very marked influence on the temperature. Spitting of blood in 
consumption may, if profuse, be followed by a distinct fall of temperature. In 
cases in which the bleeding is slight, there may be no depression, but on the 
contrary, the blood, by increasing the mischief in the lung, may elevate the tem- 
perature. 

We have said that elevation of temperature is in itself an indication for "the 
administration of certain remedies. The aconite mixture (Pr. 38) will be found 
most useful in reducing fever. It is especially indicated when there is any 
suspicion of the existence of inflammation. It should be given strictly in the 
manner recommended. Another useful medicine is the solution of acetate of 
ammonia — half a table-spoonful in a wine-glassful of water every four hours. It is 
a great thing to have the bowels well opened, and to get the skin to act. 



698 INDICATION OP DISEASE. 



THE PULSE. 

Physicians in all ages have very properly attached considerable importance to 
the rate and force at which the circulation is carried on. As a measure of these 
conditions, appeal is usually made to the pulse as felt by the finger placed over 
the artery of the wrist. The pulse may be examined in any part where an 
artery is so close to the surface that its throb can be plainly felt, but in general 
the most convenient locality is at the wrist. In feeling the pulse you 
must be very careful not to flurry your patient, or you will quicken the action 
of the heart, and render your observation valueless. You should see that there 
is no pressure on the artery in any part of its course by tight sleeves or other 
article of dress. By throwing your shoulders well back you can stop the pulse 
at the wrist. Malingerers sometimes manage to deceive the doctor in this manner. 

The usual way of feeling the pulse is to place the three fingers just above the 
root of the thumb and the joint of the wrist, with your thumb on the opposite side 
so as to regulate the pressure. Its frequency may be measured by the seconds hand 
of a watch, but considerable practice is required to detect and appreciate its peculiar 
characteristics as indicative of various phases of disease : its rhythm, its fulness or 
softness — whether it is strong and bounding, forcing the fingers almost from the 
arm ; or hard, small, and wiry, like the vibrations of a string ; or intermittent, stri- 
king a few beats, and then apparently stopping one or two beats ; or whether the 
pulsations, flowing into each other, are small and almost imperceptible. The 
information obtained by examining the pulse is often of the most interesting and 
instructive kind. 

It is necessary that we should know the number of beats which the heart habi- 
tually makes in health, for it varies much in different people. The average number 
of pulsations in a healthy adult is from 70 to 75 in a minute ; but there are persons 
who when they are quite well have always a pulse of 80 or 90, and there are others 
in whom the pulse seldom rises above 60. The pulse-rate varies considerably at 
different ages. The average number of beats in the minute is as follows : — At birth, 
140; during infancy, 120 to 130; in childhood, 100; in youth, 90; in adult age, 75; 
in old age, 65 to 70. In decrepitude, it is said that the pulse once more increases 
in frequency. The rate of the pulse is usually quicker in the standing than in the 
sitting posture, and in the sitting than in the recumbent. It is faster in the female 
than in the male, by from six to fourteen beats, but this difference is not noticeable 
in young children. It is quickened by exertion or excitement. It is quickened 
by meals, and while varying thus from time to time during the day is, on the 
whole, quicker in the evening than in the early morning. It is said to be, on the 
whole, quicker in summer than in winter. Even independently of muscular exertion, 
it is quickened by great altitudes. 

In disease the pulse may acquire a degree of frequency scarcely calculable to the 
touch — a rate of from 150 to 200 being in some cases recorded. A rapid pulse, if 
strong, full, and hard, indicates inflammation or fever; but if small and very rapid, 
it points to a state of great debility, such as is often present in the last stage of 






AN IRREGULAR PULSE. 599 



typhoid and other fevers. On the other hand, in apoplexy sometimes, or when 
fainting is impending, or in certain affections of the heart, the pulse may be very 
slow. In jaundice, too, the pulse is sometimes slower than normal. 

Irregularity of the pulse is a condition which, as a rule, is full of meaning and 
interest. This condition is curiously enough natural to some people, and when they 
get ill with fever the pulse sometimes becomes quite regular. Irregularity of the 
pulse may be dependent on a number of very different conditions ; it may be caused 
by disease within the head, or by disease of the heart, or it may be the result of 
simple disorder of the stomach, or of general debility. Do not think because 
your pulse is somewhat irregular that you are going to die. Have you been smoking 
much lately] Well, that is quite enough to account for it. And we don't suppose 
that that last glass of three of whiskey cold last night did you any good. 

Then a pulse may be intermittent. When the motions of the artery are unequal 
in number and force, a few beats being from time to time more rapid and feeble than 
the rest, we say the pulse is irregular, but when from time to time a pulsation is 
entirely left out, we say the pulse is intermittent Frequently the intermission is 
perfectly regular, a pulsation being missing every fourth, or tenth, or twentieth beat ; 
but sometimes we have, say ten or twenty beats, then an intermission, and very 
soon another. When the intermissions are frequent — i.e., every four or six beats 
— they are more likely to be regular. Intermittency of the pulse may be due to 
many diseases, but it is not always of grave importance, for very trivial causes may 
produce it It is rare in young people, but after middle age is not at all uncommon 
In some cases it is habitual, in others occasional only, and induced by indigestion, 
constipation, smoking, drinking, Sec In some people it is produced by particular 
kinds of tea, and in others by a particular brand of cigars. Some people are 
entirely unconscious of the intermissions, especially those in whom it is habitual, 
others feel as if the heart rolled over or stopped, and are made uncomfortable. 

A jerking pulse, marked by a quick and rather forcible beat, followed by 
a sudden abrupt cessation, as if the direction of the wave of blood had been 
reversed, is sometimes a concomitant of heart disease, but it occurs in the course 
of many other complaints. It should be regarded as an indication for obtaining 
medical advice, for a simple examination of the chest may serve to dispel your 
fears. 

Another important quality of the pulse is what is called its hardness or incom 
pressibility. You find that you can scarcely abolish the pulsation by any degree 
of pressure ; the blood still forces its way through the artery beneath your finger. 
Sometimes it is felt to strike a large portion also of the finger, and then we say that 
the pulse is full or large as well as hard. When it strikes a very narrow portion of 
the surface of the finger, it is compared to a thread, it is a small pulse ; and if a* 
the same time it be hard, such a pulse is often described as a wiry pulse. A full 
pulse occurs in people who are plethoric, and also in the early stages of acute 
disease. A weak pulse denotes impoverished blood and an enfeebled condition of 
the system. 

In fever the pulse is usually increased in frequency, there being, roughly, 
speaking, a rise of ten beats in the minute for an elevation of a degree in the 



600 INDICATION OP DISEASE. 



patient's temperature. Thus, if the natural pulse and temperature were respectively 
75 beats in the minute, and 98 -4° Fahr., an elevation of the temperature to 
100° would probably bring up the pulse to 90 or 95. As we have already shown, 
the pulse is so prone to disturbance from trivial causes as to render it unreliable 
as an indication of the existence of fever. Excitement will, in children especially, 
frequently quicken the pulse by twenty or thirty beats per minute. The mere act 
of counting the pulse may in itself act as a disturbing element. The slightest move- 
ment, even turning in bed, will, in debilitated subjects, increase the rapidity of the 
circulation, and mere weakness will quicken the pulse-rate, there being nothing in 
the pulse itself to indicate that the acceleration is not the result of fever. Many 
nervous, highly-susceptible people have a certain amount of voluntary power 
over the pulse, and by directing the attention to it can alter its rate. Not only 
is a rapid pulse not of necessity an indication of fever, but a normal pulse affords 
no evidence of the non-existence of an elevated temperature. In many fevers, more 
especially typhoid, the pulse may be normal, or even below the normal, during the 
whole of the illness. For the detection of fever we would strongly ur^e upon you 
lk« necessity for using the thermom: 1 ;r. 



THE TONGUE. 

An examination of this organ may afford important information in the diagnosis 
and treatment of disease. It almost seems to have been designed as an index by 
which to estimate the condition of the system, so numerous and diversified are 
the morbid affections which modify its healthy appearance. It not only participates 
in all general derangements of the system, serving as a safe guide to a correct 
judgment in relation to the degree, progress, and precise stage of the disease, but it 
especially sympathises with the different parts of the digestive tract, at one extremity 
of which it is placed. 

The bulk of the tongue may be increased or diminished. Its enlargement, when 
not so considerable as to be very obvious, may often be detected by the appearance 
of indentations on its sides made by the pressure of the teeth. Its contraction, when 
not the mere effect of dryness, is usually the result of a diminished supply of blood, 
and indicates either a general deficiency of that fluid or great feebleness of the 
heart's action. Like every other part naturally moist, it shrinks by drying and 
exposure to the air, and under such circumstances no general inference can be 
deduced from its mere loss of volume. 

Its colour may be greatly and significantly modified. Undue redness of the 
tongue is often supposed to be the sign of irritation of the stomach. Such, however, 
is not always the case, for this condition is often met with when there is no other 
evidence of stomach derangement, and it is not unfrequently absent when some disorder 
undoubtedly exists. A livid or purple colour of the tongue is usually dependent on 
deficient aeration of the blood, and may be regarded as a valuable indication of 
the existence of this condition in connection with the same colour in the lips. 



A PURRED TONGUE. 601 



Sometimes the tongue is unhealthily pale, and this is a sign of poorness of blood, or 
of great prostration or debility. 

The " strawberry " tongue of scarlet fever is so characteristic that it is in itself 
sufficient to enable one to recognise the existence of the disease. 

The condition of the tongue as to dryness and moisture is often worthy of atten- 
tion. But caution is necessary not to mistake dryness, arising from temporary 
and unimportant causes, for that due to general disease. In persons who habitually 
sleep with their mouths open, the tongue is apt to be dry in the morning ; and the 
same cause often produces the same effect in sickness. On visiting a patient we find 
the tongue unexpectedly dry, and begin to feel some apprehension until we learn 
that the patient has been breathing for some time throngh the mouth alone. A 
blocking up of the nostrils often gives rise to this phenomenon. In all doubtful 
cases, all that is necessary is to request the patient to close his mouth and then 
move the tongue about, so as to moisten it. If he succeeds satisfactorily, we may be 
sure that the dryness was accidental, and of no account. Another caution is requisite ; 
to take care, namely, that a really dry tongue is not mistaken for a moist one, in 
consequence of the patient having recently taken liquid into his mouth. Dryness 
may exist in different degrees, from mere clamminess to perfect acridity. It depends 
on a deficiency of saliva, and indicates a general tendency to diminished secretion. 
In typhoid fever the tongue often becomes quite dry, and assumes a brownish 
colour. 

The condition known as a furred tongue is one of the most important symptoms 
afforded by this organ. In this state the upper surface of the tongue is covered with 
an unhealthy coating, which adheres with the greatest firmness. Though very 
generally a sign of disordered health, it is not always so, for some people have 
habitually a furred tongue, especially on rising in the morning. A furred tongue 
is very common in the case of people who smoke much. This condition always 
accompanies fever, and is a decided characteristic of that affection. At the same time 
it must be remembered that for the detection of fever we put our trust in the ther- 
mometer, the state of the tongue being of minor importance. When the fur is 
white, thickish, and tolerably uniform and moist, it usually indicates an open, active 
state of the fever, in which, though the obvious symptoms may possibly be violent, 
there is little probability of any lurking mischief, or of a malignant tendency. A 
yellowish hue of the fur is commonly indicative of disordered liver. A brown or 
black tongue is a bad sign, usually indicating a low state of the system, and a general 
condition of depression. Malingerers sometimes manage to simulate the condition by 
chewing liquorice, tobacco, burnt coffee-grains, &c. 

The manner in which the fur takes its departure is worth observing. When it 
slowly recedes from the tip and edges, thinning gradually as it retires, it intimates 
a favourable convalescence. A portion of fur often lingers near the root of the 
tongue, long after the disease has given way. Sometimes the fur loosens and 
separates in flakes, often beginning at the middle or near the root, and sometimes 
in large patches, or over almost the whole tongue at once, leaving a smooth, red 
surface. In these cases, if the tongue remains moist, convalescence almost always 
takes place, though it is usually tedious — sometimes very lingering. In less 



602 



INDICATION OP DISEASE. 



favourable cases, the tongue, after having commenced the process of cleaning, as first 
described, or even after completing it, instead of continuing moist, becomes quite 
dry, with an aggravation of the symptoms and increased danger. This is a very un- 
favourable condition, more especially when, in addition to its dryness, the surface 
becomes gashed or fissured, or exhibits a rough, scaly appearance. 

A smooth, red, glossy tongue, either moist or dry, is not uncommon in chronic 
diseases, and is generally regarded as a bad sign. 

In some diseases the manner in which the organ is protruded may serve to indi- 
cate the nature of the complaint. Take St. Vitus's dance, for example. If you 
ask the patient to put out his tongue, he makes sundry attempts to do so before 
he can accomplish it, and then the tongue is suddenly thrust out and as sud- 
denly withdrawn, and the jaws snap together as if he were resolved that you 
should have as short a glimpse of it as possible. In delirium tremens the tongue 
is protruded with a jerk very similar to that we have just described. It almost 
always trembles; usually it is covered with a yellowish fur, but it may be clean, 
red, and glassy on the one hand ; or brown, dry, and cracked on the other. 



THE URINE. 

Healthy urine is a clear, watery, amber- coloured fluid, having a faint peculiar 

odour which is familiar enough to everybody. 
Certain drugs, such as turpentine and copaiva, and 
certain articles of food, such as asparagus and 
garlic, communicate special odours to the urine 
which are readily recognisable. The urine in 
diabetes when fresh has a faint whey- like fragrance, 
and when fermenting it smells like sour milk. 
Certain medicinal substances, when administered 
internally, produce peculiar alterations in the colour 
of the urine. Thus, when rhubarb is taken it 
colours the urine a deep gamboge-yellow, which on 
the addition of a little hartshorn is at once changed 
to red. Senna communicates a brownish, and log- 
wood a reddish tint to the urine, and santonine 
imparts a conspicuous orange-red colour if it be 
alkaline, and a rich golden-yellow if it be acid. 
Creosote, and the external application of tar oint- 
ment, produce a very dark, almost black urine, and 
the same effect is noticed when carbolic add is 
used as a dressing in surgical operations. 

In many cases it is very important to learn th« 
density or specific gravity of the urine. This fact is ascertained by means of a 
little instrument called the urinometer (Fig. 16). If you take a tumblerful of 
ordinary drinking-water, and immerse the urinometer in it with the bulb (b) down 




Fig. 16.— URnyOMETE*. 



HOW TO EXAMINE THE URINE. 603 

wards, you will find that it will sink to the point marked 0, and this is called 
1,000. Now if you substitute for water the urine of a healthy person you will find 
that the urinometer will not sink so far, and will probably float at some point 
between 15 and 25. This shows that urine, like blood, is denser or thicker than 
water. Supposing the urinometer had come to rest at the point marked 20, we 
should say that the specific gravity of that urine was 1,020, the specific gravity of 
water being 1,000. In taking the specific gravity of the urine or any other fluid 
you must take care that the instrument floats quite freely, and does not touch the 
sides or bottom of the vessel anywhere. You should also see that bubbles have 
not collected round the stem of the urinometer, for they are apt to buoy it up, 
and make the urine appear denser than it really is. You should never 
take the specific gravity of a urine directly it has been passed, but wait till 
it is cool, or a material error may be introduced. The best way is to collect all 
the urine passed in twenty-four hours, and to take the specific gravity of a 
portion of this. That is the only way to get a really correct reading. The 
specific gravity of healthy urine, as we have seen, ranges from 1,015 to 1,025, 
but frequently it occasionally exceeds these limits. If you take a copious 
draught of water on an empty stomach you will find that it will very quickly 
run through you, and that your urine will, for the time, be profuse in quantity, 
clear, and almost as dilute as water. On the other hand, prolonged fasting 
and abstinence from fluid will cause the urine to become concentrated, and of a 
higher specific gravity. These are facts which must be familiar to every one. If, 
however, your urine exhibits habitually, and especially in the morning before 
breakfast, when it ought to be concentrated, a specific gravity below 1,015, it looks 
suspicious. It may mean nothing, but it is suspicious. Do not be satisfied with a 
single examination, but take the specific gravity on several occasions at some days' 
interval. Do not forget that the observation is not to be made when the urine is 
warm. If you are quite sure that the specific gravity of your urine is habitually 
below 1,015 the first thing in the morning, you had better have it examined. It 
may mean nothing, it probably does mean nothing, but still you had better have it 
seen to, to make quite sure. It is about ten to one that your doctor will be able to 
give you a clean bill of health, or at all events put you on your legs again without 
much trouble. Hysterical women often pass a great deal of pale-coloured water of 
very low specific gravity. We are not referring to those cases, for in them the urine is 
very rarely affected. Then again, if the specific gravity of your urine is not too low, 
perhaps it is too high. A density of 1,030, especially in a pale, apparently diluted 
urine, is also suspicious, and if the specific gravity of your urine is 1,040 or 1,050, all we 
can say is, we don't like the look of it. Mind, we are not speaking of the specific gravity 
of a single specimen of urine, that is of not the slightest consequence, but of the specific 
gravity of a sample of all the urine you pass in the twenty-four hours. And above 
all you are not to jump to a conclusion ; it may vary from day to day, and you will want 
several careful observations before you can be sure of your facts. If you have 
positively come to the conclusion that the specific gravity of your urine is habitually 
above 1,030, you had better state your case before the doctor, and get it set to rights 
again. If vou are in health, you, of course, will not bother about the specific gravity 



604 INDICATION OP DISEASE. 



of your urine, for if anything goes wrong with it, you will probably find it out in 
some other way. But if you really think there is something wrong with the urine, 
you may derive some most useful information from the urinometer, especially if 
you are so situated that you cannot personally consult a medical man. We 
should strongly advise you not to meddle with your urine, but when occasion offers 
to send it straight off in a bottle to the doctor, with a plain, straightforward state- 
ment of your case. You had better let the doctor have two bottles of urine, one of 
the morning's urine, and the other of the evening. *Do not send too small a quantity; 
he will want at least half a pint to examine it properly. 

The more urine you pass, speaking generally, the lower density it is ; that is only 
natural. The usual quantity is from 2 to 2J pints in the twenty-four hours. 
Some people pass very much more than others. When speaking of the disease called 
diabetes insipidus, we have mentioned a man who was in the habit of passing a very 
large quantity, ' indeed as much as would fill an ordinary -sized slop-paiL The 
amount of water you pass is to some extent regulated by the fluid you drink. 
Gin has the property of greatly increasing the flow of the urine. Shakespeare refers 
to this in Romeo and Juliet. Then again the amount of perspiration is not without 
its influence on the urine. You pass less water in summer than you do in winter, 
but you take it out in perspiration. It comes to the same thing in the long run. 

Next, a word or two as to the reaction of urine. This is ascertained by means of 
test-papers. A doctor generally carries some about with him, in his pocket-book. 
They are made by dipping ordinary paper into litmus, and they are often called 
litmus paper. There are two kinds, red and blue. The blue is turned red by an 
acid, and the red is turned blue by an alkali If you take a piece of red litmus 
paper, and put it into vinegar-and-water, it turns red, and if you take a piece of red 
litmus paper, and put it into weak soda-and-water, it turns blue. Vinegar is an acid, 
and soda is an alkali. Ordinary healthy urine, when freshly passed, is acid, but 
after it has been standing for some time it undergoes putrefactive changes — that is, 
it goes bad — and then it becomes alkaline. If you want to ascertain the reaction 
of a person's urine, you must test it soon — an hour or two after it has been 
passed, and not after it has been standing about all day. When urine is passed in 
a dirty vessel, it soon becomes offensive. There is nothing like washing out the 
utensil occasionally with a little strong acid if you want to keep things sweet and 
clean. Many people never think about that. They are very particular about every- 
thing that is seen, but as the chamber utensil is generally kept concealed or out of 
the way, they totally ignore its claims. It may seem a very trivial matter, but it is 
just one of those little things that the doctor notices. He cannot very well men- 
tion it, but he appreciates it if you pay attention to it. It just makes all the dif- 
ference between things working smoothly and going all wrong. Perhaps he is about 
to make a diagnosis on the fact that the urine is alkaline, when suddenly it dawns 
upon him that possibly it was a dirty utensil that had been used, and he realises 
what importance an apparently trivial circumstance may exercise on a question of 
life and death. 

Both mineral and vegetable acids, when taken largely, tend to raise the acidity 
of the urine, but their effect is inconsiderable. Urine that is habitually alkaline 



UEINAKY DEPOSITS AND WHAT THEY MEAlf 605 

cannot be rendered acid by the internal administration of acids in even very large 
quantities. Benzoic acid is probably the most powerful acidiner of the urine that 
we have, but carbonic acid gas taken in the form of soda-water has been found 
useful for this purpose. Alkaline substances have a much more powerful influence 
on the reaction of the urine, and you can deprive your urine of its acid reaction, and 
render it alkaline at pleasure. Bicarbonate of potash and bicarbonate of soda will 
do this for it. This is often a matter of importance to people who suffer from 
graveL 

Urine on standing often throws down a pinkish deposit. You may often find 
it at the bottom of your chamber, especially on a cold winter morning. If you 
empty some of your hot shaving water into it you will find that it will quickly 
disappear, and the same will happen if you put it before the fire, supposing that you 
are Sybaritic enough to have one in your bed-room. This deposit consists of what 
is known as urates or lithates. If you took the trouble to examine it under the 
microscope — which you will not — you would find that it was quite structureless, 
not crystalline, or anything of that kind. The deposit in the urine of lithates is 
no sign of kidney disease, but its frequent occurrence is to be regarded as an 
indication of liver disorder, arising from causes sometimes temporary, at others 
more or less permanent. Persons who enjoy the best of health are liable to 
deposits of lithates in the urine after a surfeit of food, or even after partaking 
moderately of one of the fashionable dinners of the age. When more food is taken 
into the system than is necessary for the maintenance of nutrition, much of the 
excess is thrown off by the kidneys, and appears in the urine in the form of lithates. 
But what in most people is an exceptional occurrence, the result of an extraordinary 
cause, is with others habitual, and almost a daily occurrence. Tliey either eat too 
much, the food being excessive in amount and unduly stimulating, or there is some 
innate power, perhaps hereditary, in the liver, in virtue of which its healthy action 
is liable to be deranged by the most ordinary articles of diet. Lithates in the 
urine are most likely to occur in people who live generously, take little exercise in 
the open air, and do a fair share of mental work. This condition is often associated 
with a feeling of weight or fulness at the pit of the stomach or over the liver ; an 
excessive formation of wind in the stomach and bowels; heartburn and acid 
eructations ; a feeling of oppression, and often of weariness and aching pains in 
the limbs, or of insurmountable sleepiness after meals, and a furred tongue, and a 
clammy, bitter, or metallic taste in the mouth, especially in the morning. All 
these symptoms are liable to occasional aggravation from errors in diet. Gradually 
the patient finds that he has to be very careful as to what he eats and drinks. 
One thing after another he is compelled to give up. First he renounces malt 
liquors, then he discovers that port, madeira, champagne, and burgundy disagree, 
and he takes to dry sherry ; but at length this does not suit, and after an interval, 
during which a trial is made of claret or hock, and brandy or whiskey largely 
diluted with water, the patient finds that he enjoys best health when he abstains 
altogether from alcohol, and drinks nothing but plain water. He probably under- 
goes a somewhat similar experience with regard to solid food, one dish after another 
being abandoned, until, at last, if he be a sensible fellow, he makes up his mind to 



606 INDICATION OF DISEASE. 



live plainly, and eschew the so-called pleasures of the table. As a rule, those 
articles of diet are most apt to disagree which contain much sugar or fatty matter. 
Generally, the digestion appears to be strongest in the morning, and the patient 
suffers from late dinners or suppers. So much for lithates in the urine. It is a 
condition of extremely common occurrence in this country, especially among the 
well-to-do, who can afford to eat more than is good for them. 

Sometimes you get blood in the urine, but that is not very common. Of course 
when you do get it it is a serious matter, especially when there is much of it. 
Sometimes there is such a lot that it clots spontaneously, straight off, and sometimes 
there is so little that it requires a high power of the microscope, and no end of a 
lot of learning, to detect it at all. You must not think because there is not much of 
it that it does not matter. Even if it wants a microscope to see it it is a bad 
business. Nobody should get blood in his urine if he can help it. Of course if you 
have just had an instrument passed on you, or anything of that kind, it is quite 
another matter, and you must expect a little bleeding. But when the blood comes 
by itself, without any rhyme or reason, it is time to go to the doctor and ask him 
what he thinks of it It may be due to many things — a stone in the bladder will 
produce it, and so will an injury of any kind. Sometimes it occurs in the course of 
certain constitutional diseases, such as scurvy, purpura, and so on. They do say 
that mental emotion will produce it, but we have never seen that. It probably 
wants a good deal of it. It maybe vicarious of other discharges; that is quite 
possible. You have had piles for a good many years, and have been in the habit of 
losing more or less blood from them every day. By-and-by you get hold of some 
clever young fellow who says he would like to cure your piles for you. You say, 
Very well, go ahead, and sure enough he cures them, but — there is always a but in 
these cases — you have no sooner got rid of the bleeding piles than you find there is 
blood in your urine. You go back to him and tell him, but he says it is no business 
of his, he is a specialist, a pure pile doctor, and if you want to have your urine set 
right you will have to go to another man, to whom he will be very happy to give 
you an introduction. There is one little point in connection with blood in the urine 
that we ought not to pass by without mentioning, and that is that in women at the 
menstrual period blood may accidentally become mixed with the urine. It is, of 
course, of no importance, although if one did not happen to think about it it might 
give rise to a good deal of anxiety. Blood in the urine, as we have already said, is 
no joke, but at the same it is no good worrying about it, and the only thing is to go 
to a surgeon and tell him that you expect him to make it all right for you. But if 
the bleeding comes on suddenly, or in large quantities, what are you to do ? Well, 
of course you must not bleed to death, although really there is very little danger of 
that. Still it is a thing to be avoided. You had better lie down and get them to undo 
your things — the less you do yourself the better — and clap a towel, rung out of cold 
water, on the lower part of the belly. If you can get some ice, do, and rub it well 
all round the part. If there is any astringent at hand, take it Gallic acid (Pr. 29), 
tannic acid, acetate of lead (Pr. 30), alum, tincture of hamamelis virginica 
(Pr. 45), turpentine, small doses of ipecacuanha wine (Pr. 50), or anything of that 
kind will do excellently welL If you cannot get anything else, a little vinegar-and- 



ALBUMEN IN THE URINE. 607 



water, or salt-and- water, is better than nothing. Do not worry yourself, you will 
not hurt. You had better send for the doctor, and then he will find out where the 
blood comes from, and all about it. Do not you let them persuade you to take any 
hot brandy-and- water, or anything of that kind, to keep you from fainting. If you 
want to faint, faint by all means — it will stop the bleeding ; but you are not to have 
alcohol in any shape or form, on any pretence whatever, for it will only bring on the 
bleeding worse. If you were never a teetotaler before, you will have to be now. 

Then sometimes you get albumen in your urine. That is another bad business. 
When there is blood in the urine there is always albumen, because blood contains 
albumen. You can't get blood without albumen, but you may have albumen 
without blood. Albumen is the same substance as white of egg. White of egg is 
composed of albumen. Albumen in urine does not make any difference in its appear- 
ance, for you must remember that white of egg before it is cooked is a clear glairy 
fluid, and you might mix almost any amount of it with urine without causing any 
alteration that you could detect by looking at it. If you have albumen in your 
urine, you probably won't find it out for yourself. Your doctor will do that for 
you. If the specific gravity of your urine is habitually below 1,015, it is not at all 
improbable that you have albumen in your urine. Albumen is present in the urine 
in Bright's disease. We will not give the tests for albumen now, but will reserve 
them till we speak of that complaint. The treatment of albumen in the urine will 
be guided by the complaint on which it is dependent. 

Sugar is sometimes found in the urine, and it constitutes the disease known as 
diabetes mellitus, or sugary diabetes. There are two kinds of diabetes, sugary 
diabetes and insipid diabetes; in the latter complaint the quantity of urine is 
usually very great and of low specific gravity, but it contains no sugar. 

Spermatozoa are occasionally found in the urine. They are of course micro- 
scopical. They are never seen in motion in the urine. This is a positive fact. If 
you are ever stupid enough to fall into the clutches of a quack, and he tries to 
frighten you by pretending to show you living spermatozoa in your urine, tell him 
that you know better than that. He has probably got them from paste and vinegar, 
or something of that kind. It is an old trick, but it is still often practised by these 
scamps with the view of playing upon the fears of their unfortunate victims. If 
you see anything in motion in your urine, or in anybody else's urine, you may be 
sure that it is not spermatozoa, for urine kills them straight off. 

Sometimes the urine is passed quite white, just like milk. In this country cases 
are rare, but it prevails epidemically in the West Indies, the Mauritius, and India. 
The majority of cases met with in Europeans are found among sailors, merchants, 
colonists, and others who have passed a portion of their lives in one or other of these 
countries. 



PAIN. 

This feeling is quite indefinable, and can be known only by those who have felt 
it. There are many different kinds and degrees of pain. Different kinds of disease 
are accompanied by different kinds of nam, and the same disease may produce 



608 INDICATION OF DISEASE. 



different modifications of pain, according as it affects different parts. Thus the pain 
that belongs to inflammation of the lungs differs from that which is felt in 
inflammation of the bowels. Then, again, pain differs not only in its kind and 
degree, but in its mode of recurrence. Thus it may be fugitive or persistent, wan- 
dering or fixed, intermittent or continued. In its different grades it is slight, 
moderate, severe, violent, intense, excruciating, or agonising. Different epithets are 
given to the different varieties of pain, persons endeavouring to explain how they 
feel by likening their sensations to something which they have felt before, or fancy 
they have felt. Th us we hear of sharp pain, shooting pain, dull pain, gnawing 
pain, stinging pain, tearing pain, and so on. When attended with a beating sen- 
Bation, consequent upon the heart's action, it is called pulsating or throbbing, when 
attended with a feeling of weight it is described as a heavy pain, and when with 
heat as a burning pain. If pain be felt in a part only when it is touched it is said to 
be tender. A part may be both painful and tender, or painful without being tender, 
or tender without being otherwise painful. There are also peculiar sensations, such 
as itching, tingling, and pricking, which, in excess, become positively painful, though 
they might not be considered so in their slighter degrees. We have seen that 
pain is sometimes wandering or sometimes fixed. Wandering or flying pains are 
generally nervous or neuralgic in origin, wLJst inflammatory pains are commonly 
fixed ; but the distinction is by no means constant. 

Pain often is felt not in the part really affected by disease, but in some distant 
part. Thus inflammation of the liver causes pain in the right, shoulder, inflammation of 
the hip-joint excites pain in the knee, disease of the heart is often attended with 
pain running down the left arm, and many headaches result from irritation of the 
stomach. We call this indirect or sympathetic pain. 

It may be observed of pain in general that it is differently felt, or at any rate 
differently complained of, by persons of different constitutions and temperaments. 
Different people have very different degrees of sensibility, and feel with different 
degrees of acuteness. Some are but little sensitive to painful impressions of any 
kind, whilst others suffer intensely from slight causes. There are individuals who 
say that it hurts them very little to have a tooth out. It has been stated that there 
are even national differences with respect to the power of bearing pain. In surgical 
operations, before the introduction of chloroform, it was observed that the Irishman, 
generally speaking, felt more acutely, and gave freer vent to his feelings in cries 
and exclamations than the Scotchman, who most commonly preserved a resolute 
sdence. 

In judging of the degree of pain in any particular instance, one cannot always 
be guided by the statement of the sufferer. Very different meanings are often 
attached to the same words by different individuals, and some have a habit of em- 
ploying terms of exaggeration for all their feelings. One must be guided more by 
the tone of voice and expression of countenance than by what is said. If a person 
tells you with perfectly composed feelings and a calm, equable tone of voice that he 
is suffering " excruciating pain," you are justified in estimating its severity greatly 
below the real value of the term. 

In complaints associated with low spirits and hypochondriacal feelings, the pain 



THE RELIEF OF PAIN. 609 



often depends in a great measure on the eager attention that is paid to it. Accounts 
given by people who are always ailing must be taken with a grain of allowance. 
One often meets with people, lazy, selfish, hypochondriacal, always complaining, but 
never really ill. They take it as an offence if you do not seem to implicitly credit 
what they say ; and yet if you cannot convince them that much of what they suffer 
depends on their undue attention to it, they will never get well. They often cease 
to feel pain, or, at all events, they forget to think of their complaints when their 
attention is engaged by conversation, music, or otherwise. Powerful excitement, 
a loss of income, for instance, or any great mental or moral shock, often does them 
a world of good. We must admit that nothing short of an earthquake would move 
some people. 

Fortunately, the means at our disposal for the relief of pain are neither few nor 
uncertain in their action. We can often assuage pain when we cannot cure the 
disease on which it is dependent — for example, in cancer of the womb or breast. 
There is no pain more dreadful or more dreaded than that attendant on surgical 
operations, and yet even that has its specific antidote. By merely breathing for a 
few minutes an invisible gas, the corporeal sensibility is laid aside, and the knife 
executes at leisure and unfelt its terrible but salutary work. When we consider 
what ether, and chloroform, and nitrous oxide have done for us, and what they will 
do in the future, the vast amount of torturing pain that has been spared to thou- 
sands, and the pain that countless generations yet unborn may escape, we cannot 
help feeling grateful for so merciful a boon conferred on suffering humanity. Then, 
again, in opium and its active principle, morphia, we have the means of relieving the 
most agonising pain of disease, and substituting for it a calm and refreshing sleep. 
Our specific remedies for neuralgia are, as we shall presently see, neither few nor 
impotent. Every day adds to their number, and to our knowledge of the indication 
for their a dmini stration. A few years ago bromide of potassium, phosphorus, and 
gelseminum were practically unknown ; nowadays we recognise their worth, and 
are enabled by them promptly to relieve many a case of acutest suffering. 



FACIAL EXPRESSION AS AN INDICATION OF ILLNESS. 

This often affords valuable information in the treatment of disease, and should 
be carefully studied by all who have to do with the sick. The power of observing 
is a great gift. Occasionally, as in cases of insensibility, it affords almost our only 
means of detecting the nature of illness. By its means we recognise the existence of 
pain, of mental anxiety, of depression, or even insanity, when other signs are either 
wanting, obscure, or not available. In the case of children, the demented, and 
persons who may be disposed to deceive us, it is a peculiarly valuable resource. A 
doctor nearly always places his patient in a chair facing the window, so that he may 
watch the play of his features. Many diseases are attended with a characteristic 
aspect of countenance, which will often be quickly recognised by the experienced, so 
far at least as to suggest the disease in question By a glance it is often possible to 
ascertain whether our patient has changed for the better or worse since the last visit 
39 



610 INDICATION OF DISEASE. 



This power is attainable only by experience and close observation. To most doctors 
it comes almost unconsciously. It is one of the highest forms of tact. The 
modifications and combination of features which constitute expression in disease 
can be learnt only at the bedside. They are too numerous, too intricate, too 
delicate, too subtle, and too evanescent to admit of description. 

But there are certain changes in the face of a more tangible character, connected 
rather with the bodily function than with the action of the mind, which can be 
readily and accurately appreciated. The colour, shape, and various movements, 
independent of expression, often yield important information. Walk through a 
street of a crowded city, and watch the countenances of the people as they hurry by, 
and you will be surprised to find how much you can learn about them and their 
complaints, mental and physical. Look at that man with his fat, red, bloated face, 
and you have no difficulty in recognising drink. You know that in course of time 
he will get liver or kidney disease, and will die of dropsy. Look at the tall, thin, 
pale girl carrying a big bandbox. See how anemic she is. You know she is 
over-worked and badly nourished ; you know that hers is a lot of toil, and "that a 
holiday, a day in the country, a glimpse of the bright sunshine, and the fresh fields 
and flowers, is to her unknown. You know that she is not regular, that her 
appetite is poor, her bowels confined, and that she often suffers from neuralgia and 
sick-headache. 

Paleness has its significance. It may be due to anaemia, debility, or nausea, and 
some other conditions. There are different kinds of paleness having different 
meanings, as the paleness of consumption and that of cancer. Yellowness of the 
face, or jaundice, as we all know, points to some morbid condition of the liver. A 
bright red colour of the cheeks signifies one thing, and a dark red, purple, or violet 
colour another, and often the very reverse. In the former case the blood is duly 
arterialised by the lungs, and pumped up vigorously into the head by t*he heart ; in 
the latter, the heart is acting feebly, and the organs of respiration are performing 
their functions imperfectly. The colour of the lips is peculiarly expressive in its 
different tints of crimson, purple, and pallor. The features may be full, swollen, and 
turgid, or they may be shrunken, contracted, and fallen, in the one case indicating 
congestion, and in the other exhaustion and prostration. 

Coldness of the ears and tip of the nose may indicate the approach or presence 
of a chill, when other symptoms are wanting and ambiguous. In children, coldness 
of the cheeks, nose, and ears may enable us to decide upon the necessity for adminis- 
tering a stimulant when other symptoms might leave us in doubt. The flushings 
of the face, from which many middle-aged women suffer, are so common as to be 
familiar enough to most people. 



NURSING AND THE CAEE OF THE SICK. 

General Qualifications and Duties of a Nuese : Age— Strength— Dress— Attention— Reticence— 
Management of the Sick Room : Ventilation— Temperature— Disinfectants — Light — Quiet— 
Pkactical Details : Beds — How to Make and Change — Invalid Bedsteads and Cushions— Bed 
Sores, how to Avoid and How to Cure — Cleanliness an Essential — Bed Frames — Curtains — Bed Rests 
and Tables — Invalid Carriages and Chairs — How to Undress a Patient and put him to Bed — Adminis- 
tration of Medicine : Pills, Powders, &c. — Enemata — Suppositories — Lotions — Fomentations and 
other External Applications — "Warm Baths — Vapour Baths — Invaldd Diet : General Directions — 
Special Recipes — Points to which a Nurse's Attention should be Directed. 

GENERAL QUALIFICATIONS AND DUTIES OF A NURSE. 

The treatment of disease in the present day does not merely consist in the dosing of a 
patient with nauseous drugs. The wholesale drugging which was the chief characteristic 
of the medical care bestowed by our ancestors upon their sick relatives and friends — 
strong or weak, children or adults — is happily a thing of the past ; and although we 
should do wrong not to make use of the very many most valuable and indispensable 
remedies which modern science has placed at the disposal of the medical profession, 
we should at the same time remember that the nursing of the invalid is scarcely 
of secondary importance. For all diseases, the rule of treatment should be as 
follows : — 

1. So to arrange the surroundings of your patient that nature may have fair 
play in the struggle with disease. 

2. To administer remedies, or, in other words, to call art and science to the 
assistance of nature. 

The direction of both these departments of treatment is entrusted to the medical 
man. The work of carrying out the details of treatment is divided, that of the 
former department devolving on the nurse, and that of the latter mainly on the 
doctor himself. 

Nursing must and ought to be considered as a profession. No one, it may 
safely be said, is a nurse by nature ; and it is no more possible to know nursing by 
intuition than it is possible to acquire the dexterity of a Reynolds or a Pagan irti 
without years of patient and laborious practice. 

It is the commonest thing to hear a lady say, " But you know I am such a 
capital nurse ! " and in nine cases out of ten we shall be safe in inferring that those 
who make assertions of this kind have in reality no notion whatever of that 
concerning which they talk so glibly. 

"We remember hearing a story of a countryman who took his eldest son to one 
of the great London builders, with .the view of getting employment for his boy in 
the great man's building-yard. 

" Has your son any knowledge of carpentering % " was the first question asked. 

" Oh yes, sir," was the reply, " and very clever he is at it" 

"What can he doT' 



612 NURSING AND THE CARE OF THE SICK. 

" A'most anything, sir. He's never happy but what he's making something." 

" Oh, indeed ! Now, can he make a panel-door 1 " 

Since the youth who was the subject of this conversation was a country lout of 
sixteen years, it is needless to say that an answer was returned in the negative. 
Nevertheless, the boy was apprenticed, and having no little natural aptitude, he 
became, when his education was complete, a first-rate workman. 

So it is with many of these persons who have a supposed natural aptitude for 
nursing. Were one to question them, and ask, " How do you make and apply a 
poultice ? " or " How do you change the bottom sheet 1 " they would probably be 
unable to return a satisfactory answer. Nevertheless, with a little patient study 
of the subject, and after proper tuition under the superintendence of a skilled 
professional nurse, they might in most cases become adepts in the art of tending on 
the sick, and of ministering to and anticipating their various wants in a way which 
they could never have found out for themselves. 

Nursing is essentially a practical matter. There is no theory in nursing, and 
there is not much that can be learnt from mere reading. It is essential that 
every one who intends to make nursing the business of life should obtain practical 
experience in a public hospital, or other similar institution, and under the guidance 
of some one, with the double authority of position and knowledge, to correct errors 
and give all necessary instruction. It is very generally recognised now that nursing 
is women's work par excellence, and signs are not wanting that ladies of the middle 
classes will be forthcoming in large numbers to receive instruction at least, even if 
they go no further, of the most systematic kind, and if they find it necessary to turn 
that instruction to practical uses. 

"We may be expected to give some notion of the personal and physical qualifica- 
tions which are necessary for the making of a good nurse. Such a task, however, 
is by no means easy, for, after we have enumerated those qualities which no nurse 
should be without, we feel that we must still leave undescribed that indescribable 
something which some people call tact and others manner, the possession of which 
will make a good nurse out of materials which are physically unfavourable, and the 
absence of which will mar a paragon of strength, prudence, and intelligence. With 
many nursing is, unhappily, a matter of necessity and not of choice. In dealing 
systematically with the subject of nursing, it is necessary to set the highest standard 
— viz., that of a carefully-trained professional nurse — before the reader's eyes, to 
which all may at least try to attain. The reader must bear in mind, however, that 
there is no essential difference between hospital nursing and home nursing; and that 
the rules we have laid down are applicable alike to the trained nurse in a public 
institution or the amateur who is trying her best to perform a sacred duty in the 
domestic circle. 

A nurse must be strong. Her occupation is an unhealthy one, and involves 
confinement to the house, loss of rest, and other hardships which a robust 
constitution is alone able to stand. A delicate woman — one who is liable to " knock 
up " at slight causes — is not fit to become a nurse, and if she be wise she will not 
make the attempt, but will choose some other employment more suited for her 
constitution. 



NURSING PROPER AGE. 613 



It is a great advantage to a nurse to be rnuscularly strong, for she has often to 
deal with heavy, helpless patients ; but muscular strength need not be looked upon 
as indispensable, provided she be constitutionally strong. She must not be too big. 
A heavy lumbering woman is an annoyance in the sick-room. She ought to possess 
great activity of mind as well as body, and be quick to apprehend, quick to perform. 
Manipulative dexterity is a great advantage, and in this respect nurses differ 
immensely, for one will dress a patient completely while another is fumbling with a 
couple of buttons. For those who are compelled by circumstances to be nurses, but 
who unfortunately are not muscularly strong, it is important to recognise their 
deficiencies. They must relegate to others the hard work for which they are not 
suited, and endeavour so to husband their strength that the invalid shall not be 
deprived of their superintendence and necessary control. 

Mentally she should have a calm, equable temperament ; not given to flurry and 
unnecessary haste, but able to perform her allotted tasks with no needless delay, with 
the most careful attention to detail, and without noise or demonstrative activity. 
She should ever have — without seeming — an eye of pity for every sign of suffering, 
while at the same time no visible grief or alarm should be detectable in her coun- 
tenance. It is well known that the cheerful face of a nurse is always pleasant to a 
patient, and it cannot but be reassuring and conducive to occasional forgetfulness of 
suffering and distress. 

Relatives — on whom of course in most cases the duty of nursing naturally falls- - 
always make worse nurses than who have no such tie to the patient, and especially 
so if they have had no previous training. They cannot be expected to regard with 
the necessary calmness the suffering of one to whom they are tied by bonds of 
friendship and consanguinity, and there is nothing more trying to an invalid to see 
constantly around his bed the too-anxious countenances of his family, the doleful 
expressions of which are often the cause of a needless and mischievous sensation of 
alarm. Again, relatives have not the necessary control over patients; and one often 
sees the strength of an invalid wasted by little peevish family squabbles over food 
or medicine, which would have been taken without question if offered to him by a 
nurse with authority on her side. Invalid children are proverbially naughty and 
perverse with their parents, and invalid parents are usually unwilling to be controlled 
in the least degree by their children. 

A nurse should not be too young, especially if she intends to devote herself to 
general nursing and the care of either sex. Miss Yeitch, whose " Handbook for 
Nurses for the Sick " is well worthy of careful perusal, thinks that between twenty- 
five and thirty is the proper time for a woman to begin her training. " I think," 
says this authoress, "those women who do not begin hospital work until after twenty- 
four years of age stand the strain upon their health better, and for a greater number 
of years." 

Women who think of taking up nursing as a" calling " should remember that 
the work required of them is often of a most unpleasant kind, and that whatever 
duties come in their way it will be their duty to perform them without flinching. 
Nothing connected with a sick person is to be relegated by the nurse, be she born a 
lady or a peasant, to another with less experience. The duty of nursing is a sacred 



614 ITURSTNG AND THE CARE OF THE SICK. 

one, and there must be no shelving of responsibilities, no shirking of unpleasant 
duties. A nurse cannot be too highly educated. A cultured mind is always a 
blessing in a sick-room. If the patient be a person who has received a high 
intellectual training, he will appreciate similar qualities in those about him, and if, 
on the contrary, the patient is one of the lower orders, it will be found that the 
influence of education is always what the poet has declared it to be — 

" Ingenuas didicisse fideliter artes 
Emollit mores, nee sinit esse feros." 

Nursing is not to be undertaken from any sentimental motives ; from any notion 
of becoming like the " Guardian Angels " of the novelist. Such an idea must end 
in disappointment, for it will be found that the really sick have but a poor appreciation 
of sentiment, and that the routine duties of the sick-room are monotonous and 
tiresome, and such as leave but scant time for indulging one's imagination or 
poetic feelings. 

How should a nurse be dressed? She should be scrupulously clean, both for 
her own safety and for the sake of those with whom she comes in contact. Her 
dress should be simple, with no needless trimming, but by all means let it be 
becoming, and " not expressed in fancy." Many ladies who take to nursing think it 
necessary to assume the most hideous garb imaginable. If the exigencies of religion 
necessitate this course, we regret our inability to argue the case, but on medical 
grounds we feel quite sure that the dress of an attendant on the sick should be 
simple and becoming, and not such as will excite the wonder, the fear, or the 
risibility of a patient. The dress should be just long enough to clear the ground, 
and should be made of printed calico, or some other washing material, of a light 
colour and a smooth surface. Moreover, it should be frequently washed. Some of 
the nursing sisterhoods adopt a robe made of black flannel with long hanging sleeves. 
Nothing can be imagined more ill-suited for a nurse's dress. The blackness of it pre- 
vents the ready detection of dirt, the rough surface and absorbent texture is ready to 
catch and suck up all disease particles, whether dry or liquid, and the dangling 
sleeves and floating stole and girdle are certainly likely to hitch in every projecting 
object, and as they fulfil no useful purpose, it is difficult to see why they should be 
retained. Some of these lugubrious dresses are worn, too, for as long a period as were 
the hair shirts of the mediaeval hermits. And we are sorry to say that we have 
heard a sister boasting of the grimy penance to which she had subjected herself for 
more than six months. 

It is to be regretted that ladies who perform their duties with so much zeal 
and with the highest possible intelligence, should run the risk of marring much 
of the effect of their good deeds by adhering to a fashion of dress which ought to 
have died out with the Middle Ages, and before the dawning of the science of 
hygiene. 

A nurse should wear a neat cap, and should be careful to have shoes which 
are quiet and do not creak. A pair of scissors and a pin-cushion carried from 
a girdle will be found also of the greatest service. It is customary with many 
nurses to carry with them a small pocket case filled with instruments, such as 



NURSING THE DIARY. 615 



scissors, dressing forceps, caustic holder, tongue depressor, and so forth, but thia 
is unnecessary, except perhaps under exceptional circumstances. 

A nurse should always keep a diary of everything that passes in the sick- 
room, taking care to record every little event at once. In this way she will 
greatly assist the medical man, and will be the means of saving much valuable 
time. Every action of the bowels, every administration of food, and every dose 
of medicine should be carefully noted down. The following are samples of the 
kind of reports which a professional nurse would be expected to keep : — 
Night Eeport — April 10th, 1876. 

9.0 p.m.— -Subcutaneous injection of one- sixth of a grain of morphia. 

Sound and refreshing sleep from 9.30 to 12.30. 

12.30 a.m.— A small tea-cupful of arrowroot was administered. 

This was followed by free perspiration. 

Very restless till 4 a.m., when there was a copious loos© action of the bowels* 

4.30 a.m. — A dose of medicine. 

Slept tranquilly from 5 till 7 a.m. 

Coughed two or three times during the night. No expectoration. 

Day Report— April 11th, 1876. 
9.0 a.m.— Temperature 103° '4. 
9.30 a.m. — Loose action of the bowels. 

10.0 a.m. — Four ounces of beef tea, with six drachms of brandy, administered. 
11.0 a.m. — Medicine. 
11.15 a.m. — Loose action of the bowels, 
12.25 p.m.— Ditto. 
12.30 p.m. — Beef tea and brandy. 
1.0 p.m. — Another action of the bowels. 

Complained a good deal of pain in the abdomen. 
2.15 p.m. — Bowels acted again. 
2.30 p.m. — Starch and opium enema, as ordered. 
3.0 p.m. — Cup of arrowroot with six drachms of brandy. 

Dozed almost continuously till 7 p.m , when medicine was administered and a draught 
of TtiilTf and soda-water was taken. No cough to-day. No perspiration. 

To keep such a record as this would naturally require a high standard of 
efficiency, and indeed it could be done only by a thoroughly trained professional 
nurse. But the principle of the thing, which is what we wish to insist on, holds 
good throughout ; and even in the domestic circle each occurrence in the sick-room 
should be recorded at once. There must be no trusting to memory, for in case of 
forge tfulness justice may not be done either to the patient or his medical attendant. 

Thus— 

April 12th, 1876. 
9.0 a.m. — Breakfast — egg, dry toast, tea. 
10.30 a.m. — Bowels acted naturally. 
11.0 a.m. — Medicine, and a cup of beef tea. 
2.0 p.m. — Dinner — minced chicken, custard pudding, one glass of port wiaa. 

Dozed till 4. 
5.0 p.m. — Mrs. A. called and stayed half an hour. 
fi.30 p.m. — Medicine. 

Slight pains in the bowels. 
7.0 p.m. — Cup of anowroot, with two table-spoonfuls of brandy 
Slept soundly all night. 



616 NURSING AND THE CARE OF THE SICK. 

The preceding may be looked upon as fair samples of the kind of record which 
it is advisable to keep, but no nurse will be quite expert at this part of her 
duty until she has had a great deal of experience, and begins to be tolerably 
well acquainted with the course and the most characteristic phenomena of 
different diseases. A nurse who watches the course of a case continuously will 
have every symptom which the patient presents forced upon her attention, and 
whatever strikes her attention it is her duty to co mmuni cate it to the medical 
attendant. One nurse will say, "I heard the patient cough once this morning;" 
and this information may be the means of directing attention to, and ensuring 
the early treatment of some complication of the lungs ; or if the cough has been 
due to some little passing irritation of the throat, no harm will have been done 
by mentioning it, and the nurse will have done her duty. Another nurse, after 
grave lung mischief has declared itself, will say, " Oh, I heard him cough a little 
two nights ago, but I thought it was nothing" This nurse will not have fulfilled 
her duty, and her reticence may have lost her patient some hours of early treat- 
ment; and it should be borne in mind that it is always easiest to grapple with 
a disease while it is in its earliest stages. 

Never talk unnecessarily to a patient. "We do not mean by this that a nurse 
is to abstain from holding conversation with a 'chronic invalid, but we wish 
our caution to apply particularly to those who have the care of acute invalids, to 
whom talking is an effort, and with whom anything like argument is quite out of 
place. If food or medicine is to be given, let the portion or the dose be prepared, 
and when ready offer it to the patient as if there were no question that he were 
going to take it. Never say, "Will you take this, or try that? " or, "Shall I get your 
medicine now?" or put similar questions. There is no use in doing it, and if the 
invalid raise objections, as is often the case, the necessity for argument arises, 
which is a thing always to be avoided. Inexperienced nurses are very apt to 
pester and bother a patient with incessant sympathetic questionings, " Are you in 
pain now, dear 1 " " Does your head ache ? " " Are you lying comfortably 1 " " Will 
you have the door open ? " and so forth. This is bad. The good nurse will watch 
a patient, and will be quick to detect any complaint or sign of discomfort, but 
her sympathy will show itself in some action designed to remedy what is amiss, 
rather than in misplaced expressions of pity. 

Miss Veitch, in her valuable little work, gives such good advice, that we shall re- 
produce a part of it verbatim. She says, " I would give one important caution 
to nurses, that is, to guard well their tongues. The tongue is an unruly member, 
and the wise man said, * In the multitude of words there wanteth not sin ; ' 
though it is not always necessary that there should be a multitude of words to 
do mischief It is the great weakness of women generally that they must talk, 
whereby they often do serious harm. Nurses, from the peculiarity of their relations 
to their patients, often become possessed of information regarding them which 
ought to be considered perfectly sacred, never to be breathed to human ear, and 
yet, alas ! how often does the temptation to tell a secret overcome the sense of 
honour and duty in this case, and these matters become the conversation of 
gossiping women. Nothing must be withheld from the doctor that can affect the 



NURSING VENTILATION OF THE SICK-ROOM. 617 

patient's interest, but beyond him the nurse had better never speak of her patient 
except in that general way which can hurt no one, and even then take care that 
she does not indulge in what is called 'harmless gossip.' (Is gossip ever harmless? 
If it does not hurt the hearer, does it not injure the speaker?) Many people 
seem to consider they may ask questions of nurses about their patients which 
they would not dare to ask the sick person or his friends; therefore nurses must 
be on their guard not to be led to say anything which, were they in the patient's 
place, they would not like said of themselves. There is great wisdom in the 
saying, ' Put yourself in his place.' If his nurse would always do this, her 
patient would seldom have to complain of either her deeds or her words. Many 
people — women particularly — are selfish from want of thought, rather than from 
want of heart, and I know of nothing, after principle, which is so likely to check 
selfish thoughtlessness than to endeavour to change places in thought with our 
neighbours ; and I honestly believe many women gossip from mere thoughtlessness 
rather than to gratify ill-natured feeling. A patient ought to be able to look to 
his nurse as his best friend for the time being, and to feel that everything con- 
cerning his most private life is as safe with her as with himself" 

MANAGEMENT OF THE SICK-ROOM. 

Ventilation. — Miss Nightingale, in her " Notes on Nursing," says, " The 
very first care of nursing, the first and the last thing upon which a nurse's 
attention must be fixed, the first essential to the patient, without which all the 
rest you can do for him is as nothing, with which I had almost said you may 
leave all the rest alone, is this : to keep the air he breathes as pure as 
the external air without chilling him. Yet what is so little attended to ? 
Even where it is thought of at all, the most extraordinary misconceptions reign about 
it. Even in admitting air into the patient's room or ward, few people ever think 
where that air comes from. It may come from a corridor into which all other 
wards are ventilated ; from a hall, always unaired, full of the fumes of gas, dinners, 
of various kinds of mustiness from an underground kitchen, sink, wash-house, 
water-closet, or, even as I myself have had sorrowful experience, from open sewers 
loaded with filth; and with this the patient's room or ward is aired, as it is 
called — poisoned, it should rather be said. Always air from the air without, 
and that too from those windows through which the air comes freshest ! From 
a closed court, especially if the wind does not blow that way, air may come as 
stagnant as from any air in corridor." 

Miss Nightingale goes on to say that a man does not catch cold in bed, and 
that it is quite possible to open the windows and to keep him thoroughly warm 
at the same time ; and in a foot-note she adds, " With private sick, I think, but 
certainly with hospital sick, the nurse should never be satisfied as to the freshness 
of their atmosphere unless she can feel the air gently moving over her face when 
still" 

There can be no doubt that the eminent authoress whose remarks we have 
quoted is right in the main, and that a sick man cannot breathe too pure an 
atmosphere; but we dissent entirely from the last remark, and we should rather 



618 NURSING AND THE CARE OP THE SICK. 

say that directly a nurse when standing still can feel the air beating on her face, 
she ought to recognise the fact that a draught has been created, and to the 
majority of sick a draught is in the highest degree dangerous. A sick-room 
ought always to be so fresh that a person coming from the outside should be 
unable to recognise any feeling of closeness or any improper smell, but a nurse 
should be taught that when an open window is impossible, either from the state 
of the weather or the condition of the patient, that there are ways of ventilating 
a room without creating a draught. 

If the bottom sash of the window be pulled a little upwards, and a piece of boara 
or a sand-bag be inserted between the bottom of the sash and the sill, the air will 
enter at the opening left between the junction of the two sashes, and the in-coming 
current will travel upwards to the ceiling, and not laterally in any way. In this 
way there will be a constant renewal of the air, but no draught will be possible. 

A careful nurse will always be on her guard, not only to admit fresh air from 
without, but also to keep the air of the room as pure as possible. Nothing that 
can foul the air should be allowed to remain in the room longer than is absolutely 
necessary. All the excretions of the patient are to be removed with as little delay 
as possible. No cooking is to be carried on if it can be avoided, and all pungent 
liquids, such as brandy, wine, or medicine, should be kept in some adjoining room. 
If food or stimulants be spilt upon the bed-clothes, they should, if possible, be 
changed, for nothing is so antagonistic to appetite as the sickening smell of spilled 
wine, brandy, or beef tea. The room should be kept clean, and in order that it may 
be kept as clean as possible with the least amount of trouble, it is always advisable 
at the beginning of an illness to disencumber it as far as possible of all superfluous 
furniture. Carpets, bed-hangings, heavy window curtains, wardrobes filled with 
wearing apparel, should, as far as possible, be removed. A few strips of carpet by the 
bedside and in front of the fire give an air of comfort, and if these can be thoroughly 
shaken out of doors every day there is no harm in retaining them. The room should 
be thoroughly swept and dusted every day, and a good nurse will manage to effect 
this almost without attracting the attention of the patient. It is necessary that this 
should be done, and none but a bad nurse will neglect it. Pastilles and strong 
scents are to be employed as little as possible, and if a room be kept clean this will 
be seldom necessary. A few flowers growing in pots are a cheerful addition to 
the sick-room, and the pleasant scent of them — if not too strong — is agreeable to the 
patient. Such strong-smelling flowers as hyacinth, magnolia, gardenia, or orange- 
blossom should not be used. 

A small folding screen, three or four feet in height, is an almost indispensable 
piece of furniture in the sick-room. It serves to keep the draught off at such times 
as it is necessary to open the windows. It screens the patient from the fire, and is 
a great protection when he is well enough to get out of bed, either to sit in a chair, 
or to obey the calls of nature. 

Some people have a prejudice against " night air," and erroneously think that it 
is to be excluded at any price. Such a notion arises from ignorance ; and if the 
windows be kept open in the manner we have directed, they may be left so throughout 
the whole of the night. 



HURSING. TEMPERATURE — DISINFECTANTS 619 

The sick-room should be a large one, not only because the patient never leaves it 
night nor day, but because the air of it is consumed by his nurses and other 
attendants, besides himself. Directly a patient is well enough to be left alone at 
night, he should be so left, because the air of a room occupied by one person will 
keep fresher than when occupied by two. Excepting when a person is very seriously 
and acutely ill, it is always advisable that the night nurse should remain in an 
adjoining room rather than in the sick-room, provided that the patient has ready 
and certain means of communicating with her. 

A very capital method of communicating with a nurse in an adjoining room is 
by means of a pneumatic communication, which consists of a long india-rubber tube, 
terminating at one end in a whistle, and at the other in a compressible air-ball. 
When the air-ball is squeezed the whistle sounds. Now if the air-ball be placed on 
the pillow of the invalid, the tube being fastened to the bed-rail with a tape, the 
tube may be taken out of the sick-room and any reasonable distance to the room of the 
nurse, the whistle being secured to the head of the nurse's bed, and as close to the 
nurse's ear as may be deemed advisable. By this method the patient is enabled to 
communicate with his nurse without any appreciable effort on his own part. If the 
patient be less ill, a communication may be established by means of a cord tied round 
the nurse's wrist, or even the medium of an ordinary bell may be sufficient. 

Temperature. — In this country it is almost always necessary to have a fire in a sick- 
room. A fire gives warmth, and it also assists ventilation very materially. The fire 
should be brisk with a bright flame. A sluggish fire backed up with cinders and 
ashes is of very little use for ventilation. A thermometer should always be kept in a 
sick-room, and it should be placed as near the centre as possible. The temperature 
should not be lower than 60° Fahrenheit, and in many cases, especially of lung 
disease, it is deemed advisable to have the temperature considerably higher. A 
thermometer is obviously the only safe guide to temperature. The feelings of the 
nurse or the patient are of little use. It is very important not to let the fire go out 
or get too low during the night or early morning, which is the coldest time of the 
four-and-twenty hours. Many a patient with bronchitis has been killed by the 
negligence of his nurse in this respect. 

Disinfectants. — A nurse who is duly careful to keep the sick-room well ventilated, 
thoroughly clean, and properly warm, is of inestimable value. Disinfectants are not 
to be incnscriminately used in a sick-room. If they be ordered by the medical man 
(as, perhaps, in cases of scarlet fever), it is all well and good, but it should be borne 
in mind that, except in cases of infectious fever, there ought to be nothing in a sick- 
room to disinfect, and the employment of strong smelling fumes or liquids is generally 
an indication that the nursing has been at fault to have allowed the necessity for their 
use to have arisen. There are cases, of course, of foul discharges from the body 
which require the employment of chemical deodorisers, but even these cases, since 
the introduction of the antiseptic method of treating wounds, are now of far less 
frequent occurrence than formerly. There are few disinfectants which have not 
some odour of their own, and any artificial odour of this kind is too apt to mask 
some other smell which would otherwise serve as a warning to a nurse to open a 
window or adopt some other means of purification. 



620 MURSING AND THE CARE OP THE SICK. 

A sick-room should not be unnecessarily darkened. It sometimes happens that 
an invalid cannot bear the light, or that it is desirable to encourage repose in every 
way, inclusive of shutting out the light, but if no good cause to the contrary exist, 
daylight should be freely admitted. Daylight is cheerful, and its free admittance to 
every corner of a room is conducive to cleanliness. There can be little doubt also 
that daylight is necessary for perfect health, and that under its influence nutrition is 
more active. If a sick-room be kept too dark, as very often is the case, it soon 
becomes very difficult for the occupant of it to bear the light at all, and he becomes 
markedly sensitive and delicate. 

Light. — At night time it is generally advisable to burn a light, but it should be 
remembered that a light fouls the air of a room as much as a living being, and that 
the presence of a nurse and a light in a sic^-room, in addition to the patient, is quite 
a serious tax upon its power of proper ventilation. A night-light should be as small 
as possible, and should burn a very small flame. It should be looked upon rather as 
a means from which a proper light may be obtained in case of necessity, than as a 
regular source of illumination for the room. A gas-jet turned to its lowest is the best 
form of night-light. Failing this, any of the ordinary night-lights answer the 
purpose admirably. 

Although the daylight is not to be excluded during the day, care must be taken 
that it is not too obtrusive in the early morning during the summer months. It 
very often happens that invalids who are restless during the early hours of the night 
begin to fall asleep and to doze about four o'clock in the morning, and it is on all 
accounts important to take care that the early sunlight does not disturb the precious 
morning slumber. 

Miss Nightingale has some very pertinent remarks on the '* Petty Management * 
of the sick-room. It is very important for a nurse to fully recognise the fact that 
she cannot always be with her patient. It is greatly to the advantage of the patient 
that the nurse keep in good health, and it is therefore incumbent upon her to 
arrange for proper rest, and for a due amount of exercise. In making these 
arrangements, however, she must be careful really to place some one in charge during 
her absence, and to see that the person in charge is duly instructed as to the proper 
course to pursue. It is during the absence of the nurse that injudicious visits are 
often paid to patients, and they become tired out by conversation. A really good 
nurse will always foresee the possibility of these little contretemps y and will as far as 
possible guard against them. " How few men or women," says Miss Nightingale, 
" understand either in great or in little things what it is the being in charge — I mean, 
know how to carry out a charge ! . . . To be in charge is certainly not only to 
carry out the proper measures yourself, but to see that every one else does so too ; 
to see that no one either wilfully or ignorantly thwarts or prevents such measures. 
It is neioher to do everything yourself, nor to appoint a number of people to each 
duty, but to ensure that each does the duty to which he is appointed. This is the 
meaning which must be attached to the word by (above all) those " in charge n of 
sick, whether of numbers or of individuals (and, indeed, I think it is with individual 
sick that it is least understood). One sick person is often waited on by four with 
less precision, and is really less cared for, than ten who are waited on by one ; or, at 



NURSING QUIET ESSENTIAL. 621 

least, than forty who are waited on by four ; and all for want of this one person ' in 
charge.' " 

A sick-room should be quiet. — This is universally admitted, and extraordinary 
precautions are often taken to insure quietness. The straw in the street and the 
muffled knocker are the familiar insignia of sickness. Sudden startling noises are 
the ones which annoy the sick most; while, on the other hand, it is astonishing 
how little the patients in some large hospitals heed the inevitable noise which is 
incessantly going on both within and without. 

" Unnecessary noise," says Miss Nightingale, " or noise that creates an expec- 
tation in the mind, is that which hurts a patient. It is rarely the loudness of the 
noise, the effect upon the organ of the ear itself, which appears to affect the sick. 
How well a patient will generally bear, e.g., the putting up of a scaffolding close to 
the house, when he cannot bear the talking — still less the whispering — especially if 
it be of a familiar voice, outside his door ! 

" Never to allow a patient to be waked, intentionally or accidentally, is a sine qud 
non of all good nursing. If he is roused out of his first sleep, he is almost certain to 
have no more sleep. It is a curious but quite intelligible fact, that if a patient is 
waked after a few hours' instead of a few minutes' sleep, he is much more likely to 
sleep again. Because pain, like irritability of brain, perpetuates and intensifies 
itself. If you have gained a respite of either in sleep, you have gained more than 
the mere respite. Both the probability of recurrence, and of the same in intensity, 
will be d im inished ; whereas both will be terribly increased by want of sleep. This 
is the reason why sleep is so all-important. This is the reason why a patient waked 
in the early part of his sleep loses, not only his sleep, but his power to sleep. A 
healthy person who allows himself to sleep during the day will lose his sleep at 
night. But it is exactly the reverse with the sick, generally ; the more they sleep 
the better they will be able to sleep." 

It is very important never to allow oneself to indulge in conversation in a sick- 
room in which a patient cannot, or is not meant to, participate. " It is rude to 
whisper." This is one of the maxims we incessantly din into the ears of children. 
It should be remembered in the sick-room, where whispering is not merely rude, but 
often positively harmful. Although noise is to be avoided as much as possible, it 
must be remembered that a certain amount of work must be done, and that the 
performing of it will entail a certain amount of noise. A good nurse will thoroughly 
make up her mind as to what is necessary to be done, and then, being fully satisfied 
as to the necessity of action — be it the making up of the fire, the cleaning of the 
room, the administration of food or medicine, or what not — she will set about her 
work and perform it thoroughly, quickly, and with the least amount of noise that is 
consistent with thoroughness. An inexperienced nurse will take ten minutes to poke 
the fire, moving one coal at a time, and inserting the poker between the bars with 
absurd gentleness. In the end, the fire is not properly made up, the patient is 
bothered beyond expression by the persistent fidgeting, or perhaps wakes with a 
start as a big knob of coal falls with a crash into the fender. For merely replenishing 
the fire, knobs of coal may be placed upon it with the gloved hand ; but it is better to 
make it up thoroughly, and run the risk of half a minute's noise, than to keep up an 



622 NURSING AND THE CARE OF THE SICK. 

undercurrent of disturbance for a quarter of an hour. Never ask a doctor's opinion 
in the presence of a patient, nor put questions to him as to the treatment advisable 
to be pursued. All consultations which affect the patient's welfare should be held 
out of his hearing, and in an adjoining room. To have to deny some proposition 
may lead to the inference on the part of the patient that he is not so well as he 
was, and this may cause some needless depression of spirits. 

A nurse should never suggest any alteration of treatment without first consulting 
the medical man in charge. By so doing she may cause much disappointment to the 
patient, and may loosen that confidence which ought, in the patient's interest, to 
exist between her and the doctor. A sensible doctor is always willing, or rather 
glad, to receive any suggestion, or to hear any proposition made by an experienced 
nurse. 

A nurse who is continuously with a patient is very much more likely to know 
his wants and to understand his troubles than the medical man who only comes 
occasionally, or, at most, at intervals of some hours ; and any medical man who 
would show any hufnness at receiving a suggestion from a nurse must have " a 
plentiful lack of wit." If, however, the suggestion made does not find favour with 
the medical man, the nurse must remember that it is her bounden duty to acquiesce 
without question in the dictum of her superior officer. Any assertion of her own 
opinion, in contradiction to that of the doctor's, either to the patient or his friends, 
is a most unwarrantable thing, and is very likely to be prejudicial to the patient's 
welfare. Of course it occasionally happens, and always will happen, that a medical 
man does not understand a case, and that a second opinion or a change of treatment 
may be essential to the patient's recovery. A good nurse may be the means of un- 
masking an ignorant man ; but she ought to be very sure of her ground, and to be 
very sure that she is not acting on merely personal reasons, before she breathes a 
word which may deprive a patient of his medical man, or lessen the confidence which 
he should have in him. The person who has had the care of a case from the 
beginning is more likely than any other to conduct it satisfactorily to its termination, 
and any change of treatment or change of doctors, unless really good and sufficient 
reasons exist for the change, is generally the most unfortunate thing that can happen 
to a patient. 

The same remarks apply also to those well-meaning persons who flit about the 
world always offering advice to sick people. They have been benefited themselves 
by some patent medicine, mineral water, watering-place, milk cure, grape cure, 
movement cure, rubbing, galvanic baths, or the last new fashionable remedy, what- 
ever it may be. Or because Dr. So-and-so has treated them successfully for the 
gout, they think he must be good for sprained ankles also, and they accordingjy come 
with their recommendations, being well assured, and having no doubt in their own 
silly heads, that in medicine "What is sauce for the goose must be sauce for 
the gander also." " Somehow or other," says Miss Nightingale — who alone of all 
writers on the subject, seems capable of really entering into the feelings of an 
invalid — " somehow or other, it seems a provision of the universal destinies that 
every man, woman, and child should consider him, her, or itself privileged especially 
to advise. Why ? That is precisely what I want to know ; and this is what I have 



NURSING QUIET ESSENTIAL. 623 

to say to them. I have been advised to go to every place extant, in and out of 
England, to take every kind of exercise by every kind of cart, carriage — yes, and 
even swing (!) and dumb-bell (!) in existence ; to imbibe every different kind 
of stimulus that has ever been invented ; and this when those best fitted to know, 
viz., medical men, after long and close attendance, had declared any journey out of 
the question, had prohibited any kind of motion whatever, and closely laid down the 
diet and drink. What would my advisers say, were they the medical attendant, 
and I, the patient, left their advice and took the casual adviser's] Again," con- 
tinues the same writer : — 

" ' Chattering hopes ' may seem an odd heading. But I really believe there is 
scarcely a greater worry which invalids have to endure than the incurable hopes of 
their friends. There is no one practice against which I can speak more strongly 
from actual personal experience, wide and long, of its effects during sickness, observed 
both upon others and upon myself. I would appeal most seriously to all friends, 
visitors, and attendants of the sick to leave off this practice of attempting to cheer 
the sick by making light of their danger, and by exaggerating their probabilities of 
recovery. 

" Far more now than formerly does the medical attendant tell the truth to the 
sick who are really desirous to hear it about their own state. 

" How intense is the folly, then, to say the least of it, of the friend, be he even a 
medical man, who thinks that his opinion, given after a cursory observation, will 
weigh with the patient against the opinion of the medical attendant, given perhaps 
after years of observation, after using every help to diagnosis afforded by the 
stethoscope, the examination of the pulse, tongue, &c. ; and certainly after much more 
observation than the friend can possibly have had I" 

The kindest thing one can do to a chronic invalid is to try and interest his mind, 
and give him some sort of small employment. Do not be too officious and too ready 
to do, or to help to do, all those little things which he can do for himself without 
injury. Try and lead his thoughts beyond himself, and beyond the dreary limits of 
his own sick-room. Talk to him, let him know all the humanising gossip of his own 
neighbourhood ; who are engaged to be married ; who has got a baby ; and do not be 
afraid to tell him who, like himself, has fallen ill, for it will not do him any harm 
to think of others, and provided he can be led to forget his own sufferings, it is of 
comparatively little importance what is the subject upon which his thoughts dwell. 
Miss Nightingale suggests a pet of some kind as an excellent source of amusement 
for a sick person. A baby or young child is an endless pleasure to an invalid 
woman, and in attending to the wants and listening to the prattle of her little 
companion she will forget her own troubles. A singing bird, which requires to be 
cleaned and attended to every day, is a capital distraction. 

While speaking of the advisability of allowing patients, for their own sakes, to 
do sundry acts for themselves, there is another aspect of the question which is very 
delicately touched upon by a writer to whom we have already referred. " I would 
add," she says, " one general remark on the relations of nurses and male patients. 
While ready at all times cheerfully and willingly to perform any service, however 
unpleasant, for a patient who is really helpless, a nurse should be very careful to 



624 NURSING AND THE CARE OP THE SICK. 



discontinue such service the moment it ceases to be absolutely necessary; and also 
never to sdlow a patient, through mere shameless laziness, to demand from her any 
service ^rWich a sense of decency should make him perform for himself. It is 
a matter ci very great importance in male wards that the patients should thoroughly 
respect th-»ir nurses. This respect is never endangered by the most ready and 
cheerful pe.-formance of the most unpleasant duties for those who are really helpless, 
but it will vanish the moment any approach to immodest carelessness on the part 
of the nurfed is detected. And I would remind all nurses that in these points men 
are instinctively quick and accurate judges." 

PRACTICAL DETAILS OF NURSING. 

We m&y now leave these preliminary matters, and proceed to discuss seriatim 
those more practical details, the arrangement of which naturally falls upon the 
nurse. 

Beds. — T"here is nothing of more importance to a sick man than the nature of the 
bed upon which he is expected to lie during sickness. We are all agreed that the 
beds of our ancestors were abominable, and it will be needless for us to waste time 
or space in decrying the four wooden posts and framework, the heavy hangings, and 
the bag of feathers which constituted the common bed of all English households 
before the dawn of the iron age. In these beds stuffiness, vermin, lumps and 
hollows, were the chief characteristics, and the smell of the hangings — hangings 
which were often heirlooms — reminded one, perhaps, of all the respectability belonging 
to antiquity, but it is hardly possible that the inseparable fustiness could be con- 
ducive to health. 

In country places, even in the present day, old-fashioned people sleep in these 
beds, and it must be borne in mind that, to a person accustomed to this style of 
thing, the transference to a modern mattress is often accompanied by loss of sleep, so 
that we mus t insist that, unless there be good reasons for a different course, the patient 
should sleep upon the bed to which he has been accustomed. 

If patients are not very ill, and if they are not likely to be in bed for more than 
a week, or i£ they are only partially bed-ridden, and are able to sit up for part of the 
day, then there can be no reason why they should not keep to the bed, whatever 
kind it may be, to which they are accustomed. 

If, however, the patient is likely to be long in bed, if it is evident that the first 
signs of a prolonged fever have appeared, or if a fractured limb or other serious 
accident necessitates a long rest, absolutely on the back, then the proper selection of 
a suitable bed is of the greatest importance, and mere habit or preference must not 
be allowed to outweigh more serious considerations. 

A bed in which a patient is going to spend the whole of his time for some period 
must have no hangings, and, in our opinion, it should have neither valance nor curtains, 
for the former is merely a shield for cobwebs and dirt, which are less likely to be re- 
moved as soon as they accumulate if they be hidden from view, and the latter are only 
necessary in cases where it is requisite to protect the patient from every draught (as 
in some cases of consumption). 



1TURSING— INVALID BEDS. 625 




A bed should not be too wide, but, on the other hand, it should be of such a 
width that the patient, lying in the middle of it, can be easily reached by the nurse 
from either side. 

The part of the bed which supports the mattress is usually made of iron rods 
interlaced, and for ordinary purposes there can be nothing better, as it is light, 
permits a current of air to the under surface of the bed, and is very readily cleaned. 
If the bed is to be as comfortable as possible, a flock mattress should be placed upon 
the bars, and upon the top of this another mattress of horsehair, which is a more 
resilient material, not so hot, and altogether a more pleasant material to lie upon 
than flock. 

A feather bed is a most unwholesome and unsuitable bed for an invalid, and 
should never be employed except in cases where there is no choice. A very excellent 

mattress for sick persons is the " Patent woven 
wire mattress " (Fig. 1), which is a strong fabric 
of wire interwoven in all directions, with plenty 
of spring in it, and which gives to pressure in 
every direction. It is most comfortable and 
Fig. i— wieb uitirmm. clean, and being made of tinned wire does not 

corrode. 

If these mattresses be used, it is usually sufficient to place only one other 
mattress upon them, or the patient may even lie upon three or four folds of a 
blanket placed upon the wire mattress. 

The bed upon which a patient lies must always be absolutely flat and perfectly 
smooth. If his head or any part of his body is to be supported, this must be done 
by means of pillows placed to suit the requirements of the patient, but these accessory 
pillows must always be placed above the bottom sheet of the bed. If a blanket be 
placed between the mattress and the bottom sheet, it is necessary to take great care 
that no wrinkles or inequalities are left in it. 

The bottom sheet must always be protected as far as possible from everything 
that is likely to soil it, since it may be very undesirable to subject a weak patient 
to the fatigue, annoyance, and excitement of changing the sheets oftener than is 
absolutely necessary. This is done by means of " draw-sheets," which are placed 
under the middle of a patient, or under any part of his body from which any 
discharge is issuing or likely to issue. Draw-sheets are made of old sheeting 
doubled and sewn together. The size will depend upon the requirements of the case, 
but it is better not to have them too small. In some cases it is necessary to put a 
piece of mackintosh beneath the draw-sheet, but this should be avoided if possible, as it 
is apt to prove too hot for the patient. The ends of the draw-sheet should be tucked 
under the mattress on either side, and great care should be taken that it, as well as 
the sheet beneath it, is absolutely free from inequalities. The draw-sheet should be 
removed as often as it becomes soiled. The thankfulness of a patient suffering from 
acute illness, if only he be kept perfectly clean, cannot be over-estimated. 

It is not always very easy to change a draw-sheet if it be under the patient's 
middle, and he is heavy and helpless. To effect this, two people are required, and 
often no small amount of strength is necessary. While one raises the patient's bodv. 
40 



626 NURSING AND THE CARE OF THE SICK. 

the other should take the clean draw-sheet, half rolled up, to the side of the patient's 
body opposite to that on which the first nurse is standing, and taking the free edge 
of the soiled draw-sheet and rolling it up, should push it away from under the 
patient's body at the same time that she slips the clean one into proper position. A 
patient can often render great assistance to his nurses, and every bed should be 
furnished with a rope hanging above it, furnished with a transverse handle, which 
the patient may catch hold of, and so raise himself slightly off the bed as these 
necessary manipulations are accomplished. A good substitute for the rope and 
handle is a jack-towel fastened to the bed-rail at the foot of the bed. 

The upper clothing of the bed should not be too heavy, but it is not necessary to 
give directions on a matter which may be left to the common sense of the nurse. If 
the weather be cold, additional blankets beneath the counterpane should be added. 
It is a dirty plan to throw plaids, railway rugs, and heavy coats, <fcc, which have 
probably never been washed, across the bed. 

To change the bottom sheet for a helpless patient is an operation wh : ch demands 
some little skill from the nurse. The clean sheet should first be thoroughly aired, 
and should then be rolled up without folding. The patient should th^u sit up in 
bed, or, if necessary, be propped up. The sheet to be removed should then t e freed from 
the bolster and the head of the bed, and should be rolled up under the patient's 
back. This being done, the clean sheet should be partially unrolled, pid the free 
end made fast under the bolster, and should then be rolled downwardr under the 
patient's back until the rolls of the clean and dirty sheet lie parallel tc each other 
under the patient's back. Now comes the tug of war, and the whole difficulty lies 
in passing the two sheets beneath the buttocks of the patient. Usually ho is able to 
raise his body slightly by his own efforts with the help of the rope hue •» over the 
bed ; and if the patient have ever so little power, it is astonishing what c?i be done 
by perseveringly inserting the hand beneath the back, and persistently 'oiling up 
one sheet and unrolling the other. If the patient is very helpless, it is nr 'essary to 
have assistance ; and if the patient be very heavy, one person to lift hiir and two 
others to manipulate the sheet will be found essential. 

Since changing the bed-clothes is often a great effort to a patient, ever/ possible 
care must be taken to keep them as clean as possible, so that the necessity may not 
arise at too frequent intervals. Directly, however, the necessity does arise, there must 
be no hesitation, and a patient must not be permitted on any account to remain on 
a sheet which is either damp or soiled. When a patient is fed, the bed-clothes must 
be -carefully protected, and all crumbs must be diligently searched for and removed 
with scrupulous care. 

In many cases of fever, and especially in typhoid fever, it is advisable to change 
the bed every day, and this can be done without any exertion on the part of the 
patient. The two beds must be brought alongside of each other, and the one into 
which the patient is going to be moved must be carefully made, aired, and the upper 
clothing turned back over the bottom rail. All the clothing, except the blanket, 
must then be removed from the patient's bed. The borders of the patient's bottom 
sheet should then be rolled inwards towards the patient, so as to afford a firm grasp 
to the two assistants who are to do the lifting. These two lifters must stand, ts# 



HTURSING INVALID BEDS. 



627 




LIFT AND BACK BEDSTEAD. 



one on the edge of the patient's bed and the other on the bed into which he is to be 
moved. In this position they will be able to exert all their strength towards the 
desired object. A third person must take charge of the patient's head, and must 
stand behind the head-rails of the beds (the beds being moved away from the wall 
prior to the process of shifting). If the patient have a broken leg or any local injury, 
a fourth person will be required, to take charge of the injured part. Thus it will be 
seen that three persons at least, and possibly four, are necessary for the safe shifting 
of a patient from one bed to another. All arrangements must be made before the 
operation is begun, and great care should be taken that each person fully understands 
his share of the work, and the patient must on no account be harassed by discussion 
and loud talking. All being in readiness, and the under sheet rolled up, the lifters 

(having removed their shoes) 
mount on the bed, and then, at 
the word " now " from the person 
in charge of the head, all Ufb 
together, and the change is 
effected without difficulty. The 
patient is thus lifted in the 
sheet, and the sheet is easily re- 
moved from under him by the 
process of rolling described for 
the removal of bottom sheets 
and of draw-sheets. 

Bedsteads should be provided with foot-boards. They are always a great comfort, 
as without them patients are very apt to slip down in bed, and to get their legs over 
the end. It is convenient to have the foot-board movable, especially in cases of 
injury to the lower extremities. 

Invalid Beds. — We have shown in Fig. 2 a bedstead which the inventor calls his 
"Patent Lift and Rack Bedstead" 
which is as simple as it is ingenious 
in construction, and is said to be a 
great boon to patients who are help- 
less and paralysed. This piece of 
apparatus is due to the ingenuity of 
Mr. William Denne, medical super- 
intendent of the Three Counties' 
Asylum, Arlesey, Eng., and what 
is claimed for this invention is that 
"the patient may be easily raised, 
the bed made, the stool used, and the 

necessary ablutions nerformed, and again lowered on the bed, without the slightest 
fatigue." 

The water-bed, which we owe to the ingenuity of Dr. Neil Arnott, is an 
invaluable contrivance in cases where the patient is very weak and unable to bear 
the slightest pressure on the body. The old-fashioned water-bed was a tank upon 




Fig. 3. — METHOD OE FILLING A WATER-PILLOW. 



628 



NURSING AND THE CARE OP THE SICK. 



wheels with a cover of mackintosh, upon which the patient lay. Its great merit was 
that of equalising pressure, so that the pressure being equally distributed over every 
part of the patient's body, it did not fall with undue severity upon any one part. 
Large water-mattresses are now manufactured which are, for all ordinary purposes, 
quite as effectual as Arnott's bed. The accompanying figure (Fig. 4) shows an 
ordinary full-sized water-mattress applied to an ordinary bedstead. This mattress, as 
well as all similar articles, can be inflated with air instead of being filled with water, 
if it be thought desirable. For cases of utterly helpless bed-ridden invalids, a water- 
mattress has been devised with a central tube (Fig. 5), so that all moisture can 
be readily conveyed away. In those very distressing cases in which the patient is 
utterly inattentive to the calls of nature, such a contrivance is really a very great 
boon. 

Invalid Cushions. — Happily, it is only rarely that a complete water-bed or a full- 




-WATEB OS AIB MATTBESS. 



Fig. 5.— BEDSTEAD WITH MATTBESB AJT» CZKTBAL TUBES. 



sized water-mattress is necessary. A water-cushion, for the support of the part affected, 
is usually all that is required. The advantage of a water-cushion over an ordinary one lies 
in the fact that it never gets into wrinkles, that the support which it affords is always 
equable and not lumpy, and that it is easily cleaned. A water-cushion can be filled 
to any extent, so as to be quite tense, or soft and flabby ; they can be put into 
position too, and filled to the requisite amount afterwards (Fig. 3); and, lastly, they 

can be filled either with hot or cold water, 
according to the requirements of the patient. 
Water-pillows are now happily among the 
common articles of domestic use, and they can 
be usually obtained in remote country dis- 
tricts without difficulty. The annexed figures 
(Figs. 3 and 6) show an ordinary air or water- 
cushion, and the method of filling it after it 
is in situ. It is advisable generally to add 
a little air to the water, so that after it has been partially filled, a little air should 
be blown in by the mouth. 

The temperature of these pillows can be regulated to a nicety, and by drawing 
&S a little cold water and adding more hot any degree of heat which may be thought 




Fig. 6. — AIB PILLOW. 



HURSING BED-SORE*. 629 

desirable may be obtained. Before introducing a pillow under a patient it should be 
slightly distended with water. 

The pillows, cushions, and mattresses which we have been describing are 
warranted to stand any temperature, from zero to 212° Fahrenheit, which latter 
is far above anything which could possibly be needed, or which, indeed, could 
be used with safety. Water-cushions must be treated with care, but if they be so 
treated they are very durable. The one thing which seems fatal to them is neglect, 
and if they be put away and are folded up, and allowed to get dry and hard, they will 
inevitably be spoilt. They must be very carefully protected from grease, since oil, in any 
form, dissolves the material of which they are made, and inevitably destroys the pillow. 
A water-cushion must never be placed near a part to which ointment is being applied, 
and if they be put under the head the patient should forego the luxury of pomatum, 
or hair-grease of any kind. For their proper protection they should be covered with 
flannel, and if they be placed under a patient's body, a blanket should be put over 
them so as to completely cover every part of the cushion. If this be not done, the 
patient is very apt, while having his meals, to bring his fingers in contact with the 
cushion, and if, as is generally the case, the fingers be soiled with a speck of butter 
or any other greasy material, the destruction of the pillow is the consequence. The 
writer of this paper remembers very well how the rapid decay of the water-beds and 
pillows in one of the large London hospitals was eventually traced to this very 
cause — contact of buttery fingers with india-rubber — and the simple precaution 
of careful \j protecting the edges of the pillows resulted in a considerable saving 
to the institution. 

Bedsores inevitably result when a patient, weakened by disease, is compelled to 
lie for long together in one position. They are a disgrace to a nurse, and whenever 
& bed-sore occurs the nurse should question herself very closely as to whether or no 
it is in any way attributable to neglect or want of knowledge on her part. A bed- 
sore can usually be prevented by proper attention on the part of the nurse ; and a 
nurse should always bear in mind that they are much easier to prevent than to cure, 
and that the occurrence of a bed-sore on her patient will not only lay her open to 
the suspicion of neglect, but will certainly increase her labours by an incalculable 
amount. It is right to add that bed-sores are not in every case preventible, and 
perhaps in some cases of fracture of tlie spine no amount of skill and attention on the 
part of the nurse will serve to avert so untoward an occurrence ; but the experience 
of surgeons certainly is universally the same, that the number of bed-sores under 
the care of different nurses varies immensely. 

What is a bed-sore ? — A bed-sore is a sloughing or mortification of the skin, 
due to pressure. If a healthy man were fixed in one position in bed without 
the possibility of moving he would get bed-sores very quickly; but since in 
health we are almost constantly and unconsciously shifting our position, such an 
accident could never possibly occur. Now, it must be remembered that in 
sickness we get immobility from weakness, and the constant pressure, coupled 
with great feebleness of circulation, is not slow to bring about the mortification of 
the part pressed on. Even in disease, when the patient is reduced to a state of 
extreme prostration, he is happily strong enough to fret and to complain, and the 



630 NURSING AND THE CARE OF THE SICK. 



most constant request, perhaps, which a sick man makes is to have his position 
altered, and if the nurse attends patiently to his requests she will be doing much 
towards the prevention of bed-sores. Again, the thinner a patient is, the more likely 
is he to have bed-sores over the projecting points of his bones from the squeezing of the 
skin between the hard pillow without and the harder bone within; which without the 
intervention of any soft padding of fat soon determines its sloughing and destruction. 
We may derive some profit from considering the condition of things which occurs in 
fracture of the spine, which, of all accidents and disasters to which our body is liable, 
is the one in which bed-sores are most likely to occur. Now, a man who has his 
spinal column fractured ( say in the middle of the back) loses all power of motion and 
sensation in the parts below the injury. Having lost the power of motion he is 
unable to shift his position for himself; and having lost sensation he is unconscious 
of the pain which constant pressure produces ; and, unlike the ordinary invalid, and 
being " dead from the waist down," he thinks not of his lower limbs, and does not 
ask to have his position in bed altered for him. It is the duty of the nurse in these 
distressing cases to think and feel constantly for her patient, and to remember to shift 
his position in bed constantly, whether he ask or no. 

All bed-ridden patients who are compelled to use the bed-pan and the bed-bottle 
are put at a great disadvantage as regards cleanliness, and it must be constantly 
borne in mind by the nurse that nothing is so sure to cause a bed-sore as any 
inattention to the absolute cleanliness of her patient. A sick person must be kept 
as clean as a baby, and whenever the bowels are acted upon the parts must be 
thoroughly cleaned with a sponge (and warm soap and water if necessary), dried with a 
soft towel or an old silk handkerchief, and powdered. To think of a patient lying 
on a bed moist with irritating urine, or with his body fouled with its own discharges, 
is too horrible, and the good nurse will be constant and unremitting in her attention 
to these things. 

Now the patient with fractured spine who has neither motion nor sensation in 
the lower half of his body is unconscious of the calls of nature. His bowels act and 
his urine passes from him without any knowledge on his part, and consequently, in 
addition to the constant pressure to which his body is subjected, we have to contend 
with the evil of constant soaking in urine and liquid faeces. " The skin of the patient's 
nates (buttocks)," says a medical writer, " becomes sodden and macerated, the irri- 
tating fluid acting upon his tissues like a caustic." We are obliged to speak of these 
matters plainly, because. the prevention of bed-sore is one of the most important duties 
of a nurse ; and since we are enlisting in the ranks of nurses women of more refined 
culture than formerly was the case, we think it right that they should understand 
how disgusting and how indelicate their duties may at times become. We do not use 
these strong terms from any feeling that ladies and women of superior education are 
unfit for the duties of nursing, nor do we for an instant think that a woman who 
performs these unpleasant offices from a high sense of duty or philanthropy is guilty 
of the least indelicacy ; but we have often heard the complaint from surgeons that 
the " high-class nurse " of the present day is not always so careful in these matters 
as she might be ; nor is it to be wondered at that a woman of good education and 
refined habits of thought should shrink from performing these unpleasant duties for 



NURSING BED-SORES. 63] 



the first rough man (for in hospitals there can be no selection of patients) who may 
be placed under her care. For those who do perform those duties we have the 
greatest respect, but all who are contemplating the adoption of nursing as a profes- 
sion should ask themselves if they are so constituted as to be able to take all the 
necessary steps for the prevention of a bed-sore in the first rag-picker or any such 
who may require their services. 

The old-fashioned nurse — the strong muscular woman of the lower classes — was 
often a person who was not so black as she is sometimes painted. She not unfre- 
quently took a great pride in the cases under her care, and looked upon a bed-sore as 
something which affected her personal honour and reputation. She was often rough, 
no doubt, but then she was ready also, and being accustomed to hard and dirty work 
from her youth up, and being taken from the same class as the majority of the 
patients who came under her care, she was never squeamish at her duties, and 
consequently never hesitated for an instant in the thorough performance of those 
very unpleasant offices which it must of course fall to the lot of every nurse occa- 
sionally to perform. 

For the prevention of bed-sores the first requisite is cleanliness, and whenever 
the necessity arises, the draw-sheet must be changed, and, if it be found necessary, 
the under-sheet and blanket also. Whenever the patient uses the bed-pan he 
must himself be thoroughly washed and dried as perfectly as possible by the 
nurse, since these are matters which a bed-ridden patient can seldom manage for 
himself. 

If the case be one in which there is much dribbling of urine, it may be necessary 
to supply the patient with an india-rubber urinal which he must wear constantly. 
A urinal is simply an india-rubber bag which fastens round the waist, and receives 
the urine directly it is passed. They are made for either sex. A urinal must be 
kept scrupulously clean, and must be thoroughly washed out at least once a 
day, or it will soon become unbearably offensive. If it is found that ordinary 
washing is not sufficient to keep the apparatus sweet, a rinsing with a solution 
of quinine (of the strength of two grains to the ounce of water) will be found 
very efficient. If a urinal cannot be obtained, some good may be effected 
by placing a large sponge between the patient's legs, which will soak up a 
good deal of the moisture. If a sponge cannot be got, a big handful of tow or 

cotton waste, or even an old towel, will be 
better than nothing. If a sponge is used, it 
must be frequently washed and wrung out of 
boiling water; and if a lump of tow be em- 
ployed, it must be destroyed as often as it is 
changed. 

Some of the water beds are made with a 
central tube, such as we give an example of in Fig. 7, in order that the discharges 
and moisture may drain away; or, failing this, an ordinary mattress may very 
easily have a hole made in its centre through which a tube connected with a water- 
proof sheet may pass. 

None of these appliances for the artificial drainage of a patient are altogether 




632 NURSING AND THE CARE OF THE SICK. 

trustworthy, and even the best of them cannot replace that unremitting attention 
which in these cases is so absolutely necessary. Cleanliness being, as far as possible, 
insured, the next point is to relieve all points upon which the body rests from 
pressure. Bed-soro^ are most common upon the most prominent points, and 
such as the bottom of the spine or sacrum,' and upon this spot it is that bed-sores 
generally make their appearance. Bed-sores also occur upon the hip-bones and on 
the heels, and occasionally abscesses will form on the back of the shoulder-blades 
from the pressure at this spot 

It is advised by many to rub the skin over these prominent parts with spirit, 
and it is the custom of many nurses to apply either spirits of wine or brandy. Tht 
effect of this is, it is said, to harden the skin. Possibly it may do so — it may, at least, 
be regarded as a cleansing process. Painting the part with collodion is sometimes 
resorted to, and there can be no doubt that the fine film thus left upon the skin serves 
as a protective. 

The patient's position must be constantly shifted, and when he is perfectly 
helpless, as in cases of fracture of the spine, a good nurse will turn a patient in bed 
at regular intervals by the clock. If a patient lie for three hours on one hip, and 
then three hours on the other, changing every three hours during the day and 
night, the result will be far different to that which would have resulted had he spent 
twelve hours at a stretch on either hip. This constant and painstaking alternation 
of the pressure has saved many a life. 

In those cases in which it is possible, a patient may be turned completely on the 
face ; and when this can be done, there should be no possibility of the occurrence of 
a bed-sore. 

A nurse should be well acquainted with the earliest indications of the occurrence 
of a bed-sore. The skin over the part (and this is usually over the prominence of a 
bone) begins to look pale, mottled, and sodden. This is quickly followed by the 
mortification of the patch of skin. Seeing this condition of things, it is necessary 
to take prompt steps for the protection of the dangerous patch. The pressure may 
be taken off in the same way as the pressure is taken off a corn, by the ordinary 
thick corn plaster, made of a circle of felt. Several thicknesses of lint, or some lint 
having flannel between its folds, or a pad of lint lined with cotton wool, may be 
taken, and from its centre should be removed a portion slightly larger than the piece 
of skin which it is sought to protect. Upon this protective pad, which will 
have to be retained in its place by a few turns of a bandage, the patient must lie, 
and in this way the doubtful patch of skin may eventually be enabled to recover its 
vitality. 

India-rubber cushions are now made in various shapes, which serve admirably to 
take off the pressure from any part of the body. Thus they may be obtained 
circular, which is the most generally useful shape, and serves to protect almost any 
part of the body (Fig. 8). The Horse-shoe Cushion (Fig. 9) is especially useful 
for the protection of the sacrum or lower part of the spinal column, which is the 
region of all others the most liable to suffer from bed-sore. The " Spinal Water or 
Air Cushion " (shown in Fig. 10) is of very great service in those cases where, 
owing to an extreme degree of emaciation, the patient is unable to stand the 



NURSING BED-SORES. 



633 




Fig. 8. — CIRCULAR WATER 
OR AIR CUSHION. 




Fig. 9. 
HORSE-SHOE WATER OB AIR CUSHION. 



least pressure upon the prominences of the upper parts of the spinal column. It 
consists really of two cushions joined down the centre, so that the body lies upon a 
double air-pad, while a gutter or channel is left between them to receive the 
prominent spinal column. These cushions are very- 
much to be preferred to any kind of pad made with 

lint or other material of a 

similar kind, and for this 

reason, that they do not 

absorb discharges or other 

fluids, and can be very readily 

and completely cleaned. They 

also have this advantage, that 

they can be filled with either 

hot or cold water, according 

to the wish of the patient or 
the requirements of the case. A mixture of air and water is, however, on the 
whole, the best " stuffing " which can be employed. 

When once the sore is formed it requires other treatment besides the mere relief 
from pressure. While the wound is very small, painting the skin with collodion 

' is sometimes of service ; but such treatment 
is of no use when it has attained any size, 
for then 

" It will but skin and film the ulcerous place, 
Whiles rank corruption, mining all within, 
Infects unseen." 

A sore having once formed, the separa- 
tion of the slough (the piece of dead skin) 
is to be encouraged in every way. It is 
customary with most medical men to apply 
a poultice until this has been accomplished. If the patient can be turned either on 
his side or face he should be put in this position, with the bed-sore uppermost, while 
the poultice remains applied. Poultices, if used, must be frequently changed, for 
when the warm and moist linseed becomes imbued with the discharges from the 
wound it invariably becomes intolerably offensive in a very short time. 

Cleanliness essential. — Certainly the chief point in the treatment of a bed-sore is 
to keep the part sweet and free from decomposition, for if that be not done the patient 
will be in great danger of being killed by blood-poisoning. It is too often the case, 
when sores become offensive, to apply remedies rather to the air of the room than to the 
patient, and it is not uncommon to find a sick-room reeking with carbolic acid, chloride 
of lime, pastilles, incense, eau de cologne, <fec. ; and when we encounter these attempts 
to smother unwholesome smells by others more powerful (for it is more than doubtful 
if these sprinklings and fumings are of any use), we always suspect that the nursing 
and the treatment is really at fault, for if this were not so the occasion for the use 
of these masking odours would not arise. For the keeping of a wound or sore sweet, 




Fig. 10.— DOUBLE OBLONG WATER OR AIR CUSHION. 



634 NURSING AND THE CARE OF THE SICK. 

the point which demands primary and minute attention is cleanliness. It must be 
washed and cleaned daily with the most scrupulous care, and if necessary, twice 
or thrice in the day. The helpless patient must never be allowed to lie in the 
discharges which flow from his wound, and the nurse should never shrink from the 
trouble of changing the linen as often as it becomes fouled. Cleanliness and care are 
the first and best of disinfectants, and other disinfectants which may be used are only 
to be regarded as auxiliary to these. 

Disinfectants should be applied to the wound itself. These, however, should not 
be of an irritating character, or they may tend to increase the size of the wound 
which it is sought to heal, and thus do harm instead of good. One of the disinfec- 
tants which at present holds a high place in the estimation of the medical profession 
is boracic acid — the acid which is extracted from borax. Lint impregnated with 
this acid, and which is known as " boracic acid lint," is sold by many druggists, and 
if a piece of this be cut the size of the sore and kep + constantly applied (having been 
previously moistened with water), it will be found very effectual in preventing de- 
composition and keeping the part wholesome. Oakum, the ordinary teased yarn 
impregnated with pitch, is a very agreeable application to bed-sores, as it combines 
antiseptic properties with some power of absorption and no little springiness, so that 
when made into a pad the patient may lie upon it without danger of undue pressure. 
All greasy applications are favourable for bed-sores ; and they are, in our opinion, 
preferable to moist ones, which must tend to encourage decomposition. If nothing 
else is at hand, the part may be kept covered with a piece of lint or soft linen rag, 
upon which common lard or cold cream may be smeared. An antiseptic ointment, 
prepared with some common unirritating antiseptic, as boracic acid or carbolic acid 
(very weak), will be found a most excellent application. The great merit of greasy 
applications is that they do not absorb moisture. They must, however, be frequently 
changed, and whenever they are changed the part must be most thoroughly cleansed. 
Whatever is used to clean a bed-sore, or indeed any sore, should be burnt when done 
with, so that old rag or a bit of tow is the best material for the purpose. Sponges 
ought never to be employed, because the pores of the sponge become soaked with the 
discharge of the wound, which readily putrefies. The wound should be washed with 
warm water, to which a little Tilden's Fluid or permanganate of potash has been 
added. The fluid should be projected with some force on the surface of the wound 
from a glass syringe, and in this way the discharges from the surface will be dislodged. 
While washing a wound in this way, it is needless to say that great care must be 
taken to ensure that the effluent liquid does not fall into the bed. This, however, may 
usually be prevented without much difficulty by pressing the edge of an ordinary tin 
bowl against the skin, and placing the patient in such a position that the water may 
run into it If sticking plaster has been employed to retain in position any of the 
dressings or applications which have been made to the sore, it is very essential to 
cleanse the edges of the sore of all pieces of plaster which may adhere to it. This 
cannot be done by means of water, or even soap and water, for the plaster is not 
soluble in such fluids. The best solvent is turpentine or olive oil ; but while using 
the former, care must be taken not to touch the surface of the wound with it, and 
to wash the surrounding skin very carefully with warm soap and water, so as to 



NURSING — BED-SORES. 635 




remove all traces of the turpentine, which, if left adhering, might prove irritating 
or too stimulating. When the slough has separated from the surface of a bed-sore 
it must be treated just like any other sore place or granulating wound. It must 
be, kept clean, and should be dressed two or three times a day with some slightly 
stimulating application, as zinc lotion, zinc ointment, or even common resin oint- 
ment, than which nothing is better. The dressing must always be cut the exact 
size of the sore, and if the sore is healing satisfactorily it will require to be made 
smaller and smaller each day. 

While treating of bed-sores we have had frequent occasion to dwell upon the 
great importance of cleanliness, and this leads us to speak of bed-pans. Bed-pans 
should be of white earthenware — white, because the fact of cleanliness or otherwise 
is most easily noticed on a white ground, and earthenware, because it is a material 
which cannot be corroded by any acrid fluids, and can be kept in a state of absolute 
and perfect sweetness. 

The best bed-pan for ordinary use is the common, well-known round pan with 
the in-curved rounded border and the hollow handle, through which all fluids can 
be poured off (Fig. 11). It is sometimes necessary to pad 
the border of the pan, or cover it with flannel, on account of 
the inability of the patient to bear the coldness or the hard- 
ness of the earthenware. When this is necessary, two such 
Fig. 11.— bed^pak covers should be made for the pan, in order that one of 

them may be always clean. It is sometimes necessary 
and advisable to grease the edge of the pan before it is placed under a patient, so 
that it may slip into position with greater ease, and without risk of bruising the 
skin. 

After the bed-pan has been used the nurse should always be certain that the bed 
has not been fouled, and that the patient is thoroughly and properly cleansed. 

In some cases it may be essential for the safety of the patient that the stools 
should be kept for the inspection of the medical attendant. When this is the case, 
it is seldom allowable to place any disinfectant in the pan — at least, this should not 
be done without first consulting the doctor. Every bed-pan should be provided with 
a cover, and a stopper for the handle. The cover should be of earthenware or metal, 
so that it may be thoroughly and properly washed. The wooden covers, with which 
some of the old-fashioned " night-commodes " are provided, are not to be tolerated 
When the stools which have to be kept for inspection are liquid, they must not in 
any way be meddled with ; but when the stools are solid any liquid (urine) which 
may be passed with them should at once be poured off, the solid portion being alone 
retained. If this be done, it will be found that the stool is far less offensive than 
otherwise is the case. A stool which has to be kept should be immediately removed 
from the sick-room to an adjoining closet, or even outside the house, where they 
should be covered up and corked to await inspection. If the case is one in which 
the inspection of the stools is not an important matter, it is a great comfort to the 
patient and to those about him if some deodorising disinfectant be first placed in the 
pan. The most suitable for such a purpose are " chloralum " or Burnett's Fluid 
(solution of chloride of zinc), which being themselves inexpensive and odourless, are 



636 



NURSING AND THE CARE OF THE SICK. 




Fig. 12. — BED SLIPPER. 



nevertheless powerful deodorisers. If these are not at hand, carbolic acid should be 
used. 

When an evacuation is thrown away, it may generally be thrown down the 
ordinary water-closet, but in cases of typhoid or other fever this practice should not 
be resorted to. In these cases the stools should be first disinfected by the addition of 
strong carbolic acid, and they should then be buried in some spot remote from wells 
or water-courses. In all cases of fever the safe bestowal of the stools in some spot 
where there is no risk of infecting others is a duty which we owe to our neighbours. 
Some nurses prefer the " slipper bed-pan," of which we here give an illustration 
(Fig. 12). It certainly has this advantage, that it is easily 
slipped under a patient, either from the front, or behind, or 
laterally ; but for ordinary purposes it will not be found so 
generally useful as the circular varieties. 

Urine bottles are also a great comfort to invalids, and 
they are only of second importance to bed-pans. They are 
wide-mouthed, big earthenware bottles, with one flattened 

side, upon which they rest without fear of being overturned. The patient can 
use them almost without disarranging the bed-clothes, and, with a little care, 
absolutely without risk of wetting them. It is important to bear in mind that 
these bottles should be emptied and washed directly they have been used. It is very 
undesirable to allow a utensil filled with urine to remain either under or by the side 
of a patient's bed. This fault is often committed, but it is always a sign of negli- 
gence on the part of the nurse. 

Bed-frames. — It ia often necessary to keep the upper bed-clothes well off the 
patient. In cases of broken legs, or in any other condi- 
tion where the legs are immovable, it is always advisable 
to prevent the sheets from resting on the tips of the toes. 
In cases of severe inflammation of the bowels (peritonitis), 
and in all cases of wound or operation in the region of 
the abdomen or groin, it is likewise necessary to relieve 
the part from the weight of the clothing. This is managed 
without difficulty by means of the ordinary bed-frame 
(Fig. 13), which is a very simple contrivance, and one which, in cases of necessity, 
can be very readily extemporised by any carpenter of ordinary intelligence. 

It is sometimes not advisable to place a bed-frame in the bed with the patient. 
When this is the case, a patent bed-frame can be obtained, which supports the 
clothing from the outside by means of slings and clips. 

Whenever a bed-frame or any similar contrivance is employed, great care should 
be exercised that the patient's body does not get chilled by draught. He should be 
closely covered with a blanket down to the point where the cradle commences. 

Sometimes it is advisable not only to protect a limb from the superincumbent 
clothing, but also to protect it from the pressure of the clothing beneath. This is 
necessary in many cases of fractured limbs, and it is necessary also in those cases in 
which bed-sores form on the prominence of the heels. A leg may be swung by 
means of an ordinary cradle and a few turns of a wide, smooth bandage ; but, if it be 




Fig. 13. — BED FRAME. 



NURSING — BED-RESTS AND TABLES. 



637 



obtainable, the best piece of apparatus for such a purpose is that known as Salter's 
Swing (Fig. 15), which permits of movement in four directions. 

Bed-curtains are scarcely ever admissible in the sick-room ; but during the 
summer something like the gauze mosquito curtains, which must be familiar to all 
travellers in the south of Europe, will serve to protect the invalid from the attacks 
of flies and midges, which are often very harassing to a sick person, and effectually 





Fig. 14— BACK-REST. 



Fig. 15.— SALTER'S SWING. 



prevent sleep. A piece of gauze netting merely thrown over the head is often a 
sufficient protection. 

It is a great relief to a patient to be able to change his position in bed, and 
especially to alter the angle of his body. This is of course effected by means of 
pillows; and pillows of all sizes and shapes, and of various degrees of hardness, will 
be found invaluable. Whatever kinds of pillow are used, they should all be covered 
with ordinary white pillow-cases, which easily show dirt and stains, and which can 
be washed without any extraordinary trouble or expense. It is not uncommon to 





Fig. 16. — BED REST. 



Fig. 17.— " LITERARY MACHINE." 



see a patient sitting up in bed with his body supported by any odd pillows which 
can be pressed into the service from couches, chairs, ottomans, and the like, and 
covered in various coloured chintzes, worsted work, or other similar materials. 
These pillows are scarcely ever washed, and should not be employed for the 
purpose of supporting an invalid in bed before they have been properly provided 
with suitable white covers. 

Bed-rests. — The ordinary bed-rests or back-rests, such as are shown in the 



638 



NURSING AND THE CARE OF THE SICK. 



annexed figures (see Figs. 14, 16), are a great convenience and comfort to invalids, 
as by their help they can be sustained at any angle in bed without feeling any 
fatigue whatever. 

A very fair bed-rest may be extemporised by means of an ordinary light bed- 
room chair, which must be so placed that the back and rails shall be under the 
patient's back, while the front legs project over the end of the bed. 

Among jse may be mentioned the so-called "literary machine" (Fig. 17), 
which is a small reading-desk so arranged that it can be placed at any angle and in 
any position, so that a person who is even condemned to lie quite on his back may 
still be able to enjoy the pleasures of literature. 

These appliances need no detailed description. The annexed figures will at once 
show their mode of use, and the purposes they are intended to fulfil. 

Bed-tables, upon which patients' dinners may be placed, 
or which they may use either for reading or writing, are 
to be had in great variety. Of these we give a couple of 
wood-cuts (see Figs. 18> 19). One is designed to stand upon 
the bed, the legs being placed on either side of the patient's 
knees. A good variety of this sort is to be had in which 

the top can be placed at any angle, and which is provided with a drawer and lock 
and key, which would prove an amusement, if not of real utility, to an invalid. 

The other form of bed-table is so constructed that it projects across a bed without 
touching it, which is a very great convenience in those cases in which it is impossible 




Fig. 18.— BEB TABLE. 





Fig. 19. — BED TABLE (WITH BACK). 



Fig. 20. — INVALID CARRIAGE. 



to place furniture upon the bed. It is often a great blessing to be able to get these 
articles ready made and at a moment's notice, but they are so simple in construction 
and so easy to comprehend that any village carpenter would find but little difficulty 
in manufacturing something which at least would answer the purpose. 

Invalid carriages. — The transportation of a patient from place to place is 
generally a formidable proceeding, but one which it is very often essential to 
undertake. If a patient is too weak to sit up, he must be moved bodily in his 
bed. Invalid carriages are now made in England, resembling much an omnibus 
(Fig. 20), which take a person lying at full length without any difficulty. These 
may be placed upon a railway truck, and in this way an invalid may be carried 



1TURSING — INVALID CHAIRS. 



639 




Fig. 21.— HAMMOCK. 




almost any distance without serious fatigue. All railway companies are in the habit 

of keeping saloon carriages on purpose for invalids, provided with beds and every 

convenience for a long journey. 

There is nothing better for moving an invalid than a hammock (Fig. 21). If a 

real hammock is not to be obtained, 
lillitelii- there is generally but little trouble 
in getting one made. There is no 
jarring in a hammock, and it can be 
fastened up in an ordinary omnibus 
or common saloon railway carriage 
without any difficulty. 

If a patient is able to sit up, he 
may make use of the carrying chair, 
which we have shown in Fig. 22. 
These chairs are very light and 
strong, and are so ingeniously con- 
structed that they pack into a 

very small space, and consequently do not form an inconvenient addition to 

one's, luggage. The handles are so placed that they are at a convenient height 

for going up and coming down-stairs 

without tilting the patient at an angle 

which would cause him either danger 

or alarm. 

Two persons may carry an invalid 

in their arms with very little difficulty. 

They should interlace their hands by 

clasping each other's wrists, and this 

will form an excellent seat upon which 

the patient may sit, and support himself 

by placing his own hands round the 

necks or on the shoulders of his 

carriers. Or the carriers may use two 

hands to afford a seat and the other 

two to support the back of the patient. 
With regard to Bath chairs it is 

needless to speak, as they are almost 

to be reckoned as pieces of domestic 

furniture. They are of every possible form, and suited for every conceivable contin- 
gency. They are, however, very expensive, and for persons of slender means the twenty 

or thirty dollars which is often asked for a Bath chair is a serious matter. We 

show in Fig. 23 a basket-work chair made like an ordinary perambulator, which 

is scarcely a quarter the price of the more elaborately-finished and elegant chairs, 

but answers nearly every purpose quite as well. 

Chairs in which a patient can propel himself are a great luxury, and the pleasure 

which the convalescent feels in wheeling himself about a house or garden after a 




Fig. 22.— CARRYING CHAIR. 



640 



irUKSING AND THE CARE OP THE SICK. 



prolonged confinement in bed is naturally very great. These self-propelling chairf 
are of- two kinds. The so-called Merlin chair (Fig. 24) has two driving wheels and 
a guiding wheel, and each driving wheel has a propelling rail fixed to it upon which 
the patient can exert the necessary force. The other form of chair diners from the 
Merlin chair in this, that it is worked by a couple of rotating levers attached to the 
arms which are connected with endless screws, by means of which the propelling 
wheels are set in motion (Fig. 25). 

Moving a patient. — Although we have had much to say about the bed into which 





Pig. 23.— WICKEB CHAIB. 



Fig. 24 — MERLIN CHAIB. 



a patient is to be put, and the care to be taken of him when he is there, we have as 
yet been silent on the important point of putting him into bed in the first instance, 
which, in the case of broken limbs, is a very serious and difficult matter. 

In the case of a broken leg or thigh, the less that is done to a patient previous to 
the arrival on the scene of some skilled person the better. Any rough or ignorant 
handling may have the result of causing the end of the broken bone to come through 
the skin, and thus converting what is known as a simple 
fracture into a compound fracture ; and it must be borne in 
mind that the difference between a simple and compound 
fracture is often the difference between life and death. 

If a considerable time is likely to elapse between the 
receipt of the injury and the arrival of the doctor something 
must be done. If a patient has to be moved, this must be 
done on something flat, such as 



a hurdle, a door, or a 




stretcher of any kind. This should be placed on the ground _. . 

J m r * Fig. 25.— SMALL WHEEL-CHAIB. 

alongside the injured person, and then while some with the 

patient's assistance move his body on to the stretcher, others will carefully perform 
the same office for the injured leg, great care being taken that the limb is kept 
perfectly horizontal and in a straight line. 

To undress a patient requires a good deal of tact and experience. The first and 
most difficult matter is to remove the boot. A laced boot must have the laces 
completely taken out, so that it may slip off the foot as easily as possible; and a boot 
with elastic sides should have the elastic cut close to the seam on one or both sides. 
A Wellington boot or a hunting boot will often need to be cut completely open. 
The boot being loosened to its greatest extent, one person should steady the leg at 



NURSING GIVING MEDICINE. 641 

the ankle, while another gently " humours " the boot off the foot. Even with the 
tightest boot a little patience will generally suffice to get it off. There must be no 
wrenching, tugging, or jerking, or the gravest results may follow. The stocking 
should always be cut open down the seam, and the foot very gently drawn off. The 
trouser of the injured leg must be cut open completely down the outer seam, from 
the band to the bottom of the leg. There must be no hurry in carrying out these 
directions, and it must be remembered that nothing but harm can result from a 
needless destruction of clothing. Having removed the boot and the stocking, and 
one leg of the trousers being cut up, no obstacle remains to completely laying bare 
the leg. If the injured part is swollen, hot, or painful, it is often agreeable to the 
patient to have some cold water rags applied to it, and there is never any harm in 
doing this. The leg may, if necessary, be steadied by having some sand-bags placed 
on either side of it. Sand-bags are long bags like small bolsters, made of canvas or 
bed-ticking, and about four or five inches in diameter and half a yard in length. 
These, when filled — not too tightly — with sand which has been previously washed 
and baked in an oven, form very valuable supports in cases of fracture of the 
extremities. 

Keep an injured man warm. — This is very important, and although it is easily 
effected, it is too often forgotten. An injured person suffers from a condition which 
is technically known as "shock." The circulation is depressed, and a feeling of 
chilliness, often accompanied by shivering, is very apt to supervene. It is always 
necessary, therefore, except in the hottest weather, to cover a patient with blankets, 
and the administration of a little warm brandy and water is often advisable. It is 
a great mistake to cram an injured patient with brandy or other spirit, as is too often 
done. It may enable him to forget his pain and to put a " bold face " upon his mis- 
fortunes for a time, but the period of depression will assuredly follow, and it must be 
remembered that this depression will bear an exact proportion to the previous exalta- 
tion, and that an injury is a condition which demands strength not only during the 
first moments of its infliction, but during the tedious weeks which are necessary for 
its repair. Bottles of warm water are always grateful and pleasant, and are more 
serviceable in warding off the effects of shock than the injudicious administration of 
alcoholic stimulants. 

The friends of a man who meets with a serious accident are very prone to be seized 
with an itching to do something. Formerly a man who fell out hunting, or broke his 
leg, or bruised his head, ran a serious ri*k of being bled by the first good Samaritan 
that came by. Now the risk is of a too brisk administration of oil and wine. The 
proper thing to do is to guard him from harm, including ignorant interference, and 
keep him warm. 

ADMINISTRATION OF MEDICINE. 

The giving of medicine is necessarily one of the chief and most constantly-recurring 
duties of the nurse, so that we shall make a few general remarks on the pc*»*.t, feeling 
sure that they cannot but prove acceptable. 

If a patient is very ill and weak, he should never be bothered about his medicine. 
When the time for its administration comes round, the nurse should be ready with it, 
41 



642 NURSING AND THE CARE OF THE SICK. 

and the single expression of " Here is your medicine " is all that need pass. The 
fussy nurse who says, " It will soon be time to take another dose," " Are you ready 
for your medicine yet 1 " and so forth, simply annoys the patient with an unpleasant 
prospect, and does no good. 

The glass in which the medicine is given should always be perfectly clean, and 
great care ought to be taken to wash it thoroughly every time it is used. This 
is particularly important when the medicine is an oil, like cod liver oil. What more 
disagreeable can be conceived than a glass with the remains of former oily doses 
adhering to its sides ? The good nurse will never be guilty of negligence of this kind, 
but always give medicine so that it may cause the least amount of annoyance to the 
patient. Medicines are given at various times and with varying intervals ; and it is 
very important that a nurse should attend scrupulously to the directions. If it is 
thought desirable to keep the patient perpetually under the influence of his medicine, 
it is usual to give it two or three times a day in a tolerably large dose ; but there is 
a school of medical practitioners, which increases in number, with whom it is the 
" fashion " to give medicines in small doses at frequent intervals, so that while one 
would give say three grains of a drug three times a day, at intervals of about 
six hours, others prefer to give half a grain every hour. It is doubtful, however, 
whether the small doses are more efficacious than the large, but one thing is certain, 
that in the case we have supposed the patient will be disturbed with the cry of 
" medicine " eighteen times instead of three ! This discussion, however, lies outside 
the region of nursing, and all we have to say is, that whatever may be the directions, 
the nurse's duty is to obey them implicitly. 

There are one or two points, however, which require some notice. For example, 
medicines are often ordered to be given at intervals of so many hours — one, two, 
three, or more, as the case may be. Now, as a rule, a patient should never be roused 
from sleep to take either food or medicine, and there is more often a necessity to 
awake him to take the former than the latter. The nurse, however, should always 
inquire about these points, and should ask, "Is the medicine to be given at night, 
as well as during the day 1 " " Is he to be awakened to take his medicine 1 " " How 
long may he be allowed to sleep without taking medicine 1 " — and so forth. 

Some medicines are ordered to be taken at particular times, as "at bedtime," 
" before meals," " after meals," &c, and these directions require attention. ** Bed- 
time " with a patient who keeps his bed must be taken to mean " the ordinary bed- 
time," i.e., ten or eleven o'clock, as the case maybe. Tonic medicines and such as are 
intended to improve the appetite are ordered " before meals," and when no directions 
more explicit are given, about " twenty minutes " before the meal may be looked upon 
as the proper time. If these medicines are given too long a time before meals, their 
appetising effect passes off; if too short a time elapse between the tonic and the food, 
the bitter or other taste left upon the tongue is apt to interfere with the proper 
enjoyment of the meaL 

As to medicines which are given after meals, it is important to remember that 
there are some few medicines — of which number arsenic is one — which it is not safe 
to administer except after a meal — that is, upon a full sLomach — and if the medicine 
has been forgotten at its proper time, it is not to be administered at any other. 



NURSING — GIVING MEDICINE. 643 




It is advisable to shake every bottle of medicine before it is given, but there are 
Borne cases — when the medicine consists of a powder " suspended " in a thick fluid — 
in which it is absolutely indispensable so to do. 

The doses of medicines vary, and, as is well known, they are ordered in very 
varying quantities, such as drops, tea-spoonfuls, dessert-spoonfuls, table-spoonfuls, and 
divisional parts (|, i \, &c.) of the bottle in which they are contained. We ought, 
perhaps, to say a few words as to the exact meaning of these terms. With us a 
pint, which is the standard fluid measure in this country, is divided into sixteen fluid 
ounces ; each fluid ounce contains eight fluid drachms, and each fluid drachm is com- 
posed of sixty minims, or drops. Now, roughly speaking, but by no means accurately 
so, a "drop" means a minim, a "tea-spoonful" means a drachm, a "dessert-spoonful" 
means two drachms, and an ounce, which is perhaps the most common of all doses, is 
equivalent to " two table-spoonfuls." 

This method of measuring medicines by " drops " and spoonfuls is convenient, no 
doubt; and although it is accurate enough for medicines which are tolerably 
innocuous, it must be remembered that it is very far from 
absolute accuracy. Whenever accuracy is necessary, it is impera- 

Stive — and, in fact, in all cases it is advisable — to use a measuring 
medicine glass for the administration of doses of medicine. 
Medicines which are ordered in " drops " should in all cases be 
minim g oLAssBs accurately measured in a minim measure (see Fig. 26), for it must 

be remembered that medicines ordered in these small quantities 
are always very potent indeed. Drops which are let fall in a haphazard way from 
the lip of a bottle are of very variable size, and their size depends upon the nature of 
the liquid and the shape of the bottle-lip. 

Drops of thin liquids, such as tinctures and other spirituous or ethereal pre- 
parations, are very much smaller than drops of thick liquids like treacle, which, being 
more tenacious, hold together more forcibly. We have heard of such medicines as 
the solution of strychnine of the Pharmacopoeia — a highly poisonous preparation — 
being ordered in " drops," and measured by the patient or his nurse by dropping 
from the bottle. One fatal case has happened from this reprehensible practice, which 
ought to serve as a warning. 

" Spoonfuls " vary in size as much or more than drops, a fact which must be 
evident to any one who has studied the fashion 
in these matters, and has noticed how much 
these domestic articles vary in shape and 
capacity. A table-spoonful is ordinarily sup- 
posed to be equal to four drachms, or half an 
ounce, but Mr. Martindale, who has made a 

series of experiments in the matter, finds that j^. 27 — m*.diclne glasses. 

in reality the capacity of a table-spoon averages 

between five and six drachms, so that in calculating doses for hospital patients he 
finds it convenient, in order that the patients may not run short of medicine 
between the days of visiting the hospital, to reckon the table-spoonful as five 
drachms instead of four. The ordinary medicine glasses are plainly marked 






644 NURSING AN© THE CARE OP THE SICK. 

in ounces and spoonfuls (Fig. 27), so that by using these all chance of a mistake is 
avoided. 

It is very much to be hoped that before long the metrical system of weights and 
measures may be employed in this country, if not for commercial purposes, at least 
for the measuring of medicines. One great advantage would flow from this — 
viz., that our weights and measures would then be in exact accord with those 
which are in all but invariable use upon the Continent. The only essential difference 
between English pharmacy and Continental pharmacy consists in the weights and 
measures, and when we see " Pharmacie Anglaise " written over a shop door on the 
Continent it means (if it means anything) that the proprietor has mastered the intri- 
cacies of the English weights and measures and can use them for dispensing. Since 
the metrical system is in use almost everywhere except in England and America, it 
may be well to give a few words in explanation of it. 

The foundation of all metrical measurements is the metre, which is the length of 
one ten-millionth part of the distance from the equator to the pole, and which 
amounts to a little more than our yard, or, to be accurate, 39*37 inches. Now, the 
metre being taken as a standard, can either be multiplied or divided, the words 
denoting multiples of the metre being derived from the Greek, and those denoting 
divisions from the Latin. Thus 

10 metres make a Deca metre. 
100 „ ,, Hecto „ 

1,000 „ „ Kilo „ 

10th of a metre makes a Deci metre. 
100th „ „ Centi „ 

1,000th „ „ Milli „ 

Nothing can possibly be simpler than this, and by simply squaring these linear 
measurements we get means of measuring surface, and by cubing them we can 
estimate capacity. 

The standard of weight is the weight of a cubic centimetre of water at its 
greatest density. This is called the gramme, and is equivalent to 15*432 English 
grains. By multiplying or dividing the gramme we are provided with deca- 
grammes, hectogrammes, and kilogrammes, decigrammes, centigrammes, and milli- 
grammes. Can anything be simpler than this, or in greater contrast to our troy, 
avoirdupois, and apothecaries' weights, our bushel, peck, rods, poles, and perches, 
and such-like antiquated complications ] 

Usually medicine bottles, are made of certain sizes, and are known as "six-ounce," 
« four-ounce," or " ounce " bottles, as the case may be. The practised eye will sook 
detect the size of a bottle by the most cursory glance. When a bottle is furnished 
with division marks, each mark, as a rule, indicates an ounce. When the division 
marks are printed on a paper slip, it is useful to know this, in case the paper label 
should be rubbed off. 

After giving a dose of medicine, it is customary to give something to " take away 
the taste." A lump of sugar, a spoonful of preserve, a bit of lemon to suck, or 
a piece of cheese, are all useful for such a purpose, and the inclination of the patient 
may be taken as a guide in the selection of one of them. 



NURSING — PILLS, POWDERS, &C. 645 

It is very common to give medicines which contain strong acids or iron through 
a glass tube, because of the fear which patients have of corroding or blackening their 
teeth. It is well to wash the mouth after taking any of these medicines, either with 
pure water or with milk and water. 

Pills. — Many people say, " I cannot swallow a pill." This is simply ridiculous, 
and the failure is entirely due to their setting the wrong way to work. It is evident 
that the people who make this assertion swallow lumps of meat or food which are 
ten or twenty times as big as pills, and if they would try and swallow a pill exactly 
as they swallow their food there would be no difficulty. To see a person " chuck " a 
pill to the back of the throat, and then throw the head violently back, and begin to 
" o u SS^ e " — an a °ti° n which effectually closes the throat — is simply laughable. They 
would get on much better if they held the head down, or at least horizontal, in 
the position it assumes at the dinner table. Then let them place the pill just within 
the lips and take a drink of water, and the result will be that the pill must be 
swallowed, whether they wish it or not. 

Pills should not be too old, for, from being dry, they are apt not to be dissolved. 
Pills containing mineral purgatives, such as mercury or calomel, should always be 
followed in a few hours by a purgative draught, in order to insure that the mineral 
matter does not produce any constitutional effects. 

Pills are usually given at bed-time, but occasionally they are administered at 
regular recurring intervals throughout the day, like fluid medicines. If a mild 
purgative for daily use is required, it is often a good plan to give a pill at dinner 
time. In this way any violent action of the contents of the pill on the coats of the 
stomach or intestines is avoided, because the purgative matter is either dissolved or 
finely divided by the food. The pill being thoroughly dissolved in the food insures 
that the whole of the food is properly evacuated from the bowels. 

Powders are very often given instead of pills, and for a variety of reasons : thus, the 
patient's stomach may be in too delicate a state to tolerate the presence of so irritating 
a body as a pill or dose of medicine of any other kind. A very common reason for 
preferring a powder to other kinds of medicine is persistent vomiting ; and it is found 
that powders will remain on the stomach at times when it rejects everything else. 
Again, some persons — either from fancy, or possibly from some real disease of the 
throat — are unable to swallow particles of any size, and then the administration of 
powders becomes imperative ; children, as of course is well known, obstinately refuse 
to take medicine of any kind, and the wisdom of our ancestors and the infantile 
experiences of most of us has demonstrated that powders are of all things the most 
difficult to reject from the mouth. 

In administering powders it should be borne in mind that the act of swallowing is 
mainly an involuntary one, and that if the materials to be swallowed be placed far 
enough back in the throat they must continue their journey to the stomach whether 
tiie patient desire it or not. Powders therefore should be placed quite upon the back 
of the tongue, beyond what are technically known as the pillars of the fauces — i.e., the 
t«*o bunds which, on looking into the mouth, may be seen stretching from the uvula 
to ? he tongue on either side. That horrible instrument of torture which formerly was 
regard id as an household requisite, but which happily is becoming daily map **nd 



646 NURSING AND THE CARE OF THE SICK. 

more rare — we mean the physic spoon — was constructed on purpose for the adminis- 
tration of powders. It consisted of a spoon with a lid and a hollow handle, and it was 
only necessary to introduce the spoon into the mouth — into which it exactly fitted — 
when, on blowing down the handle of the spoon, the contents of it were left safely 
adhering to the back of the throat, whence all efforts to dislodge them proved almost 
absolutely futile. Powders are happily nowadays not often so bulky as formerly was 
the case, and it is seldom necessary to employ for their administration the formidable 
engine we have described. 

When a powder is given, it is advisable to place it upon the point of a spatula or 
the handle of a spoon, which should then be passed quite to the back of the throat and in- 
verted. If the patient is unconscious or only semi-conscious this is all that is necessary, 
and the powder may be left to find its own way to the stomach by the acts of swal- 
lowing which the presence of the powder in the back of the throat will assuredly set 
up. If the patient is conscious and in a state to assist in the curative measures which 
are being adopted for him, it is a good plan to give a drink of water or some other 
unforbidden liquid in order to wash it down ; and of course the sooner the powder 
reaches its destination the sooner will the effect which it is desired to produce with 
it be brought about. Powders may be stirred up with water or any other liquid, 
which the patient then drinks " dregs and all ; " in this way the powders of ergot, 
which it is customaiy to give to lying-in women, are administered. 

It is usual, of course, in the case of children to mask the presence of the powder 
by giving it in a spoonful of treacle or preserve ; this is a manoeuvre, however, upon 
which it will scarcely be necessary for us to dwell. 

In those cases in which it is not possible — owing to the patient's condition — to 
place medicine of any kind in the patient's stomach, it becomes necessary to give drugs 
in some other way ; and, happily, we have other methods at our disposal for adminis- 
tering them. 

The most common channel of administration in these cases is the bowel, into which 
we may put injections, or enemata. 

Eneirhata, or injections, are of several kinds, and vary in nature according to the 
purpose for which they are intended. 

If it is wished to influence the whole system by medicines inserted into the bowel, 
the injection must not be too bulky or it will not be retained, and the object for which 
it is administered will be defeated. Almost the only medicine which is so adminis- 
tered is opium, and there is no more effectual way of stopping diarrhoea in some cases 
than by the administration of injections of opium and starch. These injections should 
not exceed two or three ounces, or, at most, four ounces in size ; the starch or arrow- 
root, having been made in the ordinary way, ought to be allowed to get quite cold, 
and should then be of such consistence that it may be passed with ease through an 
ordinary glass syringe. A big glass syringe of the usual make is the best instrument 
for giving enemata of this kind, but care must be taken to ascertain that the nozzle 
is thoroughly rounded at the end and not in the least jagged. The opium, morphia, or 
other drug to be given must be very carefully and thoroughly mixed with the starch, 
and — the nozzle of the syringe having been introduced with the utmost gentleness into 
the bowel — the process of injecting must be accomplished as slowly as possible. 



WURSING ENEMATA. 647 



The points, then, which are to be borne in mind with regard to these enemata — in- 
tended to control the actions of the intestines or produce sleep, are : — (1) that they 
must be small in quantity ; (2) that they must be cold ; and (3) that they must be 
very slowly injected. 

The most common reason for giving an enema is to open the bowels. A simple in- 
jection of water, either tepid or cold, is habitually used by many persons, and especially 
on the Continent, for this purpose. This simple injection — or enema simplex, as it 
is technically called — may consist either of pure water, or more commonly of soap and 
water or gruel. Soft soap is usually considered the best for making this enema. 
The directions given by Miss Veitch in her hand-book are as follows : — "Enough soap 
should be rubbed down in two pints of hot vater to render it creamy, by which time 
the water will be about the right temperature. The nurse must be careful to fill the 
syringe before introducing the tube, otherwise air is forced into the bowel before the 
enema is injected." 

Before introducing the nozzle of the syringe into the bowel it should be oiled. 
It must be inserted with the utmost gentleness, and the direction winch the bowel takes 
should be ever present in the mind of the administrator. As the patient lies on his 
left side — the position which is generally recommended — the direction of the bowel 
is towards the left hip-bone of the patient. We have known patients very seriously 
hurt by the injudicious attempts of the nurse to forcibly pass the syringe in the 
wrong direction — that is, directly upwards in the middle line of the body. It is im- 
portant to remember these directions, because it very often happens that the patient is 
too insensible to guide the nurse by his own sensations. It is usually sufficient merely 
to insert the nozzle of the syringe just so far that the enema after injection is securely 
retained ; in rarer cases, however, it is deemed necessary to pass a long tube a great 
way up the bowel. This is a manoeuvre that demands great care and experience, 
and unless the nurse is well assured that she possesses these in a sufficient degree, 
it had better be left to the medical practitioner to perform. 

If the patient cannot be placed upon his side, he may lie upon his back with one 
leg raised, but the direction of the syringe must still be towards the left hip-bone. 

A great variety of syringes have been devised for the administration of injections, 
but the purchaser should be careful to select one of the most simple construction 
possible, and we would especially caution him to avoid those highly-complicated 
apparatus which are worked by springs and clockwork. Those made entirely of india- 
rubber in which the pump consists of an air-ball held in the hand, and which are 
provided with a simple suction-tube and injection-tube, are the best for several reasons. 
Firstly, they are cheap, a consideration which is always of importance ; secondly, they 
are very portable, and but little liable to get out of order ; thirdly, the amount which 
can be injected through them is in no way limited by the size of the instrument, 
but any quantity can be sucked from a basin and thrown up the bowel. 

An injection should always be slowly administered, and great care is necessary 
to avoid getting air into the machine, which occurrence is at once evident by the 
gurgling noise which the bubbles make as they are forced through the apparatus. 
To avoid getting air bubbles mixed with the enema, the nurse must carefully watclj 
that the end of the suction-tube is never above the level of the liquid in the basin 



648 NURSING AND THE CARE OP THE SICK. 

To produce a purgative action it is often advisable to inject a pint or a pint and a 
half of liquid. When the enema is only part administered it is very common for the 
patient — feeling some degree of distension of the bowel — to cry out and express a 
wish to evacuate the bowel, but to this the nurse should pay no attention, unless it be 
to discontinue the administration for a few moments — but without withdrawing the 
tube — until the sensation of distension has passed off, which it almost invariably does ; 
the injection must then be slowly continued till all of the desired quantity has been 
given, when, after a brief interval, the tube must be slowly withdrawn. The patient 
should then be directed to retain the injection in the bowel until he really feels 
that he can do so no longer, and then when it is ultimately passed, it will be found that 
a copious evacuation will follow it. When giving an enema it is of course very im- 
portant to exercise every care that the patient and the bed are neither of them soiled 
or left in a damp state after the process : a mackintosh sheet ought always to be placed 
under the patient's body before operations are commenced. 

If it is desired to produce a very strong purgative action, it is usual to introduce 
some purgative drug into the injection mixture : common olive or salad oil is given not 
only on account of its slight purgative action, but because it also serves to soften any 
old and hard accumulations of faecal matter that may happen to be in the intestines. 
Castor-oil may be substituted for common oil, and then of course a more powerful pur- 
gative a .tion is produced. It is usual to thoroughly mix about an ounce of castor oil 
with the gruel or other fluid of which the bulk of the injection is constituted. 

The U.S. Dispensatory provides for the administration of the following druge 
in the form of enemata. 

Aloes, in the enema aloes barbadensis, in the proportion of forty grains of 
Barbadoes aloes with fifteen grains of carbonate of potash in half an ounce of starch. 

Assafoetida, in the proportion of thirty grains of assafcetida rubbed down in four 
ounces of water. 

Epsom salts, in the enema magnesim sulphatis, in the proportion of one ounce of 
the salt with an ounce of olive oil in three-quarters of an ounce of starch. 

Opium and tobacco are also given as enemata, but such powerful drugs cannot be 
safely given by an amateur. 

The injection of turpentine — enema terebinthince — is a powerfully purgative enema. 
It is made with one ounce of turpentine in three-quarters of an ounce of starch. 

In cases where it is impossible to put any food into the stomach, it becomes 
necessary to feed a patient by the bowel. This leads us to speak of nutritive enemata. 
These should not be so bulky as the purgative enemata, but owing to the necessity 
of introducing food in sufficient quantity into the bowel, they are generally about half 
a pint in quantity. It is absolutely necessary that the food which it is sought to in- 
troduce in this way into the system should be of an absolutely bland nature, and in 
no way irritating, or purgative action will be set up, and thus the object of the injection 
will be defeated. Milk may be given in this way, and it may either be given alone 
or it may be made the groundwork, foundation, or vehicle, as it is technically called, for 
other matters. To the milk may be added some strong beef tea or some Liebig's Ex- 
tract of Meat. A writer, whose practical experience in all departments of nursing 
has been very considerable, recommends the following : — "Half an ounce of beef tea, 



HURSING INJECTIONS. £49 



half an ounce of brandy, the yolk of an egg, and a tea-spoonful of raw arrowroot — given 
at intervals of one or two hours." The arrowroot helps to retain the enema in the bowel 
The whole should be pumped up very slowly, so as to avoid any action of the bowels, 
which might cause it to return. It is almost needless to add that the beef tea or other 
food used for these purposes must contain neither salt, pepper, nor any flavouring of 
an irritating kind. 

Opinions differ very much as to the value of these nutritive enemata, and while 
some authorities assert that patients will live and flourish on them for even weeks 
at a stretch, others assert with equal decisiveness that the bowels — at least the lower 
end of them — having very little or no digestive power, food introduced into them is 
neither dissolved nor absorbed. 

This has led to the introduction of digested enemata, in which the attempt is made 
by the addition of chemicals to the food to imitate the action of the gastric juice, and 
thus try to imitate Nature by introducing the food into the bowel very much in thb 
condition in which it would have arrived there had it been previously passed through 
the healthy stomach. 

Digested nutritive enemata are thus prepared : the mixture of milk, beef tea, or eggs, 
having been put in a jar provided with a lid, must be placed in a warm situation at a 
temperature of about 100 degrees Fahrenheit. If the jar be put in the fender, or on 
the hob, not too close to the fire, these conditions will be about fulfilled. To the jar 
must then be added ten grains of pepsin, which may be obtained at almost any chemist's 
shop. Pepsin is the active principle of the gastric juice, and is artificially prepared 
for commercial purposes from the stomach of the calf or pig. In addition to the pepsin 
must be added hydrochloric acid, in the proportion of ten drops of the acid to each 
half-pint of the liquid. This mixture of food, pepsin, and acid, must be allowed to 
stand for about an hour, at the end of which time the acidity of the liquid — which 
would prove too irritating for the bowels — must be neutralised by the addition of a 
small quantity of carbonate of soda, which must be slowly added and thoroughly mixed 
with the food till effervescence ceases. It is highly probable that a carefully-prepared 
fluid of this kind would prove far more nourishing to the invalid than enemata which 
have not been previously subjected to this process of artificial digestion. We have 
no hesitation in recommending their adoption as a rule. 

After the administration of nutritive enemata, the patient should be directed to 
remain as quiet as possible, so that there may be no risk of the food remaining in the 
intestine too short a time for the assimilation of as much of the food as can be 
absorbed. 

Another way of administering medicine, and especially narcotic medicine, such as 
morphia, is by injection under the skin. There can be no doubt that this method of 
hypodermic injection, as it is called, is one of the most important discoveries of modern 
medicine ; at the same time, it must be borne in mind, that since only the strongest 
solutions of the most powerful drugs are given in this way, the process is never lightly 
to be had recourse to, and must be adopted only on the recommendation of a medical 
man, and must be carried out only by one who is thoroughly instructed in the use of 
the necessary instrument. 

The hypodermic syringe is a small glass syringe constructed to hold only a few drops 



650 NURSING AND THE CARE OF THE SICK. 

of liquid, and terminating in a hollow needle, through which the fluid is injected : the 
piston works sometimes with a screw, and sometimes in the ordinary way. To use it 
one must be, in the first place, thoroughly certain of the strength of the solution which 
it is intended to inject. That employed for morphia is usually of such a strength that 
six minims of the solution contains exactly one grain of morphia, or, in other words, 
one drop of the liquid equals one-sixth of a grain of the potent narcotic. The next 
point is to fill the syringe with the exact amount required, and no more ; this is 
easily done with due care, as the syringe is always plainly and carefully graduated. 
The syringe being charged, the process of injection is not difficult : it is only necessary 
to pinch up a piece of the skin between the thumb and fore-finger of the left hand, 
and then push the sharp needle-point of the syringe completely beneath the skin ; 
then, as the piston is depressed, the few drops of fluid will be seen to flow from it. 
The point of the syringe must be allowed to remain in situ for a few moments, and 
then, as it is very gently withdrawn, the pad of the right fore-finger must be placed 
upon the minute puncture, to prevent the escape of the injected fluid. 

As to the place for making these injections under the skin, we may say that the 
spot selected is of small consequence, as wherever this may be, the effect produced 
is not local, but upon the whole system. It is generally best to choose a spot which 
is not very sensitive, as the skin of the back, or the back part of the arm. 

A suppository is a dose of medicine made up in a solid form, and of such a 
shape— like a conical bolus — that it can be easily introduced into the bowel. The 
introduction of a suppository is never a matter of any difficulty. The medicines 
which are used in this way are usually of a narcotic or astringent nature. The 
U.S. Dispensatory provides formulae for suppositories of lead and opium, tannic 
acid, mercury, and morphia. 

Having discussed the various forms of medicine intended for internal administra- 
tion, we may now pass on to consider those which are for external use. 

It is often advisable to keep' a part cold or hot. If cold is required, the usual 
plan is to apply either cold water, ice, or evaporating lotion. Cold water is applied 
by simply moistening pieces of lint or linen rag, and laying them on the part. It 
must be borne in mind that the process of evaporation, even of water, is a powerful 
cause of cold, and, therefore, these applications must never be covered up, but be 
left exposed, so as to encourage evaporation in every way. In applying moist appli- 
cations to a part, care must be taken that no moisture escapes into the bed, or the 
patient will get chilled : the rags must be wrung out sufiiciently dry to avoid this. 

Evaporating lotions are merely water to which a certain amount of spirit has been 
added, so as to increase the rapidity of evaporation, and so enhance the degree of cold. 
These lotions must never be applied to a part the skin of which is broken. 

Evaporating lotions are generally made with methylated spirits of wine, but any 
spirit answers the purpose perfectly well. It is a common custom to make these 
lotions with ordinary gin. 

Evaporating lotions must be kept constantly wet, or they very soon get dry and 
hot, and then only serve to keep the part rather warmer than if they were dispensed 
with altogether. 

Occasionally an apparatus, known as an irrigator, is employed to keep a part con- 



NURSING FOMENTATIONS. 651 



stantly moist and cool. Thus, let us suppose that we wish to keep a bruised leg 
constantly cold, we may do so by suspending to the bed-cradle a wide-mouthed bottle 
filled with water, or any other liquid that may be thought advisable ; a woollen thread 
or a few pieces of cotton, twisted together like the wick of a lamp, must then be placed 
in the bottle, with one end out and hanging just over the bruised part of the leg, which 
we must keep covered with a piece of rag. The capillary force of the threads will 
serve to draw the fluid gradually out of the bottle, and it will fall on the rag in a 
succession of drips, which will keep the rag constantly moist ; and the rate of 
evaporation being nearly uniform, the degree of cold will be nearly uniform also. 
When employing irrigation it is doubly necessary to protect the bed from getting 
damp. When using cold to a part, it is very necessary to keep it persistently applied, 
because, as is well known, the moment the application ceases, reaction sets in, and 
in a short time the part glows with warmth. 

When ice is used for the maintenance of cold — which is occasionally done to the 
head and spine — it is necessary to enclose the ice in a bladder, or some other water 
proof bag. An ordinary sponge-bag answers the purpose perfectly well. 

Dr. Chapman has invented bags which are especially designed for the application 
of ice to the spine, but a nurse of ordinary intelligence will have little difficulty in 
extemporising something which will fulfil the necessary requirements nearly as well 
as the patent spinal ice-bag. 

The warm applications which the nurse will have to use are of two chief kinds, 
viz., fomentations and poultices. 

To make a fomentation three things are required — boiling water, flannel, and 
a wringer. Of these requisites the last only needs a few words of explanation. 
A wringer is made of a piece of strong coarse calico about three-quarters of a yard 
long, and a foot and a half wide. It must be double, the edges must be firmly 
stitched, and at either end a loop must be left large enough to admit a piece of 
broom-stick a little longer than the width of the stuff. When a fomentation is to be 
made, first prepare the wringer by fitting the handles into the calico, then lay the 
calico across a basin with the handles hanging over the edge ; place the flannel on 
the wringer, and then add the boiling water from a kettle. When the flannel is 
thoroughly soaked through, proceed to wring it out by means of the wringer. Take 
hold of it by the wooden handles, raise the boiling-hot flannel out of the basin, and 
then by twisting the handles in opposite directions the flannel will be wrapped in the 
calico, and the exertion of a very moderate amount of screwing power upon the handles 
will serve to wring the fomentation absolutely dry without scalding the fingers. 
Before a fomentation is applied to the skin, care must be taken to ascertain that it 
is not so hot as to be likely to scald the patient, but short of this a fomentation 
can hardly be too hot, and a good nurse will show her skill by the rapidity with 
which she can prepare a fomentation and get it applied before it has had time to 
get cooled. 

While applying fomentations to young children, it behoves the nurse to be 
especially careful that they are not too hot, because the tender skin of a child is very 
easily scalded, and they are more at the mercy of a nurse than are adult patients. 

The writer of this article has lately had brought under his notice a very sad case 



652 HURSING AND THE CARE OF THE SICK. 

of a poor child being very nearly killed by the carelessness of an inexperienced 
nurse, who applied a fomentation so hot that it took all the skin off the abdomen. 
Accidents like this would be avoided if the nurse would always remember to test 
the degree of heat on her own face before applying it to the patient. 

After a fomentation has been applied, it must be immediately covered with some 
waterproof material to prevent evaporation, or else the rate of cooling will be so 
quick that the object of a fomentation — continued warmth and moisture — will not 
\te gained. It is sometimes necessary to retain a fomentation in situ by a few turns 
ef a bandage. 

Occasionally it is recommended to add some drug to the fomentation, but it is 
very doubtful if remedies applied in this way are of any service. It is very common 
in cases where the patient is suffering much pain to sprinkle a few drops of laudanum 
on the flannel, and, although we have very great doubts as to the efficacy of such a 
proceeding, we nevertheless hesitate not to recommend that which has received the 
sanction of many generations of learned physicians. 

Fomentations need to be repeated at regular intervals, and the nurse must be 
careful to have the new fomentation in readiness before the old one is removed. 
When a fomentation is changed, the skin should be thoroughly wiped diy with a 
towel before the new one is applied ; if this is not attended* to, any part which may 
have been moistened, and which might not be covered by the new fomentation, is 
liable to get unduly chilled. 

Many special fabrics have been made for the application of fomentations, the best- 
known of which is probably the so-called Spongio Piline. This is certainly a very 
convenient and neat material, but when using it, it is advisable to cover it with a 
piece of oil-skin or other waterproof fabric to prevent evaporation from its thick 
edges. 

Poultices are either very useful and agreeable applications, or quite the reverse, 
according to the skill with which they are made. 

Poultices, or cataplasms, are of various kinds, and the Pharmacopoeia provides 
for six different poultices, namely, charcoal, linseed, Jiemlock, yeast, mustard, and 
cJdorinated soda. The bread poultice, which is the one in most common use, is not 
recognised. When we speak of a poultice we mean a linseed poultice, which is 
directed by the Pharmacopoeia to be made in the following manner : — " Linseed meal, 
four parts ; olive oil, one half part ; boiling water, ten parts. Mix the linseed meal 
with the oil, add the water gradually, constantly stirring." 

These directions, however, are very rarely followed in practice, and the method 
advised by Miss Veitch is the one usually pursued : "To make a linseed meal poultice, 
the vessel in which it is to be made should first be warmed; then boiling water 
poured in, according to the size of the poultice required. Practice alone will enable 
the nurse to judge the quantity correctly. The water should be sharply stirred with 
the hand while the meal is dropped in with the other, care being taken to stir only 
one way." After a poultice has been mixed to a proper consistence, the next thing 
is to spread it evenly on a piece of old soft linen rag. This is perhaps the most dif- 
ficult part of making a poultice, as it must be of the same thickness throughout, and 
not in th& least lumpy, or else portions of the linseed are apt to fall away from the 



NURSING POULTICES. 653 



rest and get into the bed. " If the poultice is for an open wound, care must be 
taken that no threads are left on the rag on which the poultice is laid that can 
possibly get into it. A margin of rag should be left all round the poultice, which 
should be first doubled back on itself, and then over the edge of the poultice." 

Although we speak of rag as being useful for the manufacture of poultices, we 
would impress on the reader the importance of making sure that all rags employed 
for such a purpose are absolutely clean. There is a great demand in large hospitals 
for rags for these purposes, and they are always an acceptable present, but they 
should never be sent without having been previously boiled, so an to remove any 
septic or contagious particles which may be adhering to them. 

For the satisfactory spreading of a poultice, a long thin knife, or spatula — a blunt 
knife, not unlike an artist's palette knife on a large scale — is needed. 

After a poultice has been applied, it is always necessary to cover it with a water- 
proof or oil-silk, in order to prevent drying and cooling. 

The following are the directions for making charcoal poultice, or cataplasma car- 
bonisy as it is called : — " Take of wood charcoal, half an ounce ; bread, two ounces ; 
linseed meal, an ounce and a half; boiling water, half a pint. Soak the bread in the 
water near the fire, add the meal and half the charcoal, stirring to a soft poultice, 
sprinkling the remainder of the charcoal on the surface." 

Charcoal poultices are useful in cases in which one has to deal with very stinking 
and foul wounds, as they have very great deodorising power. 

The yeast poultice is employed for very much the same purposes as the charcoal 
poultice, and, although they were once in high repute, they are now but seldom 
ordered by surgeons or physicians. The following are the directions for making the 
cataplasma fermenti of the Pharmacopoeia : — Take of beer-yeast, six parts; flour, four- 
teen parts; water, at a temperature of 100° Fahrenheit, six parts. Mix; place the 
mass near the fire till it rises. 

It is important to bear in mind that the yeast poultice diners from the others in 
this, that the water employed to make it must not be boiling, or else the fermentative 
action will be arrested, and the mixture will not rise. 

Hemlock poultice, or cataplasma conii, is very rarely employed, and is, we think, of 
very doubtful utility. The directions for it are as follows : — Take of hemlock leaf, 
in powder, one ounce ; linseed meal, three ounces ; boiling water, half a pint ; mix 
the ingredients, and add them to the water gradually, constantly stirring. 

The last poultice which we need mention is the chlorinated soda poultice, or 
cataplasma sodce, chloratce, which is made thus : — Take of solution of chlorinated 
soda, one part ; linseed meal, two parts ; boiling water, four parts ; add the linseed 
meal gradually to the water, stirring constantly; then mix with the solution of 
chlorinated soda. 

Miss Yeitch has many excellent remarks on the subject of applying poultices, 
which we make no apology for quoting : — 

" When a poultice is to be applied, the nurse should get her patient ready first. 
If he has a wound, it should be thoroughly washed and lightly covered ; then the 
poultice should be made quickly, and applied as warm as the patient can bear it. 
The bad habit of making the poultice first, and keeping it warm at the fire while fcha 



654 NURSING AND THE CARE OF THE SICK. 

patient is prepared should be carefully avoided, as by this means the water evapo- 
rates, and instead of a poultice a hard dry cake is formed. . . . . In all cases 
of poulticing or dressing wounds everything required should be got ready before the 
patient is touched. Uncover, wash, and cover again as rapidly as is consistent with 
careful dressing. I have seen nurses first remove all the dressings, then go for water, 
&c, thereby often causing much unnecessary pain to the patient. A good nurse will 
spare her patient every possible delay, fatigue, or excitement which it is in her 
power to avert from him. She should also move quickly as well as quietly." 

We may now proceed to discuss another class of external applications, viz., 
those of a stimulating or counter-irritating nature. These include blisters, mustard 
plasters, stupes, and stimulating liniments. 

The essential principle of all blistering applications is the cantharis vesicatoria, or 
blistering fly, and of this the U.S. Dispensatory contains several preparations, 
which are in the form of liquids, plasters, or papers. 

Before applying a blister the skin should be thoroughly washed, so as to remove 
from it every particle of grease, which seriously interferes with the action of the 
blister. 

If one of the blistering fluids is used, it is only necessary to paint the part for a 
few minutes with the fluid by means of a camel's-hair brush, and then to be careful 
that none of the fluid is washed or rubbed off before the part is thoroughly dry. If 
a blistering plaster is employed, this must first be cut to the exact size required. 
Sometimes when the patient's skin is very sensitive, and also for the purpose of 
avoiding any constitutional action from the blister, a piece of oiled tissue paper or 
very thin silk is placed between the plaster and the skin. In France, powdered 
camphor is sprinkled on the blister for the same purpose. 

It is often asked by patients — "How long am I to keep this blister on?" To 
this it is obviously impossible to return an exact answer couched in terms of time, 
but we may always reply — " Keep it on until a blister is raised 1 " This is, of course, 
a variable period depending on the quality of the blister, the part of the skin to 
which it is applied, and the degree of irritability of the skin of the patient on whom 
it is to be applied — facts which can only be learnt by experience. The blister may 
be removed for a short time for the sake of ascertaining how matters are going on, 
and if no signs of the desired effect are observable, it must be replaced. If the blister 
be a good one, and the skin be clean, about twenty minutes or half an hour is gene- 
rally sufficient to raise a considerable blister. 

After the blister has been raised, the next difficulty for amateurs is to know what 
to do with it. As a general rule, we should say do nothing, but if the bladders of 
fluid be inconveniently large, they may be snipped with a pair of scissors, to let out 
the fluid. If it be thought advisable to keep up the action of the blister, the 
discharge from the blistered surface may be encouraged by the application of poultices 
or warm-water dressings to the part. If, on the other hand, it is not desired to keep 
up the action, the raw surface must be carefully protected from injury or irritation, 
and the healing process may be encouraged by the application of some bland ointment 
to the part, such as cold cream or spermaceti ointment, which, for this purpose, must 
be spread upon a thin piece of soft rag, 



NURSING PLASTERS. 655 



The mustard plaster is a domestic remedy of such respectable antiquity, and of 
such acknowledged efficacy, that it is almost superfluous to say anything about it. 
The directions given in the Pharmacopoeia for making the cataplasma sinapis — as 
the mustard poultice is called — are as follows : — Take of mustard in powder two and 
a half parts; linseed meal, two and a half parts; boiling water, ten parts.. Mix the 
linseed meal with the water, and add the mustard, constantly stirring. 

The method employed in most households is far more rough and ready than this, 
and consists of spreading the contents of the mustard-pot on a piece of brown paper. 
As table mustard is always diluted with the admixture of a certain proportion 
of wheaten flour, the strength is not very different from that ordered by the 
Pharmacopoeia. 

For the sake of cleanliness, as well as to avoid the possibility of blistering the 
skin by the accidental adhesion to the skin of portions of mustard, it is generally 
advisable to place a piece of muslin between the skin and the plaster. 

It is not uncommon to hear persons speak of mustard blisters, but this is a 
wrongful application of the word blister, since it is only in very exceptional circum- 
stances that a mustard plaster has any vesicating, blistering action ; and when it has 
this is due either to the great tenderness of the skin, or to the mustard having been 
left on too long. 

Thanks to the ingenuity of a French chemist, M. Eigollot, we have a form of 
mustard plaster at our disposal which is so cleanly and convenient that it threatens 
to displace the old-fashioned forms of plaster. Bigollot's leaves are always ready at 
a moment's notice, and can be cut exactly to any size required. 

Another form of mustard plaster is sold under the name of " Sinapine Tissue;" 
but the efficacy of many of these tissues is due to cayenne pepper rather than to 
mustard, so that we cannot so confidently recommend them. 

The Pharmacopoeia of the United States contains a formula for mustard paper, 
which is as follows : — Black mustard in powder, ninety grains ; solution of gutta- 
percha, as much as will give it a semi-fluid consistence, and let it be spread with 
a suitable brush on one side of a stiff piece of paper, four inches square, and allow it 
to dry. Before applying it to the skin it should be dipped in warm water for fifteen 
seconds. The solution of gutta-percha is made thus : — Steep thin gutta-percha in 
eight times its weight of chloroform until dissolved ; mix one part of carbonate of 
lead with two parts of chloroform ; add this to the solution, and shake frequently, 
and let it stand for ten days, or until the precipitate falls, then pour off the clear 
liquid for use. 

In making mustard poultices for children, it is advisable to put at least half of 
the total bulk of linseed, or the skin may be blistered. 

We ought, perhaps, to say a few words on the use of ordinary sticking plaster, 
concerning which there is much misapprehension in the amateur mind. It cannot 
be too strongly impressed on the reader that sticking piaster is used solely for its 
mechanical properties, and that it has no healing power of any kind ; in fact, the re- 
verse rather holds good, for its undoubted utility as a mechanical support is to some 
extent counterbalanced by the sticky and dirty condition in which the parts are left 
after the plaster has been removed. Sticking plaster ought never, a3 is too frequently 



S56 NURSING AND THE CARE OF THE SICK. 

done, to be put upon a raw surface ; and although it is of great use for holding the 
edges of a wound together, care should be taken that the attachments of the plaster 
are well beyond the margins of the wound. After plaster has been used for any 
purpose, whether for holding the edges of a wound in contact or for attaching a 
blister, poultice, or other dressing to the surface of the body, great care ought to be 
taken that the skin is thoroughly cleansed from all adhering particles of the adhesive 
material of which the plaster is composed. Thi3 may be done by gently rubbing the 
part with olive oil or turpentine, which dissolves the plaster. After using turpen- 
tine the skin must be carefully washed with soap and water, or blistering may result. 

The same remarks would apply also to the employment of the various kinds of 
plasters which are used for many different purposes. To this class belong the "Poor 
Man's Plasters," strengthening plasters, and the like, which are worn for long periods 
on the body as protections against cold, to relieve internal pains, and to afford sup- 
port to parts, such as the back, which may have become weakened from any cause. 
These plaisters are often worn for too long periods at the great risk of setting up irri- 
tation of the skin beneath them. 

Stupes are fomentations to which some stimulating liquid has been added. The 
turpentine stupe is the one in most general use, and it is very easily prepared. 
Make a hot fomentation in the ordinary way, and when it is quite ready sprinkle 
over the suiface a table-spoonful of turpentine, and apply it to the part while it is 
still hot. If turpentine is too stimulating, camphor may be substituted, and this may 
be done either by sprinkling some powdered camphor, or a few drachms of spirits of 
camphor, which will answer the same purpose. Stupes are invaluable applications 
in cases of bronchitis with great difficulty of breathing ; or for cases of colic of the 
bowels, in which they often give speedy relief. 

Liniments are used for two chief reasons — either to give relief from pain, or to 
act as a stimulant, and quicken the nutritive activity of a part Stimulating 
liniments are useful in proportion to the ability and thoroughness with which they 
are applied. Any liquid will act as a stimulant provided it be applied to the part 
with sufficient friction, and many persons are in the habit of ordering l inim ents 
because they wish to insure that the part shall be properly rubbed. Rubbing is 
undoubtedly one of the most valuable curative means at our disposal ; but in order 
that it may be as useful as it can be, it must be carried out with a good deal of 
patience and method. One object of rubbing is to make the skin red, and this is 
only a matter of rapidity and hardness. A bad rubber will make the skin sore as 
well as red, and thus great harm is done, because it is impossible to apply a liniment, 
or even to rub a second time, on a sore place. Thus excess of zeal may deprive the 
patient of his necessary treatment. 

Some liniments are of so stimulating a nature that no friction is required to 
enhance their effect ; of such a nature are the liniments of mustard and croton oil, 
and, indeed, in applying the latter the nurse must be careful not to allow any of the 
stimulating fluid to adhere to her fingers, or they will be made sore thereby. When 
applying a croton-oil liniment it is advisable to protect the hand with a glove, or to 
use a piece of rag to rub with, and it is also necessary to remember to wash the hand 
witn soap and water afterwards. 



NURSING BATHS. 657 



When using a liniment which requires to be rubbed in with some force, as when 
applying soap li nim ent to a limb the seat of paralysis, a large quantity of the 
linim ent must be taken in the hand, and be applied to the limb ; the rubbing must 
be effected steadily, and with considerable deep pressure, and, as a rule, in a direction 
towards the trunk of the body. Rubbing of this kind, if skilfully done, takes the 
place of exercise to a great extent, and serves to drain the disused muscles and other 
tissues of the effete materials which accumulate in them, owing to their forced 
inactivity. The main use of the liniment in these cases is to grease the surface of 
the limb, and prevent rough friction, otherwise the surface of the skin would very 
soon be rubbed off. There are one or two so-called liniments, which would, we 
think, be better designated as pigments : these are the liniment of iodine, which is 
merely painted on the part with a camel's hair pencil ; and the liniment of aconite, 
which, when used pure, is applied in the same way. 

Baths are very often ordered as curative agents, and every nurse should know 
how to cany out the wishes of a medical man in this important line of treatment. 
In order to administer baths with precision, there should be first a large bath with 
an abundant supply of hot and cold water, and a big waste-pipe. If these luxuries 
be not at hand, the nurse must supply their place by manual labour. A thermometer 
is always necessary to test accurately the temperature ordered. A hot bath means 
a temperature of 98° or 100° Fahrenheit ; occasionally the heat may be allowed to 
rise to 104°, but this is very hot, and while a jjatient is being subjected to this 
temperature he must be very carefully watched, lest faintness ensue. A hot 
bath should not be continued more than five or ten minutes, unless it be specially 
ordered for a longer time. 

Of late years a method of treating fevers by means of baths has come very much 
into vogue. The method usually pursued is to place the patient in a hot bath, and 
then to diminish the temperature as rapidly as possible ; thus a patient suffering, let 
us say, from rheumatic fever in a high degree, is lifted out of bed and placed in a 
large bath at a temperature of 90 Q ; the water is then drawn off, and cold water is 
added, or even lumps of ice may be put in the bath, the result being that the tem- 
perature is very rapidly lowered down to 70°, 60°, or even 50°. The patient is then 
removed from the bath, wrapped in a sheet, and replaced in bed. The results of this 
treatment, heroic as it may seem, have been very encouraging, and not a few patients 
have by its means been snatched from the jaws of death. 

Sometimes the much simpler method is resorted to of merely wrapping a patient 
in a sheet wrung out of ice-cold water. This is equally efficacious in reducing the 
temperature of fever, and, strange to say, the patients who are subjected to this treat- 
ment do not particularly object to it ; and hitherto no untoward results in the form 
of chills and the like have arisen from it 

When giving cold or tepid baths to healthy people, such as children, it is always 
necessary to ascertain that a proper reaction follows the bath. In order to ensure 
this, the effect of the bath must be very carefully watched, and if the skin does not 
quickly glow after it, the temperature of the water must be raised, and the period of 
bathing must be lessened. 

It is generally advisable, at least in this country, to bathe children before a fire^ 
42 



658 NURSING AND THE CARE OF THE SICK. 

and it is a good plan to stand them in hot water while using cold water for their 
general ablutions. In this way the chilling effect of the cold water is in a great 
measure obviated, while the tonic effects are enjoyed to the fulL 

Hot air baths and vapour baths can with a little ingenuity be administered in 
a private house. The hot air bath is managed by placing in the patient's bed under 
the clothes a great Davy's lamp, so constructed that the bed-clothes are kept well off 
the lamp. This arrangement is perfectly safe, and so successful that in a very short 
time the maximum temperature that the patient can bear is reached. Whenever an 
arrangement of this kind is employed, the patient should lie between the blankets, 
in order that the veiy copious perspiration which will assuredly result may be 
thoroughly absorbed, and the patient run no chance of a chill. A vapour bath re- 
quires only a very simple contrivance : an ordinary washing-tub should be fitted with 
a false bottom, and over it should be hung a circular curtain made of flannel, and 
having a metal top like the curtain of a shower bath. An ordinary large kettle should 
then be fitted with a long tin pipe conducting the steam from the spout of the kettle 
to the tub below the false bottom, which is perforated to let the steam pass upwards. 

Bleeding. — The age of blood-letting is gradually passing away, and it rarely falls 
to the lot of a nurse to take charge of a patient for whom loss of blood has been 
prescribed. Such cases do, however, occur now and again ; and, although we think 
it is scarcely necessary to say anything about general bleeding, we feel that one or 
two observations on bleeding with leeches will be acceptable. 

Leeches are very delicate animals, and bear handling very badly ; the nurse must 
therefore be careful not to subject them to any rough usage, or they will possibly 
die or prove of no use. It is often difficult to get a leech to bite, and the most 
common cause of such a refusal is that the skin of the patient has not been properly 
cleansed before applying the leech. It is recommended by some that if the leech 
still refuses to bite the skin should be moistened with a little milk, cream, or 
sugar and water. Miss Veitch says that she once succeeded in persuading an obsti- 
nate leech to bite by putting it for a few moments into a basin with a little beer. 
When applying leeches they should be held delicately by the tail, but care must be 
taken not in any way to bruise them. Special tubes of glass called leech-glasses are 
sold, into which the leeches are to be placed when applying them, but care is re- 
quired, lest the wrong end of the leech be put into the bottom of the tube. The 
leech is very similar at both ends, but the mouth is known by its presenting an 
appearance of three rays. A leech is said when in health to be able to extract about 
a fluid drachm of blood. If it be thought desirable to encourage the flow of blood, 
this may be done by applying poultices or hot fomentations to the part, and bleeding 
may be kept up for some time from a leech-bite in this way. It occasionally happens, 
on the other hand, that the bleeding from a leech-bite is too profuse, and this may 
even go to the extent of endangering life, for there is nothing in which individuals 
show a wider difference than in the disposition to bleed. The best way to check 
excessive bleeding is to apply pressure to the part by means of a compress made of 
lint. If this does not serve, it is recommended to apply a matico leaf, or to touch the 
part with caustic. Cases are recorded in which it has been necessary to bring lh« 
edges of the bite together with a stitch. 



NURSING INVALID DIET. 659 



"We now pass on to consider a totally different class of questions, but such as are 
of the greatest importance to the invalid. First, as to sleep — tired Nature's sweet 
restorer. We need hardly say that it is to be encouraged in every way, and, as a 
rule, the nurse will do no wrong if she consider that every other curative agent is to 
give way to this, the greatest of them all. There are, however, some conditions in 
which a patient's sleep must be regulated for him. During convalescence from very 
exhausting disease, care must be taken that the patient is not allowed to go too long 
without food. After an attack of high fever, or of delirium tremens, when the 
periods of sleep are inordinately long, it is necessary to awaken a patient in order 
to feed him. If, however, the food be not in readiness, it is surprising how short a 
time will elapse before the patient is again asleep. It will occasionally happen that 
a patient shows a disposition to sleep in the day-time and to be wakeful at night, and 
when this is the case it sometimes is advisable for the nurse to use some simple 
artifice to shorten the day slumbers. Sleep should always be encouraged in the 
sick-room by all possible means, and darkness and quiet ought most rigidly to be 
maintained. The night nurse ought to see that everything that she is likely to 
want in the night is ready to her hand, so that in case of any requirements by her 
patient during the night, there may be no needless running to and fro with 
unnecessary noise. If the patient is taking any narcotic medicine in order to 
induce sleep, great care must be taken that, after the administration of the sleeping 
dose, absolute quiet is maintained in the sick-room. We have known it happen that 
a dose of medicine, intended to produce sleep, has been completely counteracted by 
persistent conversation, or by the carrying out of arrangements which ought to have 
been perfected hours before. 

INVALID DIET. 

Food is infinitely more important to an invalid than drugs, and it behoves every 
good nurse to be in some degree a cook, and able to supply for her patient, when 
occasion requires, a few wholesome, appetising, and palatable articles of food. As 
a rule, we deprecate cooking in the sick-room, and anything which the nurse finds 
it necessary to prepare ought to be done in an adjoining room. 

The diet of a sick person has to be very nicely regulated according to his condition. 

A slop diet includes milk, broths, beef-tea, and cooling drinks. We do not include 
alcoholic drinks under our remarks on food, as the administration of these more 
properly belongs to the doctor than the nurse. 

Middle diet includes the slops, with the addition of eggs, light puddings, and bread. 

Ftdl diet necessarily varies with the constitution of the patient and the nature of 
the case. It includes plain roast and boiled meats, or boiled fish, with eggs and 
light farinaceous articles. Vegetables ought never to be given without express 
permission. 

Every nurse ought to possess some knowledge as to what articles are to be 
accounted digestible, and what are to be avoided because of their indigestibility. 
It is right to state that nurses often show a surprising ignorance in these matters, 
and it often happens that a medical man is thwarted in his best endeavours to pilot 
a patient safely through some disease — such, for example, as typhoid fever — in which 



060 NURSING AND THE CARE OF THE SICK. 

careful diet makes the sole difference very often between life and death, by the 
obstinate and ignorant self-sufficiency of the nurse, who, directly her superior's back 
is turned, indulges her patient with all kinds of things for which he may have a 
fancy, and which are, of all things, possibly the most likely to work his ruin. Thus 
a case occurs to us in which a patient recovering from typhoid fever was very 
properly placed upon a very restricted diet by the medical attendant. All went on 
very welL The fever subsided, and in a few days the patient would have been able 
to leave his bed, when suddenly diarrhoea, which had been the most troublesome 
symptom throughout the illness, set in again with great violence. The cause of this 
diarrhoea was a mystery, for the nurse stoutly asserted that there had been no 
disobedience in respect of the diet. On carefully examining the evacuations, 
however, they were found to consist very largely of the debris of French beans ; and, 
on being pressed, the nurse confessed that the patient begged so hard for this 
indulgence that "she could not find it in her heart to say no." This reckless 
conduct on the part of the nurse, although it did not cost the patient his life, was, 
nevertheless, the means of confining him for an additional three weeks to his bed, 
with all the additional weakness and expense which such a course entails. This 
instance which we have given will, we hope, impress upon the reader the great 
importance of absolute firmness in all matters connected with diet. 

We must refer the reader to the sections on food, which will be given in our 
chapter on hygiene, for particulars as to the digestibility and dietetic value of 
the different varieties of food; but we may impress upon him in this place a 
few of the most important facts which must be borne in mind in the sick- 
room. The things which are most easy of digestion are the simple albuminous 
liquids made from meat or eggs. If the stomach possess any digestive power 
at all, these will always be digested in small quantities, and one advantage in 
using them arises from the fact that they leave only a very slight residue of 
insoluble matter. Farinaceous articles, such as arrowroot, are also very easy 
of digestion; but it must be remembered that to make sure of the digestion of 
these materials they ought to be thoroughly mixed with the saliva, so that in all 
cases where the patient is too ill, or from any other cause is unable to chew, they 
should be given with a sparing hand. Lastly, it must be borne in mind that fresh 
vegetables are among the most indigestible forms of food, and that they always leave 
a bulky residue of solid matter, which is liable to prove very irritating to the intes- 
tines, so that it may be laid down as a broad rule that fresh vegetables, although a 
most desirable diet for the robust, are only admissible to the sick-room under excep- 
tional circumstances, and with the express sanction of the medical man in charge. 

The staple article of diet in the sick-room is beef tea, and every nurse ought to 
know how to make it. The best beef tea takes nine hours to make, and the extra time 
taken in its manufacture will be found to be more than compensated by the very nutri- 
tious quality of the article prepared. It is made thus : — Take one pound of the best 
rump steak that can be obtained. See that it is free from fat, and cut into small cubes 
about half the size of dice ; place these in a jam-pot provided with a lid ; pour half a 
pint of cold water over them, and let them stand for three hours ; pour off the liquid, 
and set it aside. Next, pour another half-pint of water on the meat, gradually raise it 



NURSING — INVALID DlEt. 661 



to a temperature of 160 degrees Fahrenheit, and keep it at this temperature for three 
hours. To the uninitiated it may seem difficult to fulfil these conditions, and it 
may be thought that we are giving directions which are merely fanciful and impos- 
sible in practice. This, however, we assure the reader is not the case ; and if one is 
provided with an ordinary cooking thermometer and a gas jet or spirit lamp, there 
is nothing easier than to keep a liquid at any temperature short of boiling for any 
required time. Next, pour off this second liquid, and add it to the first. Lastly, 
pour upon the meat half a pint of boiling water, and keep it just boiling or 
simmering for three hours, and then pour off the liquid, and add it to the other two 
portions. In this way we shall have extracted from the meat everything that is 
soluble in cold, in hot, and in boiling water. The beef tea thus prepared is a rich 
brown liquid, with a copious brown sediment, and an odour of raw meat. We 
Relieve that beef-tea thus prepared is better than when prepared in any other 
way. 

Miss Yeitch gives the following directions for making beef tea : — " From a good 
piece of gravy-beef — which must be perfectly sweet — cut away every particle of fat, 
and then either scrape it into shreds with a knife, or cut it into very small pieces. 
Put it into an earthenware jar with a lid, add cold water sufficient to just cover the 
meat ; put on the lid, and place the jar in a saucepan of warm water, and stand it 
by a good fire, or on a hot plate or oven, where it will simmer without boiling ; it 
will require to stand for some hours before it is really good. When the meat 
becomes white and sodden-looking it is ready, as then all the good has been 
extracted from it. If not quite hot after the meat has been taken out, the beef tea 
should be put into a saucepan and heated, unless the patient is ordered or likes to 
take it cold." 

The only exception we should be inclined to take to the above very excellent 
directions is the remark that " when the meat becomes white and sodden-looking it 
is ready, as then all the goodness has been extracted from it." As a matter of fact, 
it will be found that it is only necessary to soak meat for a comparatively short time 
in cold water to render it perfectly colourless and washed-out in appearance ; but 
there is very much valuable matter still remaining in the beef, which can be 
extracted by properly regulated temperatures. 

Some authorities assert that beef tea is better made without any water at all. 
They say that it is only necessary to place the meat previously chopped up in a jar 
with a lid, and to let it, in Bismarckian phrase, " Stew in its own gravy." We are 
not inclined to agree with this teaching. Water is capable of dissolving many of the 
constituents of the meat, and it adds so little to the bulk that on every ground it 
ought to be used. Beef tea before it is served requires to be heated, and it should be 
flavoured with salt to suit the taste of the patient. When not counter-ordered, a little 
pepper may be added to make it palatable, but any excessive use of condiments is 
to be deprecated in the sick-room. As a rule, no vegetables are put in beef tea, but 
nevertheless, it is generally pleasant to the patient, and often advisable on the 
score of health, to add a little vegetable flavouring. This may be done by boiling 
with the beef tea some pieces of carrot, turnip, parsnip, or a little celery seed. 
It must be borne in mind that no pieces of vegetable are on any account to be 



«62 NURSING AND THE CARE OF TIIE SICK. 

left in the tea, but that they are to be all carefully straLied off. It is generally 
customary to serve with the beef tea a few pieces of toast, or a portion of bread 
— that is, supposing the patient is well enough to feed himsel£ When toast is 
served it should always be dry, so that it requires to be chewed before swallowing. 
The worst way of giving it is in the form of little cubes floating in the liquid. In 
this way it reaches the stomach in a most indigestible condition, and often causes 
great discomfort and flatulence. 

Raw meat is sometimes given to children when they can take nothing else. The 
best way to prepare it for them is to scrape it into a delicate pulp, and then spread it 
upon bread, or bread and butter, and flavour it with sugar or salt. It may even be 
given as a pulp out of a tea-spoon, and it is surprising to see how readily children 
will take what to most of us, if conscious of it, would seem a very disgusting mess. 

Of late years extracts of meat have been very much in vogue for feeding the 
sick, and very extravagant notions of the nutritive value of Liebig's preparations have 
been current. These have now almost exploded, and Liebig's extracts are regarded 
by most authorities more in the light of stimulants than really nutritive articles 
The effect of these extracts more resembles that of ordinary tea than beef tea or 
soup, and although they are valuable additions to a cup of beef tea or broth, they are 
not calculated to supply their place, nor are they of equal or even similar dietetic 
value. 

Dr. Ringer, in his work on "Therapeutics," gives the following recipe ior a 
restorative beef essence : — " Take one pound of fresh beef, free from fat. Chop it up 
fine, and pour over it eight ounces of soft water. Add five or six drops of 
hydrochloric acid, and fifty or sixty grains of common salt. Stir it well, and leave 
it for three hours in a cool place. Then pass the fluid through a hair sieve, pressing 
the meat slightly, and adding, towards the end of the straining, about two more 
ounces of water. The liquid thus obtained is of a blood-red colour, possessing a 
taste of soup. It should be taken cold, a tea-cupful at a time. If preferred 
warm, it must not be put on the fire, but heated in a covered vessel placed in 
hot water. 

Another Beef Essence (Dr. Ringer). — Take one pound of gravy-beef, free 
from fat and skin; chop it up very fine. Add a little salt, and put it into 
an earthen jar with a lid, fasten up the edges with a thick paste, such as is 
used for roasting venison in, and place the jar in the oven for three or four hours. 
Strain through a coarse sieve, and give the patient two or three tea-spoonfuls at 
a time. 

Mutton Broth (Dr. Ringer). — One pound of the scrag end of neck of mutton, 
two pints of water, pepper and salt, half a pound of potatoes, or some pearl barley. 
Put the mutton into a stewpan, pour water over it, and add pepper and salt. When 
it boils, skim carefully, cover the pan, and let it simmer gently for an hour. Strain, 
let it get cold, and then remove the fat. When required for use, add some pearl 
barley or potatoes in the following manner : — Boil the potatoes, mash them very 
smoothly, so that no lumps remain, put the potatoes into a pan, and gradually add 
the mutton broth, stirring it until it is well mixed and smooth ; let it simmer for 
five minutes, and serve with fried bread. 



NURSING — INVALID DIET. 



663 



Purees. — Purees are a capital form in which to give meat to an invalid. They 
are thus prepared. : — The meat is cut very fine, and simmered in a saucepan until it 
is pulpy and sufficiently soft to pass through a hair sieve or tamis cloth. Some- 
times it is necessary to pound the meat with a pestle and mortar before it can be got 
to pass through the sieve. Place the sieve upside-down on a dish, put the meat on 
the sieve, and then proceed to rub it through the sieve by means of a spoon or a 
stick with a rounded end. It may be necessary to add a little water, milk, or other 
liquid, in order to get the puree to pass the easier. The meat in a puree is in the 
finest possible state of division, and is consequently in a very digestible condition. 
A spoonful of puree meat is a welcome and valuable addition to beef tea or broth of 
any kind, or, indeed, . it may be added with advantage to farinaceous slops. We 
know of scarcely anything more nourishing than a tea-cupful of arrowroot with a small 
quantity of chicken puree stirred into it. Puree may be made of almost any kind of 
meat, but perhaps that made with chicken is the most easy of digestion, and certainly 
is the most palatable. 

It must be borne in mind that all these broths, (fee, are very apt to go bad, 
especially in hot, close weather, and it is therefore very necessary to be sure that on 
each occasion of administering beef tea that it is in a fit condition to be given. A 
cup of sour beef tea or broth may upset the care and nursing of weeks. 

Eggs. — Eggs are probably the most concentrated and nourishing food that we 
possess, and they may be given to an invalid in many ways. The Pharmacopoeia 
provides for the administration of eggs in its formula for mistura s}riritus vini 
gallici, which is known in ordinary circles as egg-flip. The official directions are as 
follows : — Take of brandy, four ounces ; cinnamon water, four ounces; the yolks of two 
eggs ; sugar, half an ounce : mix. The yolks of the eggs should first be thoroughly 
beaten in a tumbler till they are completely frothy, and strings no longer adhere 
to the prongs of the fork. Next, the sugar and some of the cinnamon water is 
to be added to the beaten eggs ; and, lastly, the remainder of the cinnamon water, 
previously mixed with the brandy, is to be poured in. It is a good plan to use 
a couple of large soda-water tumblers for mixing, and to pour the mixture a few 
times from one to the other after the manner of the makers of American drinks. 

We hardly know why the yolks only of the eggs are directed to be used, as the 
whites are scarcely less nutritious, and patients never object to them ; indeed, it is 
impossible if the mixture be properly blended to say whether they are present 
or not. 

In some cases of obstinate vomiting the patients will retain the whites of eggs on 
the stomach when they reject everything else. If cinnamon water be not at hand, 
a little nutmeg may be grated into the tumbler, and will be quite as acceptable to 
the patient. Any other spice may be substituted, or it, together with the sugar, 
may be omitted altogether, according to the taste of the invalid. 

Paw eggs may be beaten up with any kind of liquid food, such as tea, beef tea, 
or broth. 

Plain boiled or poached eggs or omelettes are delicate varieties of food which are 
of great service during convalescence. 

Plain Omelette. — The following directions are taken from " Buckmaster'a 



664 NURSING AND THE CARE OF THE SICK. 

cookery n : — " We must be careful that the frying-pan is perfectly clean, and frea 
from moisture. Place in the frying-pan about one ounce of sweet butter; break 
three eggs separately to see that they are fresh ; beat them up with a little chopped 
parsley and a pinch of pepper and salt. The eggs should not be beaten too much 
(about four seconds will be sufficient), or the white separates, and you produce 
a watery mixture, which destroys the flavour and appearance of the omelette. Now 
that the butter is melted, and in a state of froth, pour into the frying-pan the 
omelette mixture, and stir till it begins to set or thicken. Shake the pan occasionally; 
and when sufficiently firm, fold the omelette over neatly into an oval shape ; strike 
the handle of the frying-pan so as to produce a gentle vibration, which keeps the 
omelette detached from the pan, and when the omelette is of a golden colour, turn it 
quickly in the dish. To be able to prepare a plain omelette is to be able to prepare 
every kind of omelette. The chief thing to be borne in mind in cooking an omelette 
is that the mixture does not adhere to the frying-pan." 

The above recipe may be followed out in all particulars, except that we must 
warn the reader that chopped parsley is not to be given to an invalid without special 
permission granted by the medical man in charge. 

It is a very important tiling for a nurse to take every possible care that the 
patient shall not tire of his diet. A little tact and ingenuity in the matter of 
flavouring will often prevent this, and the nurse should contrive to ring the changes as 
much as possible with all the articles of diet which are permissible in any particular 
case. If once the fatal mistake is made of giving an invalid anything which is not 
perfectly good of its kind, such as a cup of sour broth, or a doubtful egg, it will 
almost assuredly turn him against that diet for the future, and thus a means of 
nourishment may be, as it were, cut off by the carelessness of the nurse. The good 
nurse is distinguishable from the second-rate or bad nurse, by the thoughtfulness 
which she invariably displays in little things of this kind, which, trifling as they may 
appear upon paper, are in practice really of the greatest importance, and deserving 
of the most anxious thought. 

Poached Eggs. — Boil some water in a saucepan, then break an egg into a tea-cup, 
being careful not to burst it, and place the tea-cup in the saucepan of boiling water. 
The egg should then be carefully placed upon a piece of toast, or a slice of bread and 
butter. 

Baked Custard Pudding. — "Warm half a pint of milk, or a little more ; whisk 
two eggs, yolks and whites, pour the milk to them, stirring all the while. Have 
ready a small tart-dish lined at the edges with paste ready baked. Pour the custard 
into the dish, grate a little nutmeg over the top, and bake it in a very slow oven for 
half an hour. 

Boiled Custard Pudding. — Prepare the custard as in the foregoing recipe. 
Butter a small basin that will exactly hold it, put in the custard, and tie a floured 
cloth over it ; plunge it into boiling water, turn it about for a few minutes ; boil it 
slowly for half an hour ; turn out, and serve. 

Hitherto we have dealt only with foods of the nitrogenous or meaty order, it must 
not be therefore supposed that farinaceous things are to be neglected in the dietary 
of the sick ; on the contrary, we believe that a great mistake is often made in not 



NURSING INVALID DIET. 665 



giving a far larger quantity of starchy matter than generally is allowed. Those who 
have stood by the bedside of an elderly invalid, complaining perhaps, as part of his 
symptoms, of chilliness and cold extremities, and have watched the general glow 
which follows the administration of a small cup of arrowroot, will have learnt a very 
valuable lesson. The effect, indeed, seems to us to be exactly comparable to putting 
coals on the fire. 

Arrowroot. — Tliis made either with water or milk is a most valuable article of 
diet in the sick-room. When made with water it is little more than a decoction of 
starch, and is useful chiefly as a heat producer ; but when the nutritive power of the 
milk is added to that of the arrowroot, we have a food which seems almost a type of 
what a food should be. 

A small dessert-spoonful of arrowroot will thicken about half a pint of water or 
milk. The arrowroot should be placed first in a tea-cup or small basin, and should 
be thoroughly mixed with a small quantity of cold water until all the little lumps are 
completely broken down ; then add by degrees the boiling water or milk, and 
continually stir the mixture. It may be flavoured with sugar, and a little nutmeg, 
or other kind of spice, or some lemon-peel may be added. 

Arrowroot Drink. — Mix two tea-spoonfuls of arrowroot in about three table- 
spoonfuls of cold water, then pour in about half a pint of boiling water : when well 
mixed, add by degrees half a pint of cold water, stirring all the time, so as to make it 
perfectly smooth. It should be of about the consistence of cream; if too thick, a little 
more water may be added ; then pour in two wine-glassfuls of sherry, or one of 
brandy ; add sugar to taste, and give it to the patient in a tumbler. A lump of ice 
may be added if allowed. 

Bread Pudding. — Grate old bread, or take stale pieces of bread, and pour 
boiling milk over them ; cover down till perfectly soaked ; beat them quite smooth, 
add sugar, eggs well beaten, and milk ; grate nutmeg on the top, and bake, or put into 
a basin and boil. Broken stale biscuits may be used instead of bread. 

Common Bice Pudding. — Butter a baking-dish ; put a small tea-cupful of rice, a 
little sugar, and a bit of butter into it ; fill the dish with milk, and grate a little 
nutmeg over the whole ; bake slowly till the rice is swelled and soft. Some persons 
like the rice to be first boiled, and an egg or two also to be well beaten with the 
milk. 

Bice Milk. — Three table-spoonfuls of rice, one quart of milk. Wash the rice, 
put it into a saucepan with the milk, and let it simmer gently till the rice is tender, 
stirring it now and then to prevent the milk burning; sweeten a little, and serve 
with a cut lemon, black-currant jam, or stewed apples. 

Tapioca Pudding. — One ounce of tapioca, one pint of milk, one ounce of butter, 
two eggs, sugar to taste. Wash the tapioca, and let it stew gently in the milk for a 
quarter of an hour, stirring it now and then. Let it cool, mix with it the butter, 
sugar, and eggs, which must be well beaten ; put it into a small tart dish, and give 
it an hour's baking in a moderate oven 

Oatmeal Gruel. — Put the groats or oatmeal into a saucepan, pour a little cold 
water upon them, and mix well; add more cold water, and stir occasionally. Boil it 
slowly, and never neglect to stir it ; strain it, and put sugar or salt, as best suits the 



666 NURSING AND THE CARE OP THE SICK. 

taste. About a pint of water to an ounce of groats is the proportion, and this 
quantity requires about three-quarters of an hour's slowly boiling. 

A prominent symptom of many acute illnesses is thirst, and there is nothing for 
which the invalid so often asks as " something to drink." It is important to know 
how to satisfy these cravings. 

Toast and Water. — This is made by toasting a piece of crust of bread until it 
is quite brown, or almost black ; then it is placed in a j ug, and upon it is poured 
some cold water. After standing for a short time it is fit to drink. 

Soda Water and Milk. — There is no better drink than a bottle of soda water 
mixed with a third part of new milk, and cooled with a lump of ice. 

Linseed Tea. — An ounce of linseed and a pint of boiling water are put into a 
jar provided with a cover. This should be allowed to stand for an hour before 
the fire, and should then be strained. It may be flavoured with sugar or lemon- 
peel. 

Pearl Barley Waier. — Wash an ounce of pearl barley in cold water three or 
four times, throwing away the water each time, as it will be very dirty; or boil it for 
a few minutes, and then throw the water away. Next add about a pint and a half 
of water, a bit of lemon-peel, and a little sugar. Allow it to simmer, stirring it 
constantly until it is of a very nice thickness ; then strain it, and add lenion-juiee. 
If a very slight flavour of lemon is preferred, with a very little acid, put a slice of 
lemon with the barley in the water. Sweeten to taste. Barwell recommends a few 
sweet almonds beaten to a paste to be first added, as they give a very pleasant and 
smooth flavour to the drink. While sweetening all the drinks of the barley-water 
type, it must be borne in mind that too much sugar is apt to cloy the palate, and 
also to generate wind in the intestines. 

Lemonade. — Peel one lemon or more, according to the quantity required and the 
size, of the fruit. Pour a small quantity of boiling water over the peel, and cover it 
close. Squeeze the lemon, and remove the pips. Pour some boiling water upon 
sugar in a separate vessel ; when the sugar is perfectly melted put the juice into it, 
add cold water, tasting as you proceed till you find the drink does not taste too 
strongly of the juice ; then put in enough of the peel to flavour it according to taste. 
" Lemons," says Barwell, " differ so much in the quantity of juice they yield, and 
even in the strength of the acid, that accurate directions as to quantities are 
useless ; you must be guided by the taste. Be careful to melt the sugar in water 
before you add the juice. Oranges may be used with or instead of lemons. 

Imperial Drink. — This is a time-honoured drink in the sick-room, where it was 
formerly known as Potus imperialis. It is made by dissolving a drachm or a drachm 
and a half of cream of tartar in a pint of boiling water, and flavouring with lemon- 
peel and sugar. When cold it may be taken ad libitum as a refrigerant drink. It 
has also slight diuretic qualities which are often of service. Cream of tartar enjoys 
a wide-spread reputation as a cooling salt, and is consumed very largely by Europeans 
working in hot climates or hot places, such as the stoke-holes of ships, &c. 

Caudle. — Beat up an egg to a froth, add a wine-glassful of sherry, and half a 
pint of gruel. Flavour with lemon-peel and nutmeg, and sweeten to taste. We do 
not profess to know what are the particular virtues of this renowned beverage, but 



NURSING — INVALID DIET. 667 



we give it a place in our catalogue of invalids' foods, because it would seem too 
discourteous to omit it. 

Orgeat. — Blanch two ounces of sweet almonds and four bitter almond seeds. 
Pound with a little orange-flower water into a paste, and rub this with a pint of 
milk diluted with a pint of water until it forms an emulsion. Strain and sweeten 
with sugar. This is recommended by Dr. Pavy as a demulcent and nutritive 
liquid. 

"Whey. — Curdle warm milk with rennet, and strain off the opalescent liquid for 
use. This is a favourite drink in many complaints, and in several parts of Germany 
invalids resort to particular localities to undergo the so-called "Whey Cure." It is 
said to produce perspiration and diuresis, and it is also mildly nutritive. 

"White -Wine Whey or Posset. — To half a pint of milk, whilst boiling in a 
saucepan, add a wine-glassful of sherry, and afterwards strain. Sweeten with 
pounded sugar according to taste. This is a favourite remedy for colds. 

Treacle Whey. — Pour two or three table-spoonfuls of treacle into a pint of 
boiling milk, and afterwards let it boil up well, and strain. This is drunk as hot as 
possible after the patient is in bed at night, and is regarded by many as a sovereign 
remedy for a cold. 

Tamarind Whey. — Stir two table-spoonfuls of tamarinds into a pint of milk 
whilst boiling, and afterwards strain. This is recommended by Dr. Pavy as a 
refrigerant and slightly laxative drink. 

We may bring our remarks on the feeding of the sick to a conclusion by laying 
before our readers a few additional recipes for the cooking of wholesome dishes 
which may be of service to the delicate and convalescent, as well as to the acutely ill. 

Oatmeal Porridge. — The following are Dr. Pavy's directions for making this 
highly nutritious article of diet : — 

" Mix a large table-spoonful of oatmeal with two table-spoonfuls of cold water. 
Stir well to bring to a state of unifonnity, and pour into a pint of boiling water in a 
saucepan. Boil and stir well for ten minutes. Flavour either with salt or sugar as 
preferred. Milk may be used instead of water, or the boiling may be continued for 
half an hour, and the porridge turned out into a soup-plate, and cold milk poured 
over it. Thus prepared, the porridge sets and acquires a solid consistence, and the 
milk and porridge are mixed together little by little, as they are eaten, with a spoon. 
If the coarse Scotch oatmeal is used — and this is generally considered the best — two 
table-spoonfuls may be sprinkled into a pint of boiling water, and stirred and boiled 
for half an hour. At the end of this time the oatmeal is sufficiently cooked, but 
many allow the porridge to continue simmering for two or three hours. It may be 
turned out into a soup-plate, and eaten with milk after the manner above mentioned." 

Milk and Suet. — Boil one ounce of finely-chopped suet with a quarter of a 
pint of water for ten minutes, and press through linen or flannel. Then add one 
drachm of bruised cinnamon, one ounce of sugar, and three-quarters of a pint of milk . 
Boil again for ten minutes, and strain. A wine-glassful to a quarter of a pint forms 
the quantity to be taken at a time. It constitutes a highly nutritive and fattening 
article, but if given in excess is apt to derange the alimentary canal, and occasion 
diarrhcaeu 



668 NURSING AND THE CARE OF THE SICK. 

Calf's-foot Jelly. — Procure two calf's feet or a cow heel, the latter being much 
cheaper and equally nourishing. Buy the feet with the hair on, because when ready 
prepared a great deal of the substance which makes jelly has been boiled away. In 
order to get the hair off, have ready a saucepan of boiling water ; hold the foot in it 
with your fingers so that the water just covers the hair ; from five to ten minutes is 
long enough ; the hair will scrape off easily with a knife. Put the feet into about 
five pints of water, and boil them till half the water is wasted ; strain it, and when 
cold take off the fat. Put it into a saucepan with sugar, lemon-juice, some lemon- 
peel, according to taste. If wine is permitted, you will put in as much as is judicious. 
In order to clear the jelly, the whites of five eggs well beaten up to a froth and the 
shells broken up must be added. Set the jelly on the fire, but do not stir it after it 
begins to warm ; when it rises to a head, let it boil for twenty minutes. Prepare a 
conical bag of coarse flannel, with two strings on the broad part, with which to tie it 
to the backs of two chairs. A coarse huckaback towel, which may be tacked together, 
making one corner the point, is even a better jelly-bag. Dip the bag in hot water, 
and squeeze it dry. Having placed a basin or shape under the point of the bag, 
pour the contents of the saucepan carefully into it, and they will run slowly through 
into the shape. Do not press the bag, or the jelly will be cloudy. Great clearness 
is not important, since this quality is more to please the eye than the palate. Calf s- 
foot jelly may be made without wine. 

Plain Boiled Sole. — Thoroughly wash and clean a sole, and put it into plenty 
of cold water, with salt, say one ounce to a quart of water ; bring it gently to the 
boil, put it aside to simmer for five or ten minutes, according to size. When ready, 
place it in a clean napkin, garnish with parsley and slices of lemon, and serve with 
plain melted butter or whatever sauce is preferred. Violent boiling is to be avoided. 

Panada. — Take the white part of the breast or wings, freed from skin, of either 
roast or boiled chicken, or the under side of cold sirloin of beef, or cold roasted leg 
of mutton, and pound in a mortar with an equal quantity of stale bread. Add 
either the water in which the chicken has been boiled, or beef tea, until the whole 
forms a fluid paste, and then boil for ten minutes, stirring all the time. 

We shall bring our observations on nursing to a close by bringing under the 
notice of the reader some of the more important points about a patient which a nurse 
ought to know how and when to observe. 

First, as to temperature, we may say that no nurse can be considered as at all 
competent to fulfill her duties until she has completely mastered the very simple 
process of taking a temperature accurately, and keeping a record of the same. The 
temperature is the most certain indication we have as to a patient's condition, and of 
all instruments used in the investigation of disease, the thermometer is the least 
likely of any of them to mislead. Special thermometers, called clinical ther- 
mometers , are sold for use in the sick-room. They are three or four inches long, 
and about the thickness of an ordinary pencil-case. They ought all to be self- 
registeiing, and we would not advise the purchase of such as do not fulfil this 
requirement, because it is inconvenient and disagreeable, not to say dangerous, to 
be constantly leaning over a patient to read off the thermometer before it has been 



NURSING TEMPERATURE — THE PULSE. 669 

removed from contact with his body. We have known more than one case of fever 
which was presumably contracted in this way. The natural temperature of the body 
is 98*4 degrees of Fahrenheit. Any deviation from this is an indication of some- 
thing wrong, but for practical purposes we may say that no temperature need be 
looked upon as too high unless the thermometer stand above 99 degrees. The 
temperature is usually taken by placing the thermometer either in the mouth or the 
armpit of the patient If the patient be in bed, perhaps the armpit is as good a 
place as any. The patient should be turned slightly on one side, and then the bulb of 
the thermometer should be thrust completely into the very point of the armpit of the 
side which is uppermost. The hand should then be drawn across the chest, and the 
patient must be thoroughly covered up with the bedclothes. After the thermometer 
has remained in situ about five minutes, it may be removed, and the temperature 
be read off and immediately recorded. In reading off a temperature, it must be 
remembered that the top end of the register, and not the bottom end nearest the 
bulb, is the correct indicator. We should have, perhaps, reminded the reader always 
to be sure to see that the register stands well below the normal temperature before 
applying the thermometer. This seems an almost needless precaution, but our 
experience tells us that it is very often neglected, and loss of time is consequently 
entailed. If the patient be not in bed, or if a temperature is wanted in a hurry, the 
thermometer may be placed in the mouth. In this case the bulb should be put under 
the tongue, and the patient directed to close the lips, but not the teeth. With the 
thermometer in this position, a correct temperature may be taken in about a minute. 
If the patient be a very young child, or insensible from delirium or any other cause, 
the best place, perhaps, to take the temperature is the lower end of the bowel or 
rectum. Here, too, a temperature may be taken quicker than in the armpit 
Always ' remember to wash the thermometer thoroughly after taking a temperature. 
If this be neglected, the thermometer may be the means of conveying contagion 
from one patient to another. Special charts for the recording of temperatures may 
be obtained, but it is generally sufficient, for ordinary purposes, to enter in a book 
or on a sheet of common notepaper the temperature and the time at which it 
was taken. The temperature, in any case in which an accurate knowledge of it is 
important, ought to be taken at least twice a day — morning and evening — and as 
much oftener, of course, as the medical man may desire. 

A nurse should also be able to "take a pulse." This is done by placing the fore- 
finger on the blood-vessel which may be felt at the wrist, on the outer side, just 
above the junction of the thumb with the wrist-joint While the pulse is being 
counted, the patient should be in a recumbent position, with the arm on which the 
pulse is being counted in a state of absolute repose. The finger should then be 
placed quietly on the pulse, the attention of the patient being attracted thereto as 
little as possible, since the pulse is very easily altered by slight emotional causes. 
The pulse may very well be taken while the thermometer is in position. The pulse 
should be counted for at least a minute by the seconds' hand of an ordinary watch. 
In old days, before watches were provided with seconds' hands, it was usual to compare 
the pulse of the invalid with that of some other person known to be healthy. Thus, 
in Pepys' " Diary," we find it recorded : — " October 1 9th, 1 663. Coming to St. James's, 



670 NURSING AND THE CARE OF THE SICK. 

I hear that the queen did sleep five hours pretty well to-night, and that she waked 
and gargled her throat, and to sleep again ; but that her pulse beats fast, beating 
twenty to the king's or my Lady Suffolk's eleven. It seems she was so ill as to be 
shaved and pidgeons put to her feet, and to have the Extreme Unction given her by 
the priests, who were so long about it that the doctors were angry. - . . . The 
king, they all say, is most fondly disconsolate for her, and weeps by her, which 
makes her weep ; which one this day told me he reckons a good sign, for that it 
carries away some rheume from the head." 

This gives an interesting and amusing idea of medical practice in the time of the 
merry monarch ; and from it we may gather that if his majesty's pulse were not 
quickened, the queen's beat about one hundred and thirty in the minute. 

Directly the pulse has been taken it should be recorded with as little delay as 
possible. 

A record of the rate of respiration is in many cases of scarcely less importance 
than that of the pulse. It is best taken by laying the hand quietly, and without 
attracting the patient's attention to the fact, upon the stomach if the patient be a 
man, and upon the upper part of the chest if a woman, and then simply counting the 
number of times the chest or abdomen heaves in a minute. 

The respirations should be taken at the same time as the pulse, and these two records 
must be entered on the same page with the temperature. The pulse and respirations 
bear in health a definite proportion to each other, and it will be found that for every 
respiratory movement there are four beats of the pulse. Any marked departure 
from this ratio is to be taken as an indication of disease. It will be readily under- 
stood that if a portion of one or of both lungs be from any cause hors de combat, that 
the healthy part remaining will have to work all the harder, and it is in such cases 
as these that we find a quickening of the ratio which respiration bears to pulse, and 
instead of its being one to four, it may rise as high as one to three or one 
to two. 

The amount of cough is another matter which a nurse ought carefully to notice, 
and not only the amount but the manner of coughing also. Thus a cough may be 
violent or hacking, tight or loose, accompanied by expectoration or otherwise, and 
these points are all to be carefully noted. The fact that a patient who has not 
previously coughed has been heard to cough only once or twice during the night 
may be a fact of the greatest importance. The character of the expectoration — 
supposing some untoward circumstance has interfered with its being kept, as it 
always ought to be, for the inspection of the physician — is always to be noted. Was 
there any blood in it ? How much was there 1 Was it watery or thick 1 Was it 
yellow or rusty-coloured 1 Was it very sticky and tenacious ? Did it smell strongly ] 
These are questions which a nurse may expect to have put to her on this point, 
and to which she should always be ready to give a prompt and satisfactory reply. 

Perspiration is another point to which the nurse's attention must be directed. 
The amount, the time, the part of the body upon which it appears most thickly, and 
any peculiarity of odour, are all to be noted. 

The amount of sleep also is a matter upon which the medical attendant wishes to 
be accurately informed. The best plan is to note down the hours of sleeping and 



NURSING — WHAT A NURSE SHOULD NOTICE. 671 

waking, and to add any remarks as to the character of the sleep which may seem 
desirable. Restlessness, wandering, or muttering are to be noted. Grinding of the 
teeth or snoring are to be noted, especially in the case of children. 

It may happen that a nurse is left alone with a patient during an attack ot 
convulsions, and it is important she should know not only what are her duties during 
the attack, but what are the points which are to be noted for the information of 
the doctor. During a fit the chief thing which needs to be done is to keep the 
patient free from harm if possible. Try to restrain the movements just sufficiently 
to avoid the bruising of the limbs by being brought in violent contact with hard 
bodies, such as walls and furniture. The safest spots on which a patient can have a 
fit is a bed or the floor, and if he be not on the one he should be placed upon the 
other. The dress should be loosened round the throat and waist, and if there is any 
tendency to bite the tongue it is a good plan to put a big cork or bung between the 
teeth. It is not much use to sprinkle water, although this is often done because the 
bystanders feel that they must be doing something. 

In an ordinary fainting fit the first and most important thing to do is to lay the 
patient down in an absolutely horizontal position; if this be not done all other 
restorative measures will be in vain. The dress must be loosened ; cold water may 
be sprinkled on the face, care being taken not to make the patient unnecessarily 
damp ; ammonia may be held to the nostrils, and a small quantity may be given to 
dxink. 

In every kind of fit the nurse ought to notice the complexion of the patient at 
the time of the seizure, whether natural, or pale, or dusky. The presence or absence 
of any sudden cry at the first moment o f . onset is also important. Anything which 
the patient may say just before or during a fit will often serve to give one a clue to 
a right appreciation of the true cause. If the patient be convulsed, the mode of onset 
of the convulsions should be particularly noticed, whether, for example, they begin 
in the arm, or the leg, or the face, and on which side of the body. 

Occasionally it is necessary to restrain a patient, owing to the violence of his 
delirium, and there is a marked difference in the tact with which different nurses 
control patients of this class. First, it is necessary never to be frightened ; but to 
give such a direction as this is, we know, a simple absurdity, since fright is generally 
a matter which is quite beyond our own control, and no directions of ours will enable 
a nurse not naturally endowed with nerve to be courageous under trying circum- 
stances. Use, however, is second nature, and since much fear arises from ignorance 
and misapprehension, it will be found that the nurse with the greatest amoimt of expe- 
rience is the most cool and collected in times of excitement. If a patient shows a 
disposition to be troublesome, he must be managed quietly and firmly. Do not talk 
to him unnecessarily, and always let him see that you mean to be obeyed. Never 
argue with a sick man, and least of all with one whose malady is mental. If a 
patient with delirium tremens, as is very often the case, gets a notion that there are 
persons in the room with him, or that there are plots against him, much may be 
done to remove his alarm by quiet demonstration of the real facts of the case. It is 
one of the characteristics of these patients that " They do fear each bush an officer," 
and to their diseased imaginations the commonest objects become sources of alarm. 



072 NtniSINO AND THE CARE OP THE SICK. 



If, however, the curtain, or the hanging garment, or whatever it may be that has 
caused the fear or apprehension, be removed, the patient may become quiet. If, in 
spite of these demonstrations, his delusions continue unabated, it is best not to talk 
about them ; and if he persist, do not worry him by contradiction. The writer is not 
one of those who object to restraint of a mechanical kind ; on the contrary, he believes 
that in cases where it has been necessary to apply it, that many lives have been lost 
by timorous hesitation on the part of the patient's protectors. A straight waistcoat, 
when properly applied, does not inflict any serious suffering, and it often happens 
that a patient becomes much more calm after it has been put on than he was before. 

A correct account also of the condition of the patient's bowels, and of the 
evacuations passed from them, is, as is well known, of the first importance. The 
number of motions per diem is to be carefully recorded, and, if necessary, each 
motion must be set aside till it has been seen by the medical attendant. 

The colour and consistence of stools is also to be noted. The proper colour is a 
deep brown. Blackness may arise either from the patient taking some preparation of 
iron as medicine, and, in rare instances, from the presence of blood in the motion. 
Pale yellow stools are supposed to show a sluggish action of the liver ; the stools of 
typhoid fever also are pale yellow. The motions of children are often white from the 
presence in them of curdled milk, which may be taken as an indication of faulty 
digestion, either from the condition of the stomach or the food. The stools should 
always be examined for the presence of blood or slimy matter, which is often an 
indication of inflammation of the bowels, 



THE OTKSESTG OF CHILDREN. 

Gbnebal Pbtnciples of Management : Cleanliness— Warmth— Fresh Air— Infant's Food- -Sucklings- 
Feeding by Hand— Milk— The Feeding Bottle— No Starchy Food to be Given— Preserved Milk. 
Weaning : Food after Weaning. Management after Weaning : Sleep — Exercise — Education. 

GENERAL PRINCIPLES OF MANAGEMENT. 

Among the lower animals maternal instincts are the sufficient and the safe guide for 
the nurturing and bringing up of their offspring, but with the human race, who live 
in a manner which is purely artificial, and whose young are reared amid the necessary 
but disease -causing paraphernalia of civilisation, the case is far otherwise. It is a 
fact which is painfully true, that in this country, and especially among the lower 
orders, young mothers seem to have neither instinct nor knowledge to tell them what 
is the treatment which their young children should receive at their hands. 

It is not too much to say that a large proportion of the disease which is so 
common in the early years of life is due to want of attention to a few plain and 
simple rules, although much, no doubt, is caused by poverty, by diseased parentage, 
and by the bad hygienic arrangements which are to be met with among the crowded 
habitations of the poor and labouring population inhabiting our urban districts. 

"We propose in this chapter to lay down a few simple rules which may be of 
service in helping the inexperienced to safely guard the young committed to their care. 

Keep the child clean. — This perhaps is the most important point in the manage- 
ment of children. The first office which is performed for a child is to wash it, an 
operation which demands skill, patience, and attention from the nurse. A child 
should be washed all over at least once a day with warm soap and water. This 
should be done before a fire, and it is needless to say that it should be done expe- 
ditiously, so as to run as little risk as possible of causing a chill. It must be 
remembered that the skin of a child is very delicate and very sensitive — sensitive 
to heat and cold, or to the irritation of dirt, moisture, or friction. Children are 
very liable to skin diseases, and these diseases are in many instances attributable to 
want of cleanliness. Care must be taken that after washing the body is wiped 
thoroughly dry. It should first be dried with a soft towel, and it is a good plan to 
finish with an old soft silk handkerchief. It is customary to powder a child's body 
after washing. This is a good plan, as it insures dryness and prevents friction. The 
body must be dry before the powder is applied, and care must be taken that there is 
not enough moisture on the body to cake with the powder, or it will be productive of 
harm instead of good. The best powder is very finely-powdered starch. The " violet 
powder " of the shops is merely powdered starch scented. The scent is an agreeable 
addition. " Powder puffs " are usually sold for the application of powder ; a piece of 
cotton-wool will, however, answer the purpose perfectly well. 

The buttocks and pudenda of a child are constantly wet from the passing of urine 
and motions. A very young child is practically never dry, the dribbling of urine being 
almost constant. The bowels of a new-born baby should not act more than four or fiva 
43 



674 THE NURSING OF CHILDREN. 

times a day. This constant involuntary passage of the excretions necessitates the 
wearing of napkins. Napkins should be made of old calico. Old sheets or pillow-cases 
form an excellent material : they should not be made of linen. They should be double, 
and of a square shape — about three-quarters of a yard square will be found a con 
venient size. A napkin should be folded corner to corner, like a shawl. The broad 
side of the triangle should be wrapped round the waist, and the pointed end should 
then be passed between the child's legs from behind forward, and the three ends 
fastened in front by a safety pin. Ordinary pins should not be used, lest the child 
be hurt by them. Some mothers always fasten the napkin with a needle and thread ; 
but whenever we see this we cannot a\roid the suspicion that the napkins are not 
changed as often as they might be. "Waterproof materials must not be used for 
napkins, because they keep in the moisture too much. When the child is in its cot, 
it is a good plan to place a small piece of waterproof sheeting under its middle, so 
as to protect the bed-clothes. Napkins should be changed very frequently, and the 
child washed, dried, and powdered. The motions and urine are both highly irri- 
tating (much more so than warm salt and water), and if this be left long in contact 
with the body the skin will become inflamed and sore. This may savour of over- 
carefulness to many ; but when the child falls ill, and they find by bitter experience 
how much more attention a sick child requires than a healthy one, they will discover 
that no amount of attention can be considered as too much if it but tend towards 
keeping the child healthy. The necessity of wearing napkins places the human infant 
at a disadvantage when compared with the young of any other animal. It is a 
necessity, we admit, but it is a necessity which is fraught with no small amount of 
danger to health. Disease sometimes places the adult in the same position as the 
infant in these respects, and the mind recoils at the thought of the disgusting 
discomfort which this entails. The evils of the napkin can only be counterbalanced 
by the most unremitting care and attention to cleanliness. Any nurse who is 
slovenly in this important matter is not fit to have the care of young children. 

Some authorities are of opinion that children ought to be washed at night before 
being put in their cots, rather than in the morning. This is a matter of no great 
moment, and may well be left to the mother or nurse to suit her own convenience. 

Keep the child warm. — This is as important as the previous injunction. They are 
best kept warm by warm clothing, and not by big fires and closed doors and windows, 
which are highly injurious. The clothing should not be tight, and should allow of 
the free exercise of the limbs. That which is next the skin should be of flannel 
Cleanliness in the clothing is of great importance, and it should be changed when- 
ever it becomes at all soiled. A healthy child delights to kick, and in its cot seems to 
spend its time, when awake, in smiling and crowing, and in an endless endeavour to 
put its toes into its mouth. This kicking takes the place of exercise in older people. 

Children that are born prematurely require a great deal of artificial heat, and in 
the few cases on record in which a child born at the sixth month has been reared, this 
has only been by the most extraordinary efforts in supplying it with artificial heat by 
means of hot bottles, &c. 

Give a child plenty of fresh air. — The windows of the day nursery should be 
opened wide at least once a day, to get the room thoroughly ventilated, and great 



KURSING OP CHILDREN — INFANT^ FOOD. 675 

tare should be taken that the sleeping-room is not over-crowded. The washing of 
small articles (such as napkins, &c.) is not to be carried on in the nursery, as the 
steam from the hot water and the drying of the clothes spoils the atmosphere. A 
child should be taken frequently into the open air during fine weather, its body 
being well wrapped up, and its face protected by a thick veil. Although we 
recommend plenty of fresh air as necessary for a child, we need hardly say that it 
should be protected most carefully from draughts and chills to which they are 
particularly sensitive. "When in the air, the head must always be carefully 
protected from the heat of the sun, and the nurse must always be careful to hold a 
sunshade over it, and to pull up the head of the perambulator when necessary. 

infant's food. 

Suckling. — A child must be fed with the greatest care. The proper food for a young 
child is its mother's milk, and provided the mother be healthy and have sufficient 
milk, the child should be fed upon nothing else for the first seven months of its life. 

A child that is suckled should be put to the breast at regular intervals, and 
should be allowed to remain there until it shows signs of repletion, when it should 
be removed. A child under three months of age should be suckled every two hours ; 
bet wen three and four months old, every two hours and a half; between four and 
five months, every three hours ; between five and six months, every three hours and 
a half; and at seven months, every four hours. A child is not to be fed, as is too 
often the practice, every time it cries. In this way the stomach gets over-distended, 
and is never properly rested, and the child becomes very liable to be tormented by 
wind and spasm. It is insisted upon by some that the child should always be 
suckled in an upright and not a recumbent position. 

If the child be suckled by a wet nurse, great care should be taken to ascertain 
that she have no hereditary disease. " A wet nurse should have been confined at 
about the same date as the mother. The best age is between twenty and thirty ; 
and it has been asserted that brunettes make better nurses and give better milk than 
blondes." If the child while suckling should suffer from diarrhoea, or any other 
form of illness, it is always well to make very particular inquiries as to the state 
of health of the mother or nurse. Slight causes, even emotional ones, seem capable 
of reacting prejudicially on the child through its nurse. 

If the mother or nurse have sufficient milk, the child need receive no other food 
whatever until it is seven months old ; but if the supply of milk fall short, there is 
no reason why it should not be supplemented by the milk of some other animaL 
There is an old-fashioned prejudice very common among monthly nurses that " it is 
dangerous to mix the milks." There is no ground whatever for such a belief. In 
fact, we believe that it is often better to mix the milks, than to deprive a baby 
altogether of that nourishment which its own mother is able to supply it with. 

Feeding by hand. — If a child be brought up by hand it should be fed entirely 
upon milk for the first seven months of its life or until it has cut its four front teeth. 

Milk is a food which will support life at any age. It has been spoken of as the 
typical food which contains all the "alimentary principles" to be found in the 
animal, vegetable, or mineral kingdoms. 



676 



THE NURSING OP CHILDREN. 



That part of milk which makes cheese, which is technically known as caseine, is 
the nitrogenous principle, and must be compared to lean meat in nutritive value. 

That part of milk which rises to the surface in the form of cream, and of which 
we make butter, is the fatty principle. 

That which gives the sweetness to milk — the sugar of milk, or lactine — is exactly 
comparable to the nutriment got from the sugar-cane and other sweet vegetables. 

Besides this, milk contains saline matter and water. We cannot feed a child as 
we feed a man upon a slice of fat meat, bread, and salt ; but it must fill our minds 
with wonder and thankfulness that Providence has provided for our young a fluid 
which contains in solution all those substances which are necessary to support life. 

Compared with this wondrous food which Nature has provided, the various 
foods and mixtures which have been invented by Liebig and by other chemists 
appear the most clumsy imitations, and fall far short of their prototype, as the most 
delicately-painted landscape fails to represent the soft natural beauty of the original, 
or the most carefully and skilfully-constructed automaton fails to be anything but 
the most bungling imitation of the breathing, moving, thinking being that it is 
designed to represent. 

The mother's milk is the best and safest food for a child, for two reasons : first, 
because it is the most delicate of any kind of milk, and it is not too rich for the 
fragile creature it is intended to support ; and secondly, being drawn direct from 
Nature's fount, it cannot be adulterated (unless the nurse be unhealthy), watered, 
sour, rancid, or otherwise unwholesome. 

The following table sets forth at a glance the chemical composition of different 
varieties of milk, and shows the proportion in a hundred parts, which each ali- 
mentary principle holds : — 

Mean Composition op the Milk op Various Animals. 



Caseine (cheesy matter) and in- 
soluble salts 

Fatty Matter 

Sugar of Milk and soluble salts 
Water 





Woman. 


Cow. 


Goat. 


Sn«@p. 


Aus. 


j 


3-35 


455 


4-50 


800 


1-70 




3-34 


370 


410 


6-50 


1-40 




3-77 


635 


6.8 


4-5 


6-4 




89-54 


86-4 


85-6 


8200 


90-5 




10000 


100-00 


10000 


10000 


10000 



Mam. 



0-20 

8-75 
89-33 

10000 



Thus it will be seen that, taken in the order of strength (that is, the amount of 
solid constituents in 100 parts), these milks will come as follow, beginning with the 
weakest. Ass, woman, mare, cow, goat, sheep. 

It will be seen, too, that, on the whole, the milk of the cow approximates most 
closely to that of the woman, and that the milk of the ass and mare are as poor in 
cheese and fat as the milk of the sheep is rich in these materials. 

A child under seven months of age should, then t when brought up by hand, be 



KURSING OF CHILDREN — FEEDING BY HAND. 677 

fed entirely upon cow's milk, and since cow's milk is somewhat richer than woman's 
milk, every pint of it should receive the addition of about one-third part of water, 
so that every pint (of twenty ounces) should, after dilution, form twenty-seven ounces 
of milk and water. 

The milk of a woman as it flows from the breast has the same temperature as 
the blood, which is 98° or 99° of Fahrenheit. A baby's milk and water should 
accordingly be heated to the same temperature, or a little higher, as it soon cools 
in the bottle. 

The proper food f&r a child before it cuts its teeth is therefore a mixture of three 
parts of cow's milk and one part of water, at a temperature of 98? Fahrenheit. 

It is customary to add a little sugar to this mixture, in order to make it palatable 
to the child. There is no harm in this probably, but on chemical grounds there 
seems to be no necessity, and the sugar used ought to be the most pure and delicately 
refined which can be obtained, and great care should be taken not to add too much. 
The coarse brown sugar used by the poor is no doubt a very bad thing for children. 

Row much milk and water should be given at a time ? — This is a very difficult 
question to answer with exactitude. The weights and sizes of children at birth differ 
immensely, some weighing much more than others. Cases are recorded in which a 
new-born baby has weighed as much as 14 lbs., and as little as 3 lbs. Now, if a child 
weighs four times as much as another child, it might require four times as much food, 
so that it is impossible to lay down any absolute rule as to the quantity of nourish- 
ment which children are to have. About a quarter of a pint (5 ozs.) may be taken 
as the maximum amount which should be put at any one time into a child's feeding- 
bottle. A child, like a grown-up person, will exhibit symptoms of hunger and 
satiety, and when it shows that it has had enough, the watchful nurse will remove 
the bottle, and will soon learn the quantity which the infant is capable of taking. 

As to the frequency of feeding, the same rule holds good with artificial feeding as 
with natural feeding. Thus : — 



Under 3 months • • 


• . Every 2 houri 


Between 3 and 4 months . • 


• • „ 2* „ 


„ 4 and 5 „ . • , 


• • » 3 » 


„ 5 and 6 „ • • 


• • »> 3£ „ 


At 7 months 


• • n * » 



As the intervals between the times of feeding get longer, the quantity given at 
any one time should be proportionately increased. A child should never be roused 
from its sleep for the purposes of feeding, and, on the other hand, feeding at odd 
times should never be resorted to as a means of quieting a noisy child. Regularity 
in feeding is of the greatest consequence, and if the rules laid down be departed from, 
the child will suffer from wind and colic and all the troubles which follow on 
repletion. A child which is brought up by hand must be fed from an infant's 
feeding-bottle. Good serviceable feeding-bottles are easily obtained, and are very 
cheap. They must be simple in construction, and easy to wash out and keep clean. 
A feeding-bottle may be easily extemporised. To do this, take a clean soda-water 
bottle, fit it with a good cork ; perforate the cork so as to admit the passage of a 
piece of glass tubing. The glass tube should pass to within a quarter of an inch of the 



678 THE NURSING OP CHILDREN. 



bottom of the bottle, and should project half an inch or an inch beyond the cork. 
To the upper end of the tube fit a piece of india-rubber tubing about ten inches or a 
foot long, and furnished with a nipple at its extremity for the child to suck. The 
tubing and nipple may be obtained at any of the india-rubber shops, which are now 
tolerably common in all large towns. Feeding-bottles form part of the stock-in-trade 
of every druggist in the country. 

A feeding-bottle must be kept scrupulously clean. — If this is not done a child may, 
or rather will, be made seriously ill. The tendency of milk to become sour and 
rancid is too well known to need comment on our part. It is difficult to keep milk 
sweet, even in a cool, clean dairy ; it is doubly difficult to do so when the milk is 
kept in a warm place, as a child's feeding-bottle invariably is and must be. Milk 
must not be allowed to lie in a bottle longer than is absolutely necessary. When 
the child has done feeding, the bottle must be emptied immediately, and the milk 
which it has left must be thrown away. It must on no account be kept for the 
child's next meal, as it is very false economy to run the risk of giving the baby sour 
milk for the sake of saving that which is of less value than a halfpenny. When the 
bottle is empty it should at once be scalded out and completely dried. The tube and 
stopper will want very careful cleaning, and water must be sucked and blown through 
the tube, and every visible particle of milk most carefully removed from it. A 
particle of milk no bigger than a pin's point, if left on the cork, or on the under 
surface of the cap-stopper, or in the glass tube, or in the india-rubber tube, will, to a 
certainty, go sour. Between the meals it is a good plan to keep the tube and cork 
always in water, but it must be remembered that mere keeping in water is not 
sufficient to thoroughly cleanse, and that the particles of dried milk, &c, must be 
carefully removed with a brush or by rubbing. Always smell the bottle to ascertain 
whether the well-known odour of acidity adheres to it. Smell especially the cork and 
the tube, which are the spots where acidity is most likely to be detected. It is a 
good plan to keep blue litmus test-papers at hand with which to test the milk. Milk 
should never do more than turn a test-paper dipped in it a delicate pink. If it turns 
a bright red it shows a dangerous degree of acidity, and such milk must be rejected. 
In hot weather, and whenever milk has to be kept for any length of time, it 
should be boiled at once, which prevents, to a certain extent, the tendency towards 
acid fermentation. 

If the milk disagrees with the child — if it forms curdled particles, or if it pass 
in curdy white pieces from the bowels — this may be taken as an indication that the 
milk (or mixture of milk and water) is too strong, or that it has a slight tendency 
to sourness when given, or that it is too quickly curdled by the acid secretions in the 
child's stomach. 

First, try diluting the milk, and instead of giving two-thirds milk and one-third 
water, try a mixture composed of equal parts of milk and water. Usually this will 
be found a sufficient measure to counteract the evil. If it be not so, the milk must be 
boiled before being administered, and if, in spite of these two measures, the child is 
found to suffer still from indigestion, a portion of lime water must be added to the milk 
and water. Lime water is a solution of ordinary builder's lime in water, and it is not to 
be confounded with lime juice, which, being the expressed juice of a variety of lemon, 






HURSING OF CHILDREN— ARTIFICIAL MILK. 679 

is a totally different thing. Lime water may be made by putting some fresh lime 
(not previously slaked) into a bottle, filling the bottle with water, and keeping it 
constantly and closely corked or stoppered. It must be allowed to stand until the 
lime has subsided to the bottom of the bottle, and the clear water on the top will be 
found to have a slightly alkaline taste (somewhat suggestive of old-fashioned sod* 
water), from the small quantity of lime which it holds in solution. When the use 
of lime water becomes necessary, a table-spoonful may be used in the place of an equal 
quantity of water in each bottleful of milk and water. Lime water is a very useful 
thing in the nursery, and it is well that every nurse should make herself acquainted 
with it. It is given to counteract the acidity of the milk before it is taken, or the 
tendency to turn acid after it is in the child's stomach. 

Every feeding-bottle should be provided with a flannel cover, in order that the 
heat of the milk may be longer retained. The covers should be thick and padded, and 
should resemble in construction the familiar " tea cozy," the objects fulfilled by which 
they are meant to imitate. In spite of these covers, however, the milk has a ten- 
dency to cool too rapidly, and it is as well, perhaps, to make the mixture two or 
three degrees higher than the exact temperature we have indicated. 

Give a child no starchy food until it cuts its teeth. — To write that " pap is an 
abomination " will seem to many of our readers to be a doctrine full of heresy ; but 
it nevertheless is true, and we have no hesitation in asserting that those nurseries will 
be the healthiest in which pap is not known. Starchy or farinaceous food includes 
bread, biscuit, rusk, baked flour, corn-flour, tapioca, sago, rice, arrowroot, potato, and 
all allied articles ; and we cannot too strongly impress upon our readers the fact that 
children are quite unable to digest such things, and that the giving of them is 
certainly the chief cause of " wind " and those other forms of indigestion which are 
so serious a drawback to the healthy development of a child. Starch in all its forms 
must be mixed with saliva, and must be thoroughly chewed before it can be digested. 
The indigestibility of new bread is chiefly due to the fact that, owing to its consistence, 
we often bolt it, instead of chewing it carefully, and mixing it with saliva. Now, 
very young children do not secrete much saliva, and what there is is incapable of 
acting upo 1 starch so as to help its digestion. As they have no teeth it is manifestly 
impossible for them to give the all needful chewing to starchy food; so that on 
these two grounds it will be evident that toothless children must not be fed upon the 
prohibited " farines." 

MfJiy patent foods are advertised in the present day. Very strong assertions 
are usually made in these advertisements as to the advantage of feeding children 
upon -these patent articles. Since, however, they, one and all, contain farinaceous 
material, we should say that, despite assertions to the contrary, they are not to be 
given to very young children. 

We cannot too often repeat that which is too often forgotten, viz., that milk 
thould be the sole food of the human infant until it begins to cut its teeth. 

Suppose a child cannot be suckled by its mother, and cow's milk is not to be 
obtained. How shall we then proceed to nourish it ? Clearly, the proper thing to 
do is to give it the milk of some other animal, and either the mare, ass, sheep, or 
goat may be used for this purpose, and it will be found that infants \erj soon 



680 THE NURSING OF CHILDREN. 

become accustomed to the milk of either of these animals. Ass's milk is recom- 
mended by some physicians as more easy of digestion than cow's milk, and peculiarly 
suited for children of weakly constitution and low digestive power. 

If fresh milk is not obtainable, recourse may be had to condensed or preserved 
milk, which has proved a great boon to children dwelling in large towns, where good 
milk is difficult to obtain. It has been the custom for many years to condense milk 
by evaporation for use on board ship, and latterly milk has been prepared in this 
country, and imported from Switzerland, which is not only condensed, but has a 
considerable quantity of cane sugar added to it. This preserved milk, which is 
sold in tins hermetically sealed, will keep for years if not opened, and a tin of it, 
even after opening, will keep sweet for three or four days. The following analysis 
of three varieties of preserved milk is taken from Dr. Pavy : — 





Anglo-Swiss. 


Aylesbury. 


English. 


Caseine . 


18-52 


17-20 


16-30 


Fatty matter . 


. 10-80 


11-30 


9-60 


Sugar of milk . 


16-50 


1200 


17-54 


Cane sugar 


2M1 


29-59 


2706 


Ash 


2-12 


224 


2-39 


Phosphoric acid 


•649 


•67 


•708 


Water . 


24-30 


2700 


26-50 



10000 10000 10000 

Oixe great fault in all these preserved milks is the amount of sugar they contain, 
which is undoubtedly too much. The sugar is added as a preservative; but we 
doubt whether it is altogether suitable for a child in such large quantities. Children 
undoubtedly do well on condensed milk, and it has been remarked that they get very 
fat, which is no wonder, seeing that fat-producers (cream, sugar of milk, and cane 
sugar) are in such large proportions in their diet. 

Besides the condensed milks we have noticed above, there are many other 
varieties. The public at present have no adequate guarantee of the genuineness of 
these hermetically-sealed articles. If they buy cow's milk at a shop, they know that 
they have their remedy at law if the cream be deficient or the water in excess ; but 
in buying " preserved milk " they are obliged to take with the milk as much sugar 
or other preservative as the manufacturer chooses to send, and they have no remedy. 
We think, that every tin ought to have upon it a plain statement of the composition 
of its contents, and then, should they be found on analysis not to agree with the 
description, the vendor would be punishable. The public ought to be protected in 
every possible way, since the importance of giving wholesome food to children is not 
to be over-estimated. If nothing but skim milk is obtainable for children, it is a 
good plan to boil some suet with the milk, and in that way the fat, which has been 
removed by skimming, is replaced. 

The following method of making artificial milk has been devised by M. 
Dubrufaut, and is taken from Dr. Edward Smith's work on food : — " Half a pint 
of water, one and a quarter ounces of cane or grape sugar, half an ounce of dry 
white of egg, and fifteen grains of carbonate of soda ; to be made into an emulsion 
whilst warm with one and three-quarters or two ounces of the finest olive oil, or some 



FUMING OF CHILDREN — ARTIFICIAL FOOD. 681 

other pure fat. This compound will be as thick as cream, and another half pint 
of water must be added to make it of the consistency of milk.. The addition of a 
little gelatine — say twenty grains to the pint — will increase the resemblance of the 
compound to cream, and will allow more water to be added." Liebig has devised a 
food which is intended to be a chemical imitation of woman's milk, and fit to 
replace it when the natural nourishment for a child is not obtainable. The following 
method of preparing it is taken from Dr. Pavy : — 

" Take half an ounce of wheat flour, half an ounce of malt flour, and seven and a 
quarter grains of bicarbonate of potash, and after well mixing them add one ounce 
of water, and, lastly, five ounces (a quarter of a pint) of cow's milk. "Warm the 
mixture, continually stirring over a very slow fire till it becomes thick. Then 
remove the vessel from the fire, stir again for five minutes, put it back on the fire, 
take it off as soon as it gets thick, and finally let it boil well. It is necessary that 
the food should form a thin and sweet liquid previous to its final boiling. Before 
use it requires to be strained through a muslin or fine hair sieve, to separate frag- 
ments of husk that may remain. 

" To avoid the trouble of weighing, it is mentioned that as much wheat flour as 
will lie on a table-spoon corresponds with an ounce, and that a moderate table-spoon- 
ful of malt flour corresponds with half an ounce. 

" It is malt made with barley that is to be used, and a common coffee-mill answers 
the purpose of grinding it into flour, which is to be cleared from the husk by a 
coarse sieve. The bicarbonate of potash is added to neutralise the acid reaction of 
the two kinds of flour, and also to raise the amount of alkali in the food to the 
equivalent of that in woman's milk. 

"The ferment contained in the malt leads, during the exposure to the warmth 
employed in the process of preparation, to the conversion of the starch of both the 
flours into dextrine (a gummy material) and sugar, the latter of which gives the 
sweet taste that is required. The newly-formed products, also being soluble, account 
for the mixture becoming thin, and it is a point contended for by Liebig that 
principles in this state tax the digestive and assimilative powers of the infant much 
less than starch." 

A recommendation, backed by the great name of Liebig, of course deserves at- 
tention; but we would, with great deference, express our decided opinion that 
these and similar artificial foods should be given only when pure milk is not to be 
obtained, or in those very rare instances in which pure milk in all forms produces 
diarrhoea and indigestion. A child ought rarely to take Liebig's Food until it is 
weaned, or until it has begun to cut its teeth. If the mother has no milk, the baby 
may take the cow's milk mixed with a third part of water; but we think the other 
ingredients had better be omitted as superfluous until the child has acquired some 
power of digesting complicated foods. 

Upon sugary foods a child will certainly grow fat ; but it must be borne in mind 
that because a child is fat it does not necessarily follow that it is strong also, and, 
indeed, the opinion has been expressed, that children fed upon the highly saccharine 
preserved milks succumb more easily than others to the attacks of diarrhoea and other 
maladies to which children arc liable. There is no question that these preserved 



682 THE NURSING OF CHILDREN. 



milks are very valuable productions, and are a perfect boon to the poor inhabi- 
tants of cities; but we think very strongly that they should only be used J ante de 
mieux, and those who are fortunate enough to command an ample supply of fresh milk 
from a healthy cow should give it in preference to any hermetically-sealed imports. 

Children are occasionally met with who do better on artificial and condensed 
milks than on the pure article. Such cases are wholly exceptional, however ; and 
whenever pure milk is to be got, it must be tried before having recourse to any 
artificial foods. 

WEANING. 

Directly a child begins to cut its teeth, and certainly as soon as four teeth 
have made their appearance, the process of weaning should be commenced. Prior 
to the process of dentition, a child is capable only of the act of suction, and its 
tender, almost rudimentary, jaws would be incapable of chewing, even supposing the 
necessary teeth were present. The appearance of the teeth, however, may certainly 
be taken as an indication that the jaws are to commence work, and the fact that the 
front teeth appear first would seem to be a beautiful provision of Nature for com- 
pelling the mother to think of discontinuing her nursing at the beginning of, instead 
of the end of, the first dentition. 

It very often happens that the appearance of the teeth is considerably delayed, 
and it not unfrequently occurs that a child may be more than a year old before it 
begins to cut its teeth. What ought to be done in such cases 1 We think decidedly 
that the weaning ought not to be delayed, but should be commenced at nine months 
at the latest. Very few women are capable of properly nourishing a child for more 
than nine months, and a continuance of the act of suckling after that period is mis- 
chievous alike to the mother and child — mischievous to the mother by causing an 
undue drain upon her vital powers, and mischievous to the child because the 
nourishment furnished by the exhausted mother is not strong enough to ensure 
its healthy development. When the teeth are delayed in a child who has been kepi 
absolutely to the breast, it may well be questioned whether the condition of the mother 
is not the cause of the delayed dentition. 

It is very much the custom of the women of the labouring classes to over-suckle 
their children, and there can be no doubt that the practice is fraught with great 
danger to health. Over-suckling is often, no doubt, the result of ignorance ; often, 
perhaps, a weak-minded woman is unable to make up her mind to sever that intimate 
bond which unites her offspring so closely to herself; but more often we believe 
that it is a custom resorted to with the avowed intention of placing a barrier against 
future pregnancies. The families of the poor are very apt to outgrow the straitened 
circumstances of the parents, and the woman, in the ignorant hope of delaying 
pregnancy, resorts to the dangerous practice of over-suckling/ It cannot be too 
generally known that over-suckling is no barrier to pregnancy, and it is an every-day 
occurrence for a nursing mother to become aware that the darling at her breast 
must, in a few short months, be deposed in favour of another little stranger. 

Although over-suckling is powerless to prevent pregnancy, it seems to have a 
very decided and a very baneful influence on the health of the child with which 



NURSING OP CHILDREN — WEANING. 683 

the mother is pregnant, and there is good reason to believe that the common disease 
called rickets is very largely dependent on a disregard of a natural law for wnich 
common sense, if no higher motive, ought to ensure respect. 

How is a child to be weaned? — This must be effected gradually, and at first, 
perhaps, there is no better plan than the substitution of an artificially-prepared meal 
twice in the day in lieu of suckling. The meal should measure a quarter or half a 
pint, and should be given in a feeding-bottle, and should consist of warm milk and 
water thickened with baked flour. 

Baked flour is preferable to raw flour, because it is more digestible. The action 
of the heat upon the starch granules of the flour causes them to burst and become 
more easy of digestion, and, further, a chemical change takes place, whereby some of 
the starch is converted into dextrine or gum, which dissolves more readily than blue 
starch. Baked flour may be prepared by putting the flour in a basin and simply 
placing it in the oven, or it may be tied up in a basin and boiled. In this the flour 
dries into a hard mass which needs to be broken and powdered before being used. 

Baked wheaten flour is probably the best thing possible to thicken a child's milk 
with. It is certainly to be preferred to the so-called " com flours," which are too 
often merely pure starch, whereas wheaten flour contains nitrogenous and other 
valuable dietetic principles in addition to the starch, which is, no doubt, its most 
important constituent. 

The next best thing to baked flour is well-baked bread, got from a reliable baker 
who does not mix potatoes or alum with the staff of life. The bread must be 
thoroughly baked, i.e., the flour must be thoroughly cooked. It is this necessity 
which has made such a favourite food of the old-established Robb's Biscuits, and the 
various kinds of rusks and tops and bottoms, which are always in great demand 
wherever young children are to be found. 

Many patent foods are advertised, and are very much used for children, but of 
the exact composition of these foods we are ignorant, and it therefore becomes 
impossible for us to recommend any of them, or to say that any one is either 
better or worse than another. They are chiefly composed of baked flour of some 
kind, mixed, in some instances, with preserved or dried milk. One thing at least 
seems to us to be certain, that none of them can by any possibility be more whole- 
some or more nutritious than baked wheaten flour and new milk. The Liebig Food, 
which we described, and the administration of which at too early a period we 
condemned, may be used with advantage as a weaning food. 

The process of weaning would, under ordinary circumstances, be commenced 
when the child is seven or eight months old, and the substitution of prepared meals 
for the breast ought to be gradually carried out until, at the end of the ninth or 
tenth month, it has become wholly independent of its mother. Some children are 
said to be easy to wean, and others are said to be weaned with difficulty. The real 
difference, we believe, is to be found in the amount of tact and patience which the 
mother is able to bring to bear upon the matter. It is necessary to be firm and 
methodical with a child, and if at first it refuse the bottle, it will, with a little 
coaxing, " come round, " and, having had its cry out, will take to its new course of life. 

A child should not have more than two allowances of thickened milk per diem, 



684 THE NURSING OF CHILDREN. 



and the mother's milk should be replaced in the main — at least at first —by cow's 
milk and water. 

Food after Weaning. — When the process of weaning is thoroughly completed — 
that is, at about the age of ten months — the child may begin to take a little thin 
broth or beef tea, which should be given to it once a day instead of one of its meals 
of milk and water. 

At this time an attempt should be made to discard the bottle, and to feed the 
child with a spoon. Beef tea and broth ought never to be given from a bottle, and 
when the bottle has been discarded, the child will be less open to two dangers : the 
danger of over-feeding, and the danger of receiving sour milk. The diet of a child 
should be entirely restricted to milk and water, thickened milk, and beef tea, until it 
is a year and a half old, at which time, if healthy, it will ha /e cut nearly all its teeth, 
and will be able to grapple with a little solid meat. 

At two years of age all the teeth will have been cut, the period of infancy comes 
to an end, and that of childhood begins. The child is no longer a helpless baby. It 
begins to stand, to walk, and to prattle, and is capable of eating and digesting stronger 
and more complicated food than heretofore. 

Milk should constitute the piece de resistance of the nursery, and it ought to enter 
largely into all children's meals. A cup of bread and milk nicely sweetened is what 
all children like for breakfast. Milk and water or pure water should be the only 
beverages for young children, and a milk pudding at dinner is a wholesome and 
pleasant addition to their simple fare. 

One meal of meat, in the middle of the day, is all that young children require. 
The youngest may have bread-crumbs and gravy, the eldest should have pieces of 
meat big enough for them to chew, and the nurse should ever be on the watch to see 
that they really do chew their food. The sin of " bolting " food should always be 
repressed, since it is sure to lead to difficulties of digestion. Children who are too 
young to properly chew their food will require to have it cut or minced for them, 
and this is a matter which demands a little thought from the mother or nurse. Bo 
not mince the food into little solid square pieces. If this is done, the child bolts them 
whole, and they arrive in the stomach in the most indigestible form imaginable. 
Meat for a child too young to chew should be very finely pounded or shredded, so 
that the actual fibres of the meat are torn asunder. If this be done, the juices of 
the stomach will be able to act upon it. Nothing is better, perhaps, for a young child, 
than & puree of meat rubbed through a fine sieve or a "puree cloth." Red meats 
are better and more nourishing for children than white; and mutton and beef 
are preferable as nursery diets to the white flesh of poultry. . 

Bread and butter is, in this country at least, the chief form in which children 
take their farinaceous food, and no better form can be devised, because it cannot be 
swallowed without thorough mastication. 

Potatoes should never be given until the child has cut all its teeth, and then great 
care should be taken that the potatoes are not too young and are thoroughly boiled. 
Green vegetables may be given in small quantities at two years and a half. 

Neither fruit nor vegetables should ever be given to very young children Li a raw 
state, unless exception be made in favour of strawberries, currants, and raspberries, 



NURSING OP CHILDREN — FOOD AFTER WEANING. 685 

which may be allowed as an occasional treat. They should, however, be carefully 
smashed up before they are given. 

Jams and preserves are always highly appreciated in the nursery, and preference 
is to be given to jellies and to those preserves which are free from stones and seeds. 
Marmalade, which is, or ought to be, largely composed of orange-peel in a very 
indigestible form, should never be given. Children are fond of treacle, and this is a 
wholesome and economical food in which they may be allowed to indulge moderately. 

Pasties and thick " stodgy " puddings are very indigestible to the young, as are 
all combinations of flour and butter. They may be, and are, allowable for the 
school-boy, who is strong, and participates eagerly in all manner of athletic games, 
but in the nursery they should never be tolerated. Plain boiled rice, with sugar or 
preserve, or stewed fruit, is the best and safest nursery pudding. All dried plums 
and currants which are liable to be swallowed whole should be tabooed. 

Never force a child at, its food. — If the child has a healthy appetite it will eat 
whatever is put before it. If it leaves its food, or plays and dawdles over it, it is 
not a good plan to press it, and it is worse than useless to be angry with it. The 
best way is to tell the child not to eat if it does not feel inclined, and then, if the 
loss of appetite is due to some passing cause, the natural craving for food will have 
returned by the next meal- time. If it does not return, then the question arises, 
whether or no the child is really out of health, and if such be the case, it will 
generally be necessary to throw the child back a stage in its diet, and confine it to 
fluid nourishment. 

Never try and tempt a child's appetite with improper food. — This is often done ; and 
we recall to mind the case of a poor woman who brought her child to us suffering 
from signs of incipient consumption. The following conversation took place: — 

" How old is your child 1 " 

"A year and nine months, sir." 

u And how many teeth has it cut » 

u Oh, sir, it is very backward with its teeth, and has only cut ten." 

u Does it take its food readily 1 " 

61 Oh no, sir \ we have a very great difficulty to get it to take anything. It is 
very taffety, and is wasting away to nothing. I try it with everything I can think 
of, and on Saturday night I took it out into the ' New Cut ' and tried to tempt it 
with a penn'orth of pickled whelks, but it would not eat even them ! " 

This was the most glaring example we have ever met with of what we believe is 
a very common error in a milder degree among the mothers and nurses even of the 
middle and upper classes, and this poor woman who made an unsuccessful attempt to 
fill her delicate child's weak stomach with food as tough and indigestible as india- 
rubber has her imitators in all ranks of society. If a child's appetite fails, it is the 
common and baneful practice to try and tempt it to eat with all manner of trash. 
Many a child who has died of a fatal diarrhoea, or of tubercular disease of the bowels 
or mesenteric glands might no doubt have been saved if its nurse had only been 
blessed with a little knowledge and a little common sense. 

At the Royal Infirmary for Children, in the Waterloo Road, London, it has been 
the invariable custom to take the temperature of every child night and morning 



686 THE NURSING OF CHILDREN. 

with a thermometer. This has been done because the temperature of the body is one 
of the surest gauges of the state of health, and a rise of temperature generrlly precedes 
the other symptoms in case of a child being attacked with any of the diseases of 
infancy (such as measles or scarlet fever), which would necessitate its immediate 
separation from the other children. Now, it has been found that the temperatures 
of children have a strange disposition to rise on those days when the children are 
visited by their friends, and the cause of this has been traced to the fact that, in 
spite of notices and warnings to the contrary, the foolish friends of the little patients 
will smuggle in all manner of edible trash — jam puffs, green apples, lollipops and the 
like — and the temporary state of fever into which they ara thrown is du° to the 
indigestion caused by the consumption of these (to them) almost poisonous articles. 

Provided that all the articles of food set before a child are wholesome, it should 
be allowed to exercise its own discretion, taste, or instinct in the rejection of, or 
preference for, any particular article of diet. Many children — most children, in 
fact — will not eat fat, and it is common to see them leave all the pieces of fat at the 
sides of their plates, and restrict their attention solely to the lean. The " leaving of 
fat " is a very common casus belli in the nursery, but it ought not to be, and if a child 
dislikes it, we should say, Do not give it any. A big slice or lump of yellow, greasy, 
slimy fat is not an appetising thing to look at, and although we have acquired a taste 
for it, we should remember that such taste has undoubtedly been acquired, and will 
be acquired in time by our children. There are many ways of giving fat in a form 
which is more pleasant to the child than in tangible slices or lumps. New milk 
contains a quantity of fat, and a bread and butter pudding, or bread and butter itself, 
is of course very rich in it. The yolk of an egg, too, contains a large quantity of fat, 
so that a little consideration will enable us to give a child as much fat as is necessary 
or good for it without shocking its tender sensibilities. 

The nursery beverages, as we have mentioned above, should be water and milk 
and water. The sole nursery condiment should be salt. 

Tea, coffee, beer, or wine, are unnecessary for young children, and should be 
entirely withheld. Occasionally, when a child is recovering from some acute disease, 
it becomes necessary to stimulate the appetite a little, and at such times a little wine 
and water may be allowed. Weak natural wines are the best and most wholesome 
for young children, and they very soon learn to appreciate a small quantity of claret, 
or Burgundy, or white Rhenish wine. Port and sherry, as sold in this country, are 
far too strong for young children ( and, indeed, for the matter of that, for adults 
also), and if the light wines are not obtainable, it is advisable to fall back upon beer. 

Children and adults should never have their meals together. — Such a plan is bad 
for the children, and disagreeable for grown-up persons. The diet of adults is not 
suitable for young children, and, among the poor, one of the main causes of infantile 
disease is undoubtedly the habit which obtains of feeding their young children upon 
" the same that we have ourselves." Nurses ought never to have their dinner with 
the children, but should first give the children their dinners, and go and dine them 
selves in another room. The habit, which is growing quite common, of allowing 
children, especially on Sunday, to come into the dining-room while dinner is on the 
table is a very bad one. and when we see children allowed to be so ill-mannered as 



NURSING OF CHILDREN — SLEEP. 687 

to pester guests, and to have a piece off mamma's plate, and a sip out of papa's glass, 
we feel that if those children are laid up, it will be due entirely to the folly of their 
parents. 

MANAGEMENT AFTER WEANING. 

Sleep. — A new-born child passes the greater part of its time in sleep. It wakes 
up when hungry, and having satisfied its hunger, it falls asleep again. It dozes quite 
twenty out of the four-and-twenty hours. As it grows, it shows a gradually- 
increasing power of doing with less sleep, but few healthy children under two years 
old sleep less than twelve or thirteen hours. 

It is necessarily of the greatest consequence that a child's sleeping quarters 
should be comfortable and wholesome. Every child should have a cot for itself, and 
the room in which it is placed should be thoroughly clean and well ventilated. The 
bed-clothes should be removed as often as they are soiled, and they should bo 
protected by a piece of mackintosh sheeting, placed under the child's middle. The 
bed should be thoroughly made once in the four-and-twenty hours, and the clothing 
should be exposed to the air for an hour every day. 

It is not a good plan for children to sleep in the same bed with their parents, and 
it is far better for them to lie in a separate cot by the side of their mother's bed. If 
they sleep in the same bed, they are very apt to get their heads beneath the bed- 
clothes, and in that case they do not breathe the utterly pure air which is necessary 
for them. Further, it is not uncommon to hear of children being killed by 
" overlaying " — that is, by suffocation during the night, by their parents lying upon 
them. In most of these cases, no doubt, the parents have been tipsy, but the fact 
that young children do get actually suffocated when lying in their parents' bed makes 
it highly probable that many more narrowly escape a similar fate, or, at least, suffer 
considerably from breathing an impure atmosphere. 

Another reason why a child should not sleep with its mother, is the temptation 
which the latter has to over-feed it. If a child cries in the night, it is the routine 
with many mothers to give it the breast, and this irregular feeding at night is very 
often the beginning of serious digestive troubles. 

A child will sleep two or three hours at a stretch, and if it be healthy it will not 
cry nor disturb anybody. The inference may, in most cases, be drawn with safety 
that a good, quiet child is a healthy child, and that a noisy, fractious, crying child 
is not well. In this latter case, the worst thing that can be done to it is to 
overfeed it, which is generally merely adding fuel to the fire ; and although one may 
succeed in this way in quieting it for a time, the result in the end is to perpetuate 
its noisy condition. A baby must be fed at its fixed proper time, and at no other, 
and if it cries between these, it should be nursed, and search should be made for 
anything which may be causing it uneasiness. The napkins should be changed ; the 
state of the feeding-bottle (if it be using one) should be looked to, and the condition 
of the mother's health should receive consideration. Perhaps the child may need a 
dose of purgative medicine. Perhaps it is cutting a tooth, and the gums may need 
lancing, or the child may be quieted by giving it something, as a coral or a bit of 
india-rubber, against which it may press the gum. We cannot pretend to discuss all 



688 THE NURSING OF CHILDREN. 



the possible causes of a child's wakefulness, but whatever they may be, it can never 
be right to feed it too often, and it is never justifiable to administer soothing syrups 
or soothing powders, or any form of narcotic medicine, all of which are literally slow 
poisons, and highly dangerous. 

It has further been alleged, with regard to the practice of children sleeping in the 
same beds with their mothers, that it is very liable to cause ophthalmia — that inflam- 
mation of the eyes which is such a scourge to young children, and which not unfre- 
quently ends in loss of sight or permanent disfigurement and impairment of vision. 
The cause of the ophthalmia is found in the fact, that the child sleeping with its 
mother often falls asleep in the act of suckling, and then the milk or perspiration, 
getting into the eye, act as irritants, and cause the inflammation. Such a result is 
only to be found, probably, among the dirtiest of the poor, but its occurrence from 
the cause stated should make nurses very careful not to run any unnecessary risks. 

Exercise. — Children want a great deal of fresh air and exercise. The air which a 
child breathes should always be as fresh as possible, and a good nurse will always 
bear a watchful eye to the ventilation of the rooms in which it lives. A nursery 
should be light and airy, for sunlight is, probably, almost as important for the healthy 
development of children as air itself. The windows should be thrown open at least 
once a day, and every means for the artificial ventilation of the room should be 
attended to. The room should not, of course, be cold and draughty, but it is quite 
possible to obtain fresh air without these disagreeable concomitants. 

Every facility should be given, even to a newly-born child, to kick and throw its 
arms about, and exercise its limbs in every way that Nature dictates. The habit 
which is common throughout Germany and in many northern countries, of using 
" swaddling clothes," which are wound round and round a child until it looks more 
like a cocoon than anything else, is thoroughly bad, as it prevents freedom of move- 
ment in the lower limbs. Not only is freedom of movement prevented in this way, 
but ventilation of the legs is rendered impossible, and although it is important, no 
doubt, to keep a child's legs warm and free from cold draughts of wind, it is scarcely 
less important to ensure a free circulation of air beneath the garments. 

The habit of using swathing bands and binders round the abdomen is bad, because 
it tends to confine the movements of the child's chest, and to impede the healthy 
action of respiration. Immediately after birth, it is necessary, no doubt, to encircle 
the abdomen with a broad band of flannel, but great care should be taken to ensure 
that it is not too tight, and it should be discarded altogether as soon as possible. 

On the whole, perhaps, there is no better form of garment for young babies than 
the " long clothes " which are common in this country. They keep a child warm, 
they protect it from draughts, and at the same time allow of the free exercise of the 
limbs, and provide for a healthy circulation of air around them. 

When a child is a month old it should, if the weather be suitable, be taken out 
of doors for a short time every day. The best vehicle for it at first is its mother or 
nurse, in whose arms it must be carried. Care must be taken to keep the child in a 
recumbent position — lying down, that is — and to support the back thoroughly with 
the left arm. Children should not be allowed to get their backs bowed while they are 
in their nurses' arms. If a child show» any inclination to sit up, it should be allowed 



NURSING OF CHILDREN — EDUCATION. 689 

to do so, as the exercise of the muscles of the back for a time will tend to strengthen 
them. In the present day, the nurse's arms have been largely superseded by 
" perambulators," and even the youngest babies may be accommodated with a little 
carriage, in which they can lie at full length, in a state of complete repose. There is 
a great advantage in using these handy little carriages, for the nurse is not only 
saved the weight of a burden, but the child is not dependent upon the state of fatigue 
or freshness in which its nurse happens to be. Great care should be taken not to jolt 
a child unnecessarily when it is riding in a perambulator. This is the one point in 
which a perambulator is a less desirable conveyance than the nurse's arm, but the 
jolting of which we speak depends upon the carelessness or stupidity of the nurse, 
rather than any inherent defect in the vehicla Every perambulator should have the 
tyres of the wheels furnished with vulcanised india-rubber bands, which help to break 
the shock of any accidental concussion. In crossing streets, in going over inequalities 
in the roads, and in going up or down steps, great care ought always to be taken to 
lodge the front wheel securely, and to support the hind part of the perambulator, as 
the two back wheels are allowed slowly to follow it. It is no uncommon thing to see 
nursemaids wheeling perambulators who have, evidently, not sufficient intellectual 
capacity to give a thought to the well-being of the tender occupant of the carriage. 
They swing it on to its hind wheels, and thus tilted backwards with its fore-wheel in 
the air, they proceed to cross a street. It is a piteous sight to see the poor baby 
undergo a kind of temporary collapse, as the loud bump with which the carriage falls 
off the curb-stone tells of the severe shock which has been communicated to the 
spinal column of the child. " Do as you would be done by " is the greatest of the 
Christian tenets; but what would these careless nursemaids think if they were placed 
in a carriage, and allowed at intervals to fall two or three feet, without break of any 
kind 1 Any nurse who is careless in such a small but nevertheless important matter 
is not fit to have charge of a baby. 

While a child is in the open air, it is of much importance to protect it with great 
care from cold, and also from the heat of the sun. A child should always be well 
wrapped up, and in windy weather its face should be protected by a veil. Its head 
should have a warm covering, which should be fastened by strings — a knitted hood 
with a string let into the border is the best thing. Elastic, going under the chin or 
behind the ears, should never be used. It is impossible to regulate the pressure, and 
it is very liable to chafe and rub, and cause sore places. 

The heat of the sun is very much felt by young children, and every perambulator 
should have a big hood, with an additional sunshade fixed to the front of it, so that a 
child may be completely screened, when necessary, from the scorching rays of the sun. 
Many an attack of tubercular meningitis has been determined by the negligence of a 
nurse in this matter. 

Older children who are no longer dependent for their locomotion on nurses and 
perambulators ought to be provided with hats of a proper shape. They should be 
somewhat high in the crown, so as to include a layer of air between the crown of the 
hat and the top of the head. In this way the head will be kept cool, and there will 
be no danger of the direct rays of the sun causing a sort of sunstroke, wteh all its 
dangerous symptoms and consequences. 
44 



690 THE NURSING OF CHILDREN. 

Education. — The education of a baby should be commenced as soon as it is born. 
This may seem a strong assertion, but we feel sure that it is a right one. We do not 
mean by education its intellectual training, but rather its moral training. " Manners 
make the man " was the good motto chosen by "William of Wykeham, and it should 
be constantly borne in mind by parents and nurses. We have endeavoured in this 
article to lay down certain fixed rules for the guidance of those who have the care of 
young children. Those rules are the result of long experience combined with scientific 
reasoning. They have been practically ratified by all the best authorities, and those 
who adhere most firmly to them will have the least trouble in bringing up their 
children. 

The rules we have laid down, then, are not to be departed from merely because a 
child is troublesome. If, for example, a child is fed every time it cries, it soon gets 
to know that it has but to bellow to be sure of obtaining what it wants, and by 
yielding to its desires against our better judgment we are instilling into the almost 
unconscious infant a lesson in selfishness and gluttony which perhaps it may never 
forget. A habit once formed is not easily shaken off, and the jar which the compul- 
sory cessation of a bad habit causes gets more difficult to bear every day that the child 
lives. By giving way to a baby we are, in fact, pickling the rod which is to make it 
smart a few years hence. If the mother or nurse of a child is reasonable, and does 
not yield to its every cry, the child soon ceases to connect together the two acts of 
crying and feeding, and stands less chance of becoming self-willed and gluttonous 
than its fellow who perhaps has received less judicious management. A habit 
scarcely less harmful than that of feeding a child whenever it cries, is the one of 
giving it something to such to keep it quiet. It is a common thing in the dwellings 
of the poor to see the baby lying in its cradle, and sucking a piece of flannel which 
has been given it by its mother. Can it be wondered at that a child who has been 
taught so filthy a trick should grow into a listless, idle, self-indulgent creature? 
When, a few months hence, it takes to sucking its thumb, the foolish mother will 
probably administer many a slap, because the poor child perseveres with the very 
trick which she has so carefully taught it. 

There are other matters which a child may be taught very young indeed, and 
we should advise every nurse to begin, when the child is a month old, to try and 
teach it a periodical observance of the calls of nature. If a child be fed at regular 
fixed times, and have its napkins removed at stated intervals, and be placed so that 
Nature's dictates may be obeyed and facilitated, it is surprising how soon it will 
learn to take advantage of these opportunities which are afforded it. We have 
no hesitation in saying that some children are as forward in these matters at four 
months old as others are at two years, and the sole reason for this difference is to 
be found in the fact that the former have been "educated" with a little trouble, while 
the latter have been allowed, as the Scotch say, "just to gang their ain gait." 
Young children should never be needlessly placed in temptation, and for this reason 
it is advisable that the denizens of the nursery should be kept as much as possible to 
themselves. When the adult and infant members of a household mingle together, 
either for purposes of feeding or otherwise, it is not to be expected that the former 
will be constantly under restraint for ths sake of the latter, and it should be borne 



KURSING OP CHILDREN — EDUCATION. 691 

in mind that it is almost a real hardship for a child to see others doing sundry 
things, and eating sundry things, and to be told that such things " are not for little 
children." 

It is very hard to deny the child we love, and much spoiling of children is brought 
about by the unnecessary mingling of children and adults at meal-times and on other 
occasions. Among the poor, who necessarily inhabit the same rooms as their children 
improper feeding is the rule, and the number of children who fall ill, because, as their 
friends say, " they eat the same as we do," is hardly to be told. 

We have said that in writing these few paragraphs we had not in view the 
intellectual education of the child, but a few remarks on this subject may not be 
out of place. 

One great error i3 to allow children to learn things wrongly, and we not unfre- 
quently see babies who have been taught to speak in the nursery being untaught in 
the parlour. This, of course, is Very greatly to be regretted, as it leads to the necessity 
of correction, where no need should have existed, and it should be borne in mind 
that correction is always galling to a greater or less degree. It is never wise to push 
a child too much. If it be a backward child, we shall not do much by incessant 
teasing ; and if it be a forward child, we shall probably do harm. Great mischief is 
often done by taking too much notice of children, and this is another of the evils 
which are likely to result when young children are allowed to mingle too much with 
adults. It is a most disagreeable spectacle, we think, to see a poor little child 
pestered to repeat its few foolish words to a select circle of admiring friends; and the 
end of such spectacles not unfrequently is " a scene," for the child gets over-excited, 
and then dissolves in tears. If there is any tendency to tubercular disease, great care 
ought to be taken not to excite children in this way, for every excitement of this 
kind causes a flow of blood to the brain, and this may often be the determining cause 
of tubercular meningitis. 



DOMESTIC SURGERY. 

The object of these papers on domestic surgery will be, not the perfectly futile and 
mischievous one of attempting to make every one his own surgeon, but only to 
furnish our readers with such simple rules for the treatment of the slight accidents 
and emergencies of every-day life as are commonly treated without resorting to 
medical advice. At the same time opportunity will be taken to point out those 
circumstances that indicate the necessity for immediate recourse to a medical man, 
and the rules laid down must be regarded as only preliminary to his arrival, and on 
no account to be insisted on should he, from the special nature of the case, see fit 
to carry out some different mode of treatment. Great harm may be done to a 
patient by injudicious meddling on the part of a well-meaning, but only partially- 
informed friend, who, finding the treatment being pursued under medical advice 
different from that here laid down, should venture to express disapproval, and shake 
the confidence of the patient or his friends in their medical adviser. When a 
patient's case has once been undertaken by a medical man, it is only just, and for 
his own interest, that the surgeon should be treated honestly, his directions fairly 
carried out, and his prescriptions attended to. If a patient or his friends are 
dissatisfied with their medical attendant, it is always open to them to have further 
medical advice. 

There are certain affections which are commonly denominated " surgical," because 
they require some manual attention on the part of the attendant. These will be 
briefly discussed, in order to point out how far they may with safety be treated 
domestically, and when it will be desirable, and even essential, to have professional 
ad rice. Opportunity will be taken, in connection with these subjects, to describe 
the mode of preparation of poultices and other applications of household surgery, 
which, though they are, in fact, matters of every-day requirement, are frequently 
mismanaged. 

It may be here remarked how essential for relief in these surgical affections it 
is that there should be no concealment of symptoms from one's medical adviser, on 
account of scruples, no doubt honourable, but misplaced, because of the so-called 
" delicacy" of some of the subjects involved. Valuable lives (as, for instance, that 
of Caroline, queen of George II.) have been lost from the concealment of the 
existence of a rupture ; and many persons live a life of discomfort for years, 
and even allow their health to be undermined, through the concealment of 
some affection of the lower bowel which could be readily remedied by medical 
advice. 

HEMORRHAGE. 

Bleeding, which is a constant accompaniment of accidental cuts and wounds, 
is always very alarming to non-professional bystanders, and it occasionally happens 
that for want of knowing how to arrest it readily, serious results occur before the 



694 



DOMESTIC SURGERY. 




arrival of professional aid. In order to be able to stop bleeding the reader must 
understand that blood may be poured out in two ways — 1st, pumped out in jets of 
a bright red colour, in which case one of the arteries which convey the blood from 
the heart to the surface is wounded ; or, 2ndly, it may flow out in a dark- 
coloured continuous stream from the veins which return the blood from the limbs to 
the heart. 

It is evident, then, that the wound of an artery of large size will give rise to 
the most serious form of bleeding, and as the blood in this case is flowing from 
the heart to the circumference, we must arrest it between the trunk and the wound 
by compressing the main artery. On the other hand, if the bleeding is from the 
wound or rupture of a large vein, the point for the application of the pressure will 
be either upon or below the wound. In the case of the upper arm the principal 

artery runs along the inner side of the limb, 

where it may easily be felt beating, and in the 

case of arterial bleeding from the hand or arm, 

pressure can be efficiently obtained by tying a 

strong tape or handkerchief around the arm 

and tightening it by twisting a stick in it on 

the outer side of the limb, as shown in the 

cut, Fig. 1. In the thigh the main artery runs 

down the middle of the front of the limb, 

Fig. L and can be controlled in the same way as in 

the arm. In both cases the introduction of 

a wine cork beneath the handkerchief in the situation of the vessel will lead to 

more efficient pressure upon it, and without so much tightening of the bandage as 

would be otherwise necessary. 

This mode of extemporising what is surgically called a tourniquet is, of course, 
only for temporary employment, and any case in which the bleeding has been 
severe enough to require its use should be seen as soon as possible by a 
medical man, and the bandage should on no account be interfered with before his 
arrival. 

Before explaining the mode of applying the dressings necessary to restrain 
haemorrhage of an ordinary kind, it will be advisable to say a few words about 
bandages. A bandage or roller is simply a strip of calico, six yards in length, and 
from two to three inches in width. Soft unbleached calico or coarse cambric is the 
best for this purpose, but on an emergency any suitable material may be employed • 
and for binding up fingers broad 
tape or narrow ribbon is very con- 
venient. In order to use a bandage 
properly it must be rolled neatly 
and tightly from one or both ends, 
as seen in Fig. 2 ; but it is only Fig. 2. 

the " single-headed roller," or that 

rolled from one end, which can be required in domestic surgery. A bandage may 
either be rolled by keeping it tight with the thumb and fingers of the left hand, 





HAEMORRHAGE. 



695 



whilst being rolled with the right, as shown in Fig. 3 ; or this may be more 
conveniently and rapidly done by using both hands for rolling, whilst the bandage is 
kept on the stretch by an assistant, as shown in Fig. 4. 

In bleeding from slight cuts about the fingers and hand, plaster (either court 





Fig. 5. 



or adhesive) may be conveniently employed if a bandage is used over it at first, and 
until the plaster has become firmly fixed ; but when the wound is considerable it is 
better to use other means. A piece of lint or soft linen should be placed over the 
wound, and over this a bandage should be firmly applied, and should extend, if 
possible, a little above and below the seat of the injury. In the case of a finger 
a roll of tape may be taken, and ten or twelve inches being drawn out and left 
loose, the finger should be rolled in a series of spiral turns from the web to the 
nail, where the spiral arrangement being reversed, the tape can be carried back 
again and across the back of the hand, and tied round the wrist with the end left 
out, as in Fig. 5. If the 
wound is in the ball of the 
thumb the bleeding is often 
sufficiently severe to require 
medical attendance, and this 
should be obtained, if pos- 
sible ; though the vulgar fear 
of " lock-jaw " from an in- 
jury of this kind is un- 
founded. When it is neces- 
sary to bind up the thumb 
the broad tape may be con- 
veniently used, and a turn 
having been taken round 
the wrist to fix the bandage, 
a series of figure of eight 
loops around the thumb and wrist should be made, beginning as low down on 
the thumb as may be necessary, and making each fold of the bandage overlap 
that which preceded it, as shown in the illustration, Fig. 6, 




696 



DOMESTIC SURGERY. 



Wounds of the palm of the hand, if severe, should be immediately seen by a 
surgeon, but as a temporary measure a slice of cork wrapped up in a piece of 

linen may be firmly bound upon the bleeding point 
with a bandage. This should be applied in figure 
of eight loops around the wrist and hand, being 
made to cross at the point where the pressure is 
required, as shown in the illustration, Fig. 7, and 
this should be repeated a few times so as to con- 
trol the bleeding. It may be advisable, where 
assistance is not readily obtainable, to bandage the fore-arm in addition, and this 
may be done by carrying the bandage once or twice round the wrist alone, and then 
proceeding up the arm, turning down the bandage in the manner shown in the 




Fig 6 




Fig. 7. 



Fig. 8. 



illustration, Fig. 8, when the shape of the arm does not allow it to lie flat and 
close upon the injured limb. 

In all cases of bleeding from the hand or arm it is important that the limb 
should be kept quiet, and in a raised position. 
For this purpose, and for many others, a sling is 
most conveniently made of a silk handkerchief, 
which should be folded like a cravat, and of a con- 
venient width. The limb being placed in the loop 
of the sling, the front end is to be brought forward 
over the opposite shoulder, and the other end over 
the shoulder of the same side to meet it at the back 
of the neck, as seen in the illustration. In this 
way the arm will be drawn forward, and can be 
easily raised to any height, and the sling will not 
slip as it always does if tied in the opposite way 

(Kg- 9)- _ " m s . o. 

Bleeding from cuts about the face is seldom 
serious, unless the lip should be divided by a blow upon the mouth, in which 
case a surgeon should be immediately consulted, or the resulting deformity may 




HEMORRHAGE. .. 697 

be great. Collodion is a very useful application to cuts about the face, and in 
applying it the part should be firmly pinched with the fingers for a few moments, 
so as to stop the bleeding, then having been wiped dry, the collodion may be 
painted on, and after a few minutes, when it has dried, the part may be re- 
leased from the fingers. Court plaster may be applied with the same precau- 
tions, care being taken that both sides of the plaster are thoroughly wetted, 
without removing the adhesive material. In extensive cuts upon the face it 
is advisable to have recourse to stitches of silk, in order to reduce the resulting 
scars to a minimum. In cases when the assistance of a medical man cannot 
be obtained, an ordinary stout sewing needle, with purse-silk or stout cotton, may 
be pushed through the whole thickness of the skin on each side of the cut, and 
an eighth of an inch from the margin, and the silk be tied in a double knot when 
the loop has been drawn tight, so as to bring the edges together. One stitch will be 
required for a cut an inch long, and so on in proportion ; and a strip of plaster 
should be put across the wound on each side. Stitches should not be left in the skin 
of the face more than two days, and should then be cut close to the knot with a 
sharp pair of scissors, and drawn out gently. Narrow strips of plaster applied 
across a wound, and slightly overlapping one another, will, in many cases, obviate 
the necessity for stitches. 

In wounds about the head, a little of the hair on each edge of the wound should 
be cut away, and a pad of lint be placed over it, and be bound on firmly with a 
bandage. This will of course vary somewhat, according to the position of the cut, 
but will consist essentially of one or two turns round the 
front and back of the head, which should be secured with 
a pin, followed by a turn beneath the chin and over the top 
of the head, which will keep the other tight, as in the 
illustration (Fig. 10). 

The trunk and lower limbs are seldom wounded, unless 
the injury is a severe one, which would necessitate imme- 
diate medical attendance. Before this arrives, the only 
assistance bystanders can give is to stop any bleeding, 
either by making pressure upon the bleeding spot, or by 
encircling the limb with a handkerchief tourniquet as j^ ^ 

already described. 

A burst Varicose Vein in the leg gives rise to serious bleeding, which will be 
dangerous if not rapidly checked. As the accident ordinarily happens when the 
patient is standing, she (for it is usually women who suffer from varicose veins) 
should immediately lie down, and the leg should be raised, whilst a bystander 
presses the finger upon the bleeding point. A pad of lint and a firm bandage should 
then be applied, and the patient should rest the leg for a few days, and continue the 
use of the bandage as long as the veins are swollen. 

To bandage a leg properly, the foot must be raised and the bandage secured 
round the ankle by crossing the ends in front of it, as represented in Fig. 12. The 
bandage is then carried beneath the foot, and again around the ankle once or twice, 
and then round the leg, each turn overlapping the preceding one. When the calf 




698 



DOMESTIC SURGERY. 



is reached, it will be 'necessary, in order to make the bandage fit properly, to turn it 
down on the outer side of the limb each time it surrounds it ; and in order to do 
this neatly the bandage should not be drawn tight until after the "turn" has been 
made. It will assist in doing this neatly if the finger is laid upon the bandage to 





rig. 1L 



Pig. 12. 



fix it at the point where the turn is to be made, as shown in the illustration 
(Fig. 11). 

Bleeding Piles may depend upon plethora, and be salutary, if slight; but if 
severe, and much blood is habitually lost, medical advice should be sought, in order 
that they may be permanently relieved. To check the bleeding temporarily, the 
injection of cold water, or cold decoction of oak-bark, is the best remedy. 



WOUNDS, BRUISES, AND SPRAINS. 

Wcnmds. — The immediate treatment of ordinary wounds of a slight character 
has been sufficiently indicated in the sections relating to haemorrhage. The after- 
treatment of a wound cannot be of too simple a character. Where there is no pain 
or discomfort about the wounded part, there can be no object in disturbing the first 
dressing applied, and this should be left undisturbed for from two to four days, 
according to the severity of the injury. If all has gone well, it is quite possible 
that a skin wound may heal at once, and merely require the application of a piece 
of plaster over it, to protect it for a few additional days. If, however, it is found 
on carefully soaking off the original dressing that the wound is open and discharging, 
the best application will be the " water-dressing." This consists simply of a double 
fold of lint or soft linen suited to the size of the wound, and wetted with warm 
water, over which a piece of oiled silk, slightly larger than the lint itself, is secured 
with a strap of adhesive plaster or a bandage. The lint should be changed twice a 
day, but the oiled silk will serve for many days in succession. If a simple wound 
fails to heal in a few days under this treatment, medical advice should be had 
recourse to. If on removing the first dressing a wound is found to have its edges 
red and tender, and the part is painful, a poultice of bread or linseed meal may be 
applied for a day or two before the water-dressing is begun. The vulgar dread of 
what is termed " proud flesh " may be mentioned here, simply for the purpose of 



WOUNDS, BRUISES, AND SPRAINS. 6^9 

stating that the so-called proud flesh is only a slight exaggeration of the ordinary 
process of healing, and is of no moment unless it rises high above the general surface, 
in which case the occasional application of a piece of blue vitriol (sulphate of copper) 
will soon reduce it to proper dimensions. 

Poisoned Wounds. — The form of poisoned wound most familiar in domestic 
surgery is in the finger of a cook who has pricked herself whilst trussing game or 
cleaning fish. The slight prick, which is not noticed at the moment, becomes painful 
in the course of a few hours, when the finger becomes hot and swollen, and a red 
blush is seen to be extending up the finger to the hand. This state of things, if 
taken in time, may be effectually checked by the application of a wetted stick of 
lunar caustic over all the inflamed surface, and for some little distance beyond it. 
The caustic, of course, causes a smarting pain, and turns the finger black, but this 
wears off in a few days. A solution of caustic answers as well, or even better, than 
the solid caustic in these cases, and the ordinary " nitrate-bath " of photography, to 
be found in so many houses, is very good for the purpose. Instead of the inflam- 
mation spreading in the above described way, it may be concentrated in the wounded 
spot and give rise to a whitlow. In this case, fomentation of the whole hand, hot 
linseed-meal poultices, and support in a sling, will be the proper treatment; but if 
matter forms, it will probably require an incision, in order to save the finger, and 
therefore early recourse should be had to a surgeon. Bites of animals may give rise 
to poisoned wounds, without there being any risk of hydrophobia ; and this is seen 
in the case of pet dogs, cats, squirrels, &c. The same treatment as for ordinary 
wounds, followed by that indicated for poisoned wounds, if occasion arises, would be 
proper in such cases. When there is the least reason to fear hydrophobia in the 
animal which has bitten, every precaution should be taken, which should include 
thorough cauterisation or extirpation of the wounded part ; but this it is impossible 
for a non-medical person to carry out effectually. The bite of the copper-head is an 
example of snake-poison met with in this country, and its effects, though serious, 
are not invariably fatal In order to prevent, as far as possible, absorption of the 
poisonous material into the system, a string should be tied tightly above the woundea 
spot, which should be well sucked, the operator taking care to rinse his mouth out 
with a little brandy-and-water, and not to swallow any of the poison. After this, 
hot fomentations and a poultice will be the proper treatment. If the poison has 
spread up the limb it gives rise to great swelling of the part, and this may even 
extend to the trunk. Friction with warm oil is the best remedy for this state of 
things, but it often does not subside for some days. The stings of wasps or bees are 
painful, but not dangerous, unless some vital part, such as the inside of the throat, 
is stung. The stings, which are often left in the part, should be extracted with fine 
forceps or tweezers, and the smarting pain may be allayed by a little moistened 
carbonate of soda being laid over, or some sal volatile and oil rubbed on the part . 

Penetrating Wounds of a slight character arise from the incautious use of some 
common articles of domestic use, such as an ordinary sewing-needle, a crochet- 
needle, or a fish-hook. The ordinary needle, if buried beneath the skin of the hand 
or other part, may be readily extracted if so placed that both ends can be felt. In 
that case it is only necessaiy to press the end nearest the surface through the skin, 



700 DOMESTIC 8URGKKJT. 



and it can be easily withdrawn. If, however, as more frequently happens, only one 
end can be felt, and it is uncertain what length of steel is in the tissues, attempts 
to force the needle out lead generally to its being buried deeper ; and it is better, 
therefore, to have recourse to medical advice at once, in order that the surgeon may, 
if he think it advisable, at once cut down upon the foreign body. Operations of 
this kind, though apparently trivial, should never be undertaken by amateurs, since 
the hand is too important an organ to be cut into lightly by one unacquainted with 
its anatomy ; and, besides, there is usually no great urgency in the case, and the 
needle may very well be left alone until, in process of time, it makes its way to the 
surface, as it is pretty sure to do. Crochet-needles are more difficult to manage 
than ordinary needles, owing to the hook at one end. If merely driven accidentally 
into the skin, the wound may be cautiously enlarged with a lancet or sharp and 
clean penknife, so as to allow of the withdrawal of the barb ; but if deeply embedded 
in a finger, or, as has happened, in the tongue of a child, it will be necessary to push 
the point through in order to cut the hook off with a pair of wire-pliers, and for 
this medical assistance should, if possible, be obtained. Fish-hooks are to be 
treated on a similar plan, except that the disciple of Walton, being generally alone 
and at a distance when the accident happens, must be content to cut the line from 
the mischievous hook, and having forced the barb through the nearest point of skin, 
should draw the hook through the wound thus made. 

Bleeders are persons who suffer from what is scientifically called a " hemorrhagic 
diathesis n — i.6., they bleed profusely with the slightest scratch, and the blood is so 
peculiar that there is the greatest difficulty in stopping its flow. This disease is 
found to affect sometimes only one or two members of a family, is often hereditary, 
and may be traced through many generations. It is, fortunately, of not very 
common occurrence, and is only mentioned here in order to warn parents of children 
who suffer from a tendency to bleed, that they should always inform their medical 
man and their dentist of the fact, so that, as far as possible, all sources of bleeding 
may be avoided ; and should haemorrhage accidentally occur, immediate medical 
assistance should be obtained, since every hour's delay renders it more difficult to 
stop the bleeding. 

Bleeding from the Nose is sometimes violent, and usually an evidence of some 
derangement of the general health, for which medical advice should be sought In 
order to check the bleeding, cold water may be employed to bathe the face and 
head ; or ice water may be injected with a syringe or india-rubber bottle into one 
nostril, when, if the patient will keep the mouth open, the water will flow round the 
nose and out of the opposite nostril. In slight cases, merely sniffing up cold air 
forcibly will often check the bleeding, and, in addition, powdered alum or tannin 
may be used as snuff When the bleeding continues for any time, the surgeon 
should be called in to plug the nostrils. 

Bruises and Contusions are common accidents where there are children, and 
fortunately a child is able to sustain, without serious after-consequences, a bruise 
which might be of importance to an older person. A severe bruise is alarming to 
the bystanders on account of the rapid swelling which takes place, and is annoying, 
in addition, to the recipient on account of the ecchymosis or discolouration left for 






WOUNDS, BRUISES, AND SPRAINS. 7Gi 

some days after. The application of cold in any form has a tendency to check the 
swelling and sub-cutaneous extravasation of blood constituting a bruise, and this 
may be applied in any form most convenient — cold vinegar-and-water, iced water, 
or the favourite cold metal spoon. Raw beef-steak is popularly supposed to have a 
great controlling effect upon bruises, but apparently without good foundation. 
There is a medical remedy of recognised utility in these cases, however, and this is 
the tincture of arnica ; and this may be painted on the skin, if not broken, or 
applied diluted with water, if the skin is torn. There is, however, one caution to 
be observed in the use of arnica — that in some persons it excites an irritation of the 
skin closely resembling erysipelas, particularly if applied to a broken surface. Some 
caution should, therefore, be used in its first application, though the frequency of 
the occurrence of any untoward result is probably very greatly exaggerated. 
Contusions are more severe accidents than mere superficial bruises (with which, 
however, they may be combined), since they may endanger the life of the sufferer 
from injury to deep-seated and important organs. The immediate effect of a severe 
contusion of any part is ordinarily to produce faintness and nausea, and for this the 
patient should be laid in an horizontal position, should be allowed plenty of fresh 
air (and consequently should not be crowded upon by bystanders), and may, if able 
to swallow, drink a small quantity of weak brandy-and-water or wine. On 
recovering from the first faintness, no other symptoms may appear, and the patient 
may have received no further injury than the "shock" of the accident ; but if, from 
the nature and severity of the injury itself, it may be suspected that some internal 
injury has been received — as shown by long-continued faintness, by hiccup, or pain 
in the abdomen or chest — immediate recourse should be had to medical aid. 

Concussion of tlie Brain is the common result of a contusion of the head, and 
cannot be too seriously regarded. In any case of injury to the head, where 
insensibility has occurred, a doctor should be sent for, but even in slighter cases, 
when the concussion has apparently only produced a temporary dizziness, careful 
treatment, both at the time and after the injury, will be necessary to restore the 
patient to a healthy state of both mind and body. In any case of insensibility from 
injury to the head, no harm can possibly be done by cutting the hair close, and 
applying cold to the head until the surgeon's arrival ; or should this be delayed, and 
the patient's body be cold and the skin clammy, hot bottles may be put to the feet 
in addition. Beyond this, however, it is never safe for a non-professional person 
to go in a case of severe injury to the head ; and most particularly ought the 
administration of stimulants in any form to be avoided. 

Sprains. — A severely sprained ankle is a common, and at the same time a serious, 
accident. As it is very possible that the accidental twisting of the foot to one side 
may have broken the small bone of the leg near the ankle, such a case should always 
be seen as soon as possible by a medical man. But if the sprain is of a sufficiently 
slight character to be treated domestically, it should be borne in mind that complica- 
tions may occur at a later period, for which medical advice should not be too long 
delayed. In the case of a sprained ankle, it is of the first importance to get the 
boot off before the swelling, which invariably follows, has come on. If the accident 
has happened at a distance from home, the foot should then be firmly bound up with 



702 



DOMESTIC SURGERY. 




Tiff. 13, 



a bandage applied round the ankle in a series of figure of 8 loops, and the foot kepi 
in an elevated posture during the conveyance of the patient to his home. On reaching 
home, the bandage is to be removed, and the foot assiduously fomented with water 
as hot as can be borne, until the pain is relieved, some tincture of 
arnica or poppy-heads being useful adjuncts to the fomentation. 
The application of leeches to bad sprains is often of service, but it 
is not safe to have recourse to them without medical sanction. The 
use of cold applications to sprains, though popular, is not to be 
recommended The cold lowers the vitality of the part, and tends 
to prevent the very repair which it is our object to bring about. 
Support and rest are the points to be insisted on, and these are 
most readily obtained by strapping the joint firmly with adhesive 
plaster, so that no movement of the ankle is possible. In order to 
do this, it is necessary to have a yard or two of good " strapping " 
©r u soap plaster," so that the pieces required may be cut " in the length " of the 
calico. Strips long enough to encircle the foot and cross by some inches, are to be 
cut, and must be thoroughly warmed, one by one, either by holding them with the 
plain side to the fire, or, better, by plunging them for a moment into a basin of 
hot water. The foot being then brought to a right angle with the leg, and sup- 
ported on the heel at a convenient height, the strips of plaster are to be applied as 
follows : — Beginning near the roots of the toes, the first strip is 
to be passed beneath the sole, and the ends crossed over the 
instep, and each strap is to be placed nearer the heel, and to 
overlap its predecessor for about half its width. When half a 
dozen straps have thus been applied, another series is to be 
made to pass around the upper part of the joint horizontally, 
crossing the first set on the instep, and thus the whole joint 
will be supported and compressed, and the patient will be able 
to get about (Fig. 13). A bandage should be applied over the 
plaster, to keep it from slipping. In a couple of days the plaster 
will have become loose, owing to the subsidence of the swelling, 
and must be renewed, the old plaster being most easily removed 
by slipping the blunt end of a pair of scissors beneath it on one 
side of the foot, and dividing it so that it can be taken away 
in one piece. For a sprain of moderate severity the plaster 
will require renewing three or four times; but even when 
its use is abandoned, it will be advisable to employ a bandage 
or an elastic " foot-piece " for some time, as the foot will still 
require support. A sprain of one of the larger joints, and espe- 
cially of the knee, is a serious injury ; and if any severe symp- 
toms show themselves, immediate recourse must be had to 
medical aid. When a knee merely gives way occasionally under a person when 
walking, and there is no swelling or heat about the part, it will often be of service to 
support the joint with a knee-cap, which may be of elastic material, and is better 
made to lace up than to draw over the leg. When the join* continues weak for 




Fig. 14. 



FEACTURES, DISLOCATIONS, BURNS, AND SCALDS. 703 

some time, it may be advantageously treated like an ankle by strapping, the 
plaster being cut long enough to go once and a half round the joint, and about 
an inch in width. The straps are then made to overlap in regular series, from 
below upwards, crossing in front until the joint is completely covered, as seen in 
the illustration (Fig. 1 4). 

A Strain is much the same as a sprain, except that it does not necessarily occur 
in the neighbourhood of a joint It consists in the tearing of some tendonous or 
muscular fibres, and is generally the result of some violent and unwonted exertion. 
The treatment consists in obtaining rest and support for the part by careful ban- 
daging, the use of a sling, &c. The term " a strain " is sometimes applied by the 
lower classes to the occurrence of a rupture from some violent exertion. If any 
swelling should be noticed in the neighbourhood of the groin after some exertion 
or athletic exercise, a surgeon should be immediately consulted, as the case may be 
a serious one, and a little delay be a matter of life or death. 

FRACTURES, DISLOCATIONS, BURNS, AND SCALDS. 

Fractures. — The treatment of broken bones is much too important to be entrusted 
to any but professional hands, but there are some points connected with the early 
care of such cases which may be advantageously insisted on. The great majority of 
fractures are what is technically called " simple," i.e., there is no wound of the skin 
communicating with the broken bone; the more serious cases, where there is a 
tround, and possibly laceration of the soft tissues of the limb, are termed "com- 
pound ;" and when the bone is broken into several pieces, the fracture is said to be 
" comminuted. n In all cases of fracture it is most important to avoid all rough 
manipulation of the limb, lest the " simple " fracture should become " compound," 
by the end of the broken bone being thrust through the skin ; and as the muscles 
of the limb itself, if excited to action, have a direct tendency to produce this 
undesirable result, the patient should not only abstain from all voluntary effort, 
but means should be taken to restrain all involuntary contraction of the muscles 
of the limb, as will be afterwards explained. 

The immediate effect of a severe injury likely to produce a fracture is ordinarily 
a certain amount of faintness, and this need give no alarm if the patient is not losing 
blood at the same time. The only treatment required will be fresh air, with perhaps 
a little cold water sprinkled on the face, the head being kept low until the faintness 
has passed off, when a little brandy may be given if the patient continues exhausted. 

Since severe accidents usually happen in the open air, the next requisite will be 
to place the patient under shelter ; and the method of conveying an injured person 
safely for some distance is a matter of no small moment. 

In the case of a broken arm the sufferer will naturally support the injured limb 
with the opposite hand in the position least painful to himself. When this has been 
ascertained, and if there is any distance to travel before a surgeon can be seen, the 
arm should be supported both by handkerchiefs arranged so as to sling it, and also 
by a handkerchief or bandage bound — not too tightly — round the arm itself, so as to 
support the parts. A piece of cardboard (such as is used for tying up gloves), or 
a piece of common hat-box four inches wide, may be advantageously placed on each 



704 DOMESTIC SURGERY. 




side of the broken bone a ad secured with the bandage which envelops it. The 
patient may then be safely driven some miles in a carriage ; and a four-wheeled 
conveyance with good springs is to be preferred. 

If one of the bones of the leg is broken the patient is immediately rendered 
helpless, and the greatest care will be requisite, lest in moving him great pain should 
be inflicted. 

By far the most satisfactory way to carry a wounded man is on some form of 
litter borne by four bearers. A hurdle, or a small door taken off its hinges, is a very 
good substitute for a regular " stretcher," and either, with a mattress and pillow, 
will form a very comfortable temporary means of transport. When neither of these 
is at hand, a blanket may be used to carry a patient in for a short distance, or if 
four poles can be procured and fastened together to form a framework the blanket 
can be tied to the corners, as shown in the illustration, Fig. 15, and will then be 

much more efficient and 
easy to carry. Whatever 
method is adopted there are 
certain rules with regard to 
carrying a stretcher which 
should be carefully attended 
Fig. 15. to : — A stretcher should be 

carried by four men rather 
fehan by two, and should always be carried by the hands and not on the shoulders ; 
the drawbacks to the latter proceeding are the difficulty of finding on an emergency 
lour men of the same height, so that a level position may be secured ; and also 
that any tilting of the stretcher may throw the patient off from such a height as 
seriously to aggravate his injury. Besides, the raising and lowering of the burden 
is not an easy matter, and is apt to frighten the patient when unskilfully performed. 
It is not advisable that the bearers of a stretcher should " keep step." If only 
two men are carrying a stretcher, and they march "in step " the load they are carry- 
ing will be swayed to the right and left side alternately, to the great discomfort of 
the patient ; but if one advances his right foot and the other his left, the burden 
will be kept perfectly even. The same rule applies to the case of four bearers, only 
here the front and rear men of opposite sides should keep step, and be out of step 
with their companions. 

A temporary splint may be advantageously applied to a broken leg before the 
patient is moved on to the litter, as has already been advised in the case of a 
broken arm, and for this purpose nothing answers better than seme clean wheaten 
straw laid along each side of the broken limb, and bound to it by two or three 
handkerchiefs. 

In the case of a badly-sprained ankle, or a crushed foot, it will be sometimes 
convenient to carry a patient between two bearers in a sitting position, or semi- 
recumbent. The first method is shown in the accompanying illustration, Fig. 16, 
the opposite hands of the bearers being interlaced under the thighs and behind the 
loins, and the patient putting his arms round the bearers' necks. This method is 
very trying to the bearers, and could only be endured for a short distance. A 



FRACTURES, DISLOCATIONS, BURNS, AND SCALDS. 



705 



patient is much more easily carried in the semi-recumbent position, if placed in the 
arms of two men, arranged as shown in the illustration, Fig. 1 7, their opposite hands 
firmly interlacing in front, and their other hands being placed on each other's 
moulders, so as to support the patient behind; thus the weight of the patient falls 
chiefly on the two arms behind him, and he can be carried for some distance without 
fatigue. 

Another way of carrying a patient is upon what is known among schoolboys as 
> " sedan-chair," each bearer grasping his own fore-arm and that of his fellow about 




Fig. 16. 



Fig. 17. 



its middle, as shown in the illustration, Fig, 1 8, and the patient grasping the bearers* 
necks, as shown before in Fig. 16. This is a convenient way to carry ladies over 
shallow streams, &c, in the course of country walks or at picnics; and as on those 
occasions sprained ankles are not altogether unknown, a disabled member of a party 
may thus be transported for a long distance with relays of bearers, the two working 
together being as nearly as possible of a height. 

Dislocations. — A dislocation, like a fracture, should always be submitted to the 
}are of a surgeon as soon as possible. When a bone has slipped from its socket the 
limb is useless, and there is more or less pain, and the neighbourhood of the joint is 
bformed. 

A dislocation of the shoulder is at once the most common, the most painful, and 
che most readily reduced of these accidents, and we venture, therefore, to give a few 
45 



706 



DOMESTIC SURGERY. 



hints for its treatment. A fall into a ditch is a common cause of this accident, the 
elbow being caught on the bank and suddenly thrust upwards, when the head of the 




Fig. 18. 

bone slips out of its socket and into the arm-pit, giving rise to excruciating pain 
from its pressure upon the large nerves. This being an accident which may happen 
to a rider when hunting, or when unable to obtain assistance, he may safely make 
an attempt to reduce the arm himself, by using a gate for the purpose of a fulcrum, 
as shown in Fig. 19. Here, lifting his arm over the gate with the other hand, the 
patient grasps the lowest bar he can reach, and allows the weight of his body to 

hang on the other side of the gate 
until by the pressure of the top bar 
the bone is forced into its socket 
with a snap. 

Another method, which may be 
safely employed by a bystander, is 
to seat the sufferer in a strong chair 
and to put the foot on the seat with 
the bent knee under the dislocated 
shoulder, as shown in Fig. 20. The 
arm is then to be grasped and for- 
•p. 19 cibly bent over the knee, when the 

dislocation will probably be reduced ; 
no more violent efforts are justifiable in the hands of non -professional persons, 
and in any case, even of reduced dislocation, the patient should be seen by a 




FRACTURES, DISLOCATIONS, BURNS, AND SCALDS. 



707 




Fig. 20. 



Burgeon as soon as it is convenient, lest any other injury which he may have .sus- 
tained at the same time should have been overlooked. 

Burns a?id Scalds. — Bums are probably not quite so frequent as scalds, but are 
much more alarming at the time of their 
occurrence, and, if severe, are much more 
serious in their results than scalds. The 
slightest form of burn, viz., a superficial 
burn or scorch, merely reddening without 
destroying the skin, may be produced by a 
slight explosion of gas, or the ignition of 
some article of clothing which has been 
rapidly extinguished. Here the pain is 
severe for the moment, but rapidly subsides 
as soon as the surface burnt is protected. 
This can be readily effected by dredging 
flour over the part, and wrapping it up in 
cotton wadding, or, should the part burnt 
be one not readily covered in this way, 
e.g., the face, by painting it over with a 
mixture of equal parts of collodion and 
castor oil, or with a solution of nitrate of 
silver, such as the nitrate-bath of photo- 
graphy. When the burn is more severe, 
little blisters rapidly form on the burnt part, and these vesicles, as they are surgically 
termed, require careful treatment. If, as is sometimes recommended, these vesicles 
are left to themselves, the contents solidify, and a jelly-like mass is left, which has 
afterwards to be got rid of by poulticing, to the great discomfort of the patient ; or, 
even if this coagulation does not take place, the thin scarf-skin, or cuticle, raised by 
the blister is apt to be torn away and leave a tender surface beneath. The best plan, 
therefore, is at once to prick the blisters on one side with a needle, or to make 
a small opening with a sharp pair of scissors, and then carefully to squeeze out the 
watery contents, pressing down the skin gently but firmly with a piece of cotton- wool. 
When this has been done the case may be treated by any of the methods already 
given for slight burns, but it must be borne in mind that fresh vesicles may form 
after the first dressing, and hence great care must be taken, in the subsequent 
dressings, not to tear open the blisters unintentionally. Scalds closely resemble slight 
burns in both their symptoms and treatment, and need not, therefore, be treated of 
at greater length. Severe bums, such as arise from the clothes taking fire — crinoline 
accidents, as they used to be called — are very serious, both as regards the life of the 
patient, and her future comfort, should she survive ; and medical attendance should 
be immediately obtained. Lacking this, however, it may be noted that the 
immediate danger to the sufferer's life is due to the violent " shock " which the 
system sustains, as is shown by the faint, semi-conscious, and pallid condition in 
which the patient is left when the conflagration is extinguished. The proper treat- 
ment will be to restore warmth and vitality to the sufferer, and this can be best done 



708 DOMESTIC SURGERY. 



by wrapping her in a blanket, and placing her in bed (or before a fire, if it is winter), 
with hot bottles or bricks so arranged about the legs and trunk as to impart warmth 
without interfering with the burnt surface. In the case of a child (and of an adult 
too, if conveniences are at hand), a warm bath is at once the most soothing and 
appropriate treatment, since the warm water (the temperature of which must be care- 
fully maintained at 90°) soaks off all the charred clothing, &c, and leaves the burns 
in the most healthy condition for dressing. At Vienna, baths are so contrived that 
patients suffering from burns, or obstinate skin diseases, can spend days or even 
weeks in them ; and anywhere, with care and attention, the temperature of a bath 
should be kept up for some hours at least. In addition to external warmth, & 
severely-burnt patient will bear the administration of some hot cordial drink, and 
then, pending the arrival of a medical man, no harm can possibly be done by 
enveloping the burnt parts with cotton wadding. 

Burns are dangerous, not merely from their immediate effects, but from the 
complications which are apt to follow in their train. Thus, in children especially, 
inflammation of the lungs is very apt to follow a burn about the trunk ; and again, 
ulceration of the bowel is found to be a frequent cause of death in these cases. The 
friends of a patient who has been burnt should, therefore, be careful to call the 
attention of the medical man in attendance to any cough or difficulty of breathing 
on the one hand, or to the occurrence of any diarrhoea on the other. 

With the best care, burns are, undoubtedly, very fatal accidents, and as pre- 
vention is better than cure, it may not be out of place to urge the necessity for wire 
fire-guards over all fire-places to which children or females have access. Men, from 
the nature of their clothing, are much less liable to burns than women, unless, 
indeed, they indulge in the pernicious practice of " reading in bed " by candle-light. 
Even when the first dangers of a severe burn are surmounted, the patient will have 
much to undergo in the healing of the wound, and here a fresh danger comes in— 
that of the contraction of the tissues in healing, so as to leave great deformity behind. 
Patients and their friends are sometimes more to blame than their attendant for 
terrible contractions of the neck, arms, &c, frequently seen after burns; and they 
do not carry out fully the surgeon's instructions, from not understanding their im- 
portance, and, being intent only upon healing-up the wound, cannot understand the 
necessity for care and attention It may be laid down as an axiom that the quicker 
a wound heals, the more it contracts, and it is evident, therefore, that the slower a 
wound can be made to heal, the less likely it is to leave unsightly contractions behind. 
In order to prevent contractions, it is often necessary to confine the patient to an 
irksome position, so as, e.g., to stretch the neck, or to apply a splint to keep out tne 
arm ; and these inconveniences should be cheerfully borne, when they are ordered hy 
a competent medical man. 

It may not be inappropriate here to give a few hints as to the best method of 
extinguishing the flames when a woman's or child's dress has unfortunately caught 
fire. If the sufferer has presence of mind enough to throw herself on the ground 
and roll over and over until the bystanders can envelop her with some thick and 
non-inflammable covering, her chances of escape from serious injury will be much 
increased ; but, unfortunately, the terror of the moment ordinarily overcomes every 






SUSPENDED ANIMATION. 709 



other feeling, and the sufferer rushes into the open air — the very worst thing she 
could do. The first thing for a bystander to do is to provide himself with some non- 
inflammable article with which to envelop the patient, and a coat or cloak — or, 
better, a table-cloth or drugget — will answer the purpose. Throwing this around the 
sufferer, he should, if possible, lay her on the ground and then rapidly cover over 
and beat out all the fire, keeping on the covering until every spark is extinguished 
To attempt to extinguish fire by water is useless, unless the whole body of flame can 
be put out at one blow ; and for one lightly-clad female to attempt to succour 
another, when other persons are at hand, is simply to imperil two lives instead of 
one. In the case of a house on fire, it is to be remembered that death is more 
frequently the result of suffocation from smoke than from contact with flame, and 
every effort should be made to reach the open air by crawling along the floor (where 
there is usually breathing space) so as to reach a window, or, if necessary, by 
enveloping the head in a thick shawl to exclude the smoke while making a rush 
along a passage or down a staircase. 

SUSPENDED ANIMATION. 

Under the head of suspended animation are included all those cases of apparent 
death in which, by the judicious application of appropriate remedies, the patient 
may be restored to vitality and health. The simplest form of suspended animation 
is that seen in fainting, when, from the effects of heat or over-exertion (combined 
possibly with tight lacing), a young lady becomes pale, falls down insensible, and appears 
scarcely to breathe. The admission of fresh air is of the first importance, and she 
should be immediately placed near an open window, and in the recumbent posi- 
tion, so that the flow of blood to the head may be accelerated. At the same time 
any tightness of dress should be at once remedied, and a little cold water sprinkled 
in the face. The use of smelling-salts is occasionally of service in rousing a patient, 
but care must be taken not to apply them too vigorously, for fear of irritating the 
nose. If, as sometimes happens, a fainting-fit is only the prelude to a fit of hysterics, 
the patient should be thoroughly roused by the free application of cold water, so 
soon as the hysterical sobbings begin to show themselves, and a brisk walk up and 
down the room, between two not too sympathising friends, will then probably avert 
a domestic catastrophe which is always annoying to all concerned. Persons with a 
feeble circulation, and, therefore, more liable to faintness, may be glad to know 
that they can often avert a fainting-fit when they feel it coming on, by at once lying 
down flat on a sofa ; or, if from position — as in church — this is impossible, then 
bowing the head well down on the knees will have the same effect. 

Drowning is the most common cause of serious suspended animation, and, as 
accidents may happen at any moment, every well-educated person should know what 
to do on the emergency. In cases of drowning, every moment is of importance, and 
the attempts at resuscitation should, therefore, be begun as soon as the sufferer is 
drawn from the water, and without conveying him any long distance to a house. 
The great object of treatment is to rouse the heart by inducing respiration, as in the 
case of fainting, and, if all efforts at this have ceased, recourse must be had at once 
to " artificial respiration," by the following method, known as " Sylvester's." The 



710 



DOMESTIC SURGERY. 



mouth being cleared of any dirt or saliva which may be in it, the tongue should be 
drawn forward, and held with the finger and thumb, or secured with a piece of 



ribbon, or an elastic band passed over the tongue and under the chin. 



This drawing 







forward of the tongue is very important, as it opens the wind-pipe, and must never 
be omitted. The patient being then laid on his back, with the shoulders and head 
slightly raised, the operator kneels behind his head, grasps the arms just above the 
elbows, and draws them steadily and gently upwards (as shown in Fig. 21) until 




they meet above the head. By ohis meant' the walls of the chest are expanded, and 
air is drawn into the lungs, and a second or oWC should be allowed for this to take 
place. The operator should then lower -'the patient £ arms to his side, and press 
them against his chest (as seen in Fig. 22), so a^ i3C force cut the air from the lungs, 
and thus imitate respiration. This series of movement zhc^LS. be repeated twenty 



StJSPEXDED AXiMATIOtf. til 



times a minute — not more — and the time should be taken from the watch of a 
bystander, or it will be found in practice that anxiety will lead to hurry and conse- 
quent damage. As it will be impossible for one person to keep up the exertion 
necessary for many minutes, from the fatigue consequent upon it, he should be 
relieved as often as may be necessary by another, who should have watched and 
learnt the method of proceeding ; but it is important that all directions should be 
given by one person, since confusion and delay are sure otherwise to occur. Whilst 
efforts at restoring respiration are being thus unceasingly carried out, the attention 
of other assistants should be given to restoring the warmth of the body of the 
drowned person, by removing wet clothes, applying hot blankets and bottles, and by 
using friction assiduously to the limbs, in an upward direction, so as to favour the 
flow of blood towards the heart. The utility of a warm bath is questioned by many 
authorities, and should only be resorted to when the patient is suffering from 
extreme cold. Even in this case, it is well to dash cold water over the face and 
chest, so as to excite respiration, and the use of the warm bath should not be con- 
tinued more than five minutes, without medical sanction Efforts at resuscitation 
should be continued for at least an hour, even in unfavourable cases, unless, indeed, 
a medical man is able to certify that the sufferer is undoubtedly dead. Patients 
recovered from drowning generally require careful after-treatment for a few days, but 
this is best left in the hands of the medical attendant. 

Cases of Hanging with suicidal intention may unhappily be met with, and 
require treatment very similar to that appropriate for drowned cases. Of course, the 
first step is to cut the sufferer down, and loosen the ligature round the neck. Cold 
water should then be dashed over the head and chest, and if no breathing is thereby 
excited, recourse should be had at once to artificial respiration, as above described. 
In cases of hanging it may be necessaiy to bleed the patient from the jugular vein, 
or temporal artery, in order to relieve the congestion of the head, but neither of 
these operations can be safely undertaken except by a medical man. 

Suspended animation from Foul Gases is most commonly met with in connection 
with breweries, where the carbonic acid gas is apt to collect in the large vats used 
for brewing ; or in wells, where the same gas collects and is dangerous to any work- 
men descending to repair pump-tube*. &c. As in these accidents several lives are 
often unnecessarily sacrificed in the well-meant but ignorant efforts made to rescue 
the first sufferer, it may not be out of place to say a few words as to the best method 
of dispersing the noxious gases, and removing those who are suffering from their 
influence. "When one man has fallen insensible under the influence of the carbonic 
acid, it is simply suicide for another to attempt to rescue him without proper 
precautions. These consist in having a strong rope securely fastened round his 
waist, so that he may be drawn up at once if overcome, and another similar rope to 
be carried in the hand and to be attached to the first victim. The mouth and nose 
should be thoroughly muffled with a woollen comforter or handkerchief, and the 
rescuer should breathe as seldom as he can whilst attaching the rope to hi3 fallen 
comrade. If sufficient assistance is at hand, efforts should at the same time be made 
to disperse the carbonic acid gas by throwing down buckets of water. By this means 
the ordinary atmospheric air will to a certain degree be mixed with the deleterious 



712 DOMESTIC STTRGEBY- 



vapour, which, being heavy, wilJ speedily find its way through an opening in th€ 
bottom of a vat, if such can be rapidly made by opening a trap, or cutting out a 
plank. A garden-engine and hose, if at hand, may be used to pump fresh air to the 
sufferers, and a fire-engine, if obtainable, would be a still more efficient mstjrun> ent. 
When the sufferer is at last placed in safety, every effort must be made to establish 
respiration in the manner already explained under the head of drowning. It is most 
important that a free access of fresh air should be allowed to him by avoiding all 
crowding of anxious relations and friends around the patient. 

Insensibility from Sunstroke is occasionally met with in the summer months, 
from exposure in the hay-field, &c. The patient complains of violent pain in 
the head, and in bad cases becomes rapidly insensible, the face being flushed 
and the head hot. The treatment is to remove the "sufferer into the shade, and 
to apply cold water freely to the head and nape of the neck. The head should 
be supported, and cold water (iced if possible) poured from a height upon it. 
At the same time mustard poultices may be applied to the calves of the legs, 
and medical aid should be immediately summoned. 

The same treatment would be appropriate to a case of apoplexy, care being 
taken, however, not to prolong the cold affusion, as the patient's strength might 
not be able to bear it. 

Cases of insensibility from Intoxication or Poisoning should be seen by a medical 
man as early as possible. No harm, however, can be done in any case by 
inducing vomiting, and this is most readily accomplished by tickling the interior 
of the throat with a feather, if the patient is unable to swallow, or if he is 
able, by the administration of an emetic of warm mustard-and-water. All con- 
striction about the neck and chest should be removed, and the patient placed on 
his side with the head slightly raised. 

Frost-bite. — The effects of cold, if severe, are scarcely less dangerous than those 
of heat, though not so frequently met with, in this country at least Probably 
the commonest form of frost-bite is the ordinary chilblain, and its close resemblance 
to a burn is shown by the fact of a vesicle forming and leaving a sore behind it 
just as if the part, had been burnt. As the worst thing for a burn is to apply cold, 
so the worst thing for a frost-bite is to apply heat, and this is frequently seen in the 
case of people who put their cold feet to the fire, and so produce the chilblains of 
which mention has been made. A frost-bitten part loses its natural colour, becomes 
of a tallowy-white, feels numbed and insensible, and, if not judiciously treated, may 
mortify and drop off. The proper treatment is to restore the circulation in the part, 
very slowly and gradually, and for this purpose friction should be used with the 
hand containing snow, or dipped in ice- water. The patient should be kept from the 
fire, and in an airy room, until the sensation in the limb and its colour are fully 
restored. When a limb is really severely frost-bitten, immediate recourse should be 
had to medical advice, as the patient may lose a part of it or hardly escape with his 
life. A person who has been long exposed to a low temperature, particularly if 
either very young or very aged, or in feeble health, may be so completely overcome 
as to be in very considerable danger. The first evidence of this is a drowsiness, 
which becomes after a time perfectly irresistible, but which, if indulged^ is equally 



GUNPOWDER ACCIDENTS. 713 



fatal Every effort should be made to rouse the patient, and to keep him awake 
until shelter is reached, when, if already passed into an insensible condition, medical 
aid should be at once summoned. In the meantime, the patient should be stripped 
and wrapped in a blanket, and friction of the limbs with the hands should be carefully 
and steadily carried on. A little warm milk may be cautiously administered with a 
spoon pushed well back into the throat, and, if an enema syringe is at hand, some 
warm water or milk may be thrown up into the bowels. Recourse should be had to 
artificial respiration, if the patient does not breathe even slightly ; but for instruc- 
tions how to carry out this recommendation the reader is referred to the remarks on 
the treatment of drowning, a much more common casualty than severe frost-bite. 

Gunpowder Accidents, though similarly treated to burns and scalds, must be 
confided to professional hands, if possible. The effect of the explosion of gunpowder 
upon the patient differs according to the proximity and the force of the explosion. 
Loose or slightly compressed gunpowder, as in a " squib," scorches the patient by 
its explosion, and is apt to carry unburnt grains of the powder into the skin. 
These leave an ugly and almost indelible mark; for though it is true that the 
grains of powder may be picked out with a needle, few sufferers will endure the 
operation, which is necessarily painful. The explosion of tightly-compressed powder, 
as when contained in a powder-flask, is of a most violent character, and is sure 
to lead to such injury of the hand which holds it as to require immediate 
surgical attention. This accident is, in fact, only mentioned here in the hope 
that a hand may be saved by calling attention to the foolhardy feat which so 
often recurs with the same disastrous result — the pouring powder from a flask 
into an open fire. Of course a complete train is thus established from the fir*? 
to the flask, with the most dreadful results to the foolish performer of the 
experiment. 

Gunshot Injuries, and particularly those occurring in civil practice from the 
incautious use of fowling-pieces, are always most serious in their nature, and require 
most skilful professional treatment As some time must ordinarily elapse between 
the occurrence of the accident and the arrival of the surgeon, it may be well, how- 
ever, to indicate the treatment to be pursued. In the first place, the bleeding 
should be arrested by binding up the wound in the manner already described 
Secondly, as the patient will be certain to be suffering severely from " shock," it 
will be advisable to keep him in the recumbent position, to apply warmth to 
the extremities, and — if the bleeding has been controlled — to give stimulants 
cautiously. We take this opportunity of calling attention to the folly — we mav 
almost say wickedness — of pointing any weapon, whether believed to be loaded or 
otherwise, at another person in jest. Such jests have so frequently turned out to 
be miserable and irremediable mistakes, from the gun being unexpectedly loaded, 
that we very itrongly maintain that from earliest childhood every boy should be 
forbidden to point even a pop-gun at a living person. 

Injuries from Chemicals are comparatively rare accidents, though they may 
prove most serious in their results. The application of any of the strong mineral 
acids — nitric, sulphuric, or hydrochloric — to the surface of the body will char the 
cuticle, and, if not immediately washed off, or neutralised with an alkali — soda, 



714 DOMESTIC SURGERY. 

potash, or lime — will eat into the part, giving rise to excruciating pain and do* 
struction of the tissue. In the same way the application of the caustic alkalies will 
destroy the surface, and require to be neutralised with some diluted acid, of which 
vinegar is a convenient form. The most serious form of accident from chemical 
substances is when they are swallowed by mistake, and these cases require immediate 
and active medical treatment. Pending the arrival of a medical man, no harm can 
be done in any case by administering olive oil or uncooked eggs ; but the surgeon 
will of course use his discretion as to the means to be subsequently adopted. 

Particles of quick-lime are occasionally blown into the eye, and produce very 
serious mischief if not immediately attended to. Since it is the contact with the 
tears which produces the caustic effect, it is of no use to merely bathe the eye with 
water, and fortunately an antidote is at hand in vinegar, which, when mixed with 
water and applied to the eye, produces an insoluble salt of lime, and arrests the 
mischief. When all pain has been allayed by the use of the vinegar-ancl-water, 
a drop of castor oil placed between the lids will give great comfort to the patient; 
but medical advice should be sought if there are, as will frequently be the case, 
white marks left upon the surface of the eye-ball. 

Foreign Bodies introduced into various parts of the body cause more or 
less mischief; and, as a rule, the earlier they are removed, the better for the 
patient. 

Dust in the Eye is a familiar example, and is very distressing from the irri- 
tation in that sensitive organ which it immediately excites. When the foreign body 
is merely lying beneath the eye-lid it can often be immediately removed by drawing 
the upper lid well down over the lower, and then allowing the eye to be slowly 
opened, when very generally the intruder will be entangled in the lower lashes and 
thus removed. If this little manoeuvre, repeated once or twice, does not prove 
successful, it will be necessary to turn the upper lid up, so as to expose its under 
surface. This can be accomplished by a non-professional person with a little care, 
and without any risk of injuring the eye, as follows : — The patient being seated, and 
leaning his head back against the operator's breast, the latter, holding an ordinary 
bodkin in one hand, presses it gently on the outside of the lid, and about half-way 
down. With the fingers of the other hand he then seizes the eye-lashes, and, draw- 
ing the lid a little forward, turns it up over the bodkin. This will be accom- 
plished readily enough if the operator is steady and the patient willing, and the 
whole surface of the eye will then be exposed, when the foreign body can be seen 
and removed. If, however, the particle is of a pointed character — e.g., a piece of 
steel — and is embedded in the cornea, or transparent covering of the eye-ball, the 
assistance of a surgeon should be at once obtained to ensure its safe and early re- 
moval. In any case of injury to the surface of the eye, the application of a drop 
of castor or other oil, as recommended in the previous section, will be found of 
great service. 

Foreign bodies are often introduced by children into the nose or ear, in sport, 
and are generally of a more or less globular form, such as beads, pebbles, cherry- 
stones, or beans. These, if near the orifice, may be readily hooked out with one 
of the common ear-picks found in ladies' dressing-cases, or with the loop of a 



FOREIGN BODY IN WINDPIPE. 715 

< 

common Lair-pin ; but if more deeply placed, injudicious poking with instruments 
may do harm, especially in the ear, and it is better to have recourse to the injection 
of a stream of warm water with a good-sized syringe, by which the interloper may 
be washed out. In the case of the nostril, a violent sneeze, induced by the inhalation 
of a pinch of snuff or pepper, will often dislodge the obstacle ; but if recourse is 
had to syringing, the best method is to inject the water through the opposite 
lostril, when, if the patient leans forward, and keeps the mouth open, the water 
rill run round the back of the nose and out at the affected nostril, bringing the 
/oreign body with it. The vulgar notion that " earwigs " have a tendency to find 
their way into the ear is a popular delusion, but as it occasionally happens that an 
ant or other small insect enters the ear, and gives rise to pain and irritation, it 
may be well to mention that .the simplest way of relieving the sufferer is to place 
the head horizontally and to fill the ear with water, when the insect will be at once 
floated out of the cavity. 

Foreign bodies in any part of the wind-pipe are always serious, and may be 
immediately fatal. The accident commonly happens from a child having some 
plaything, such as a bean, small marble, bead, or nut-shell, in its mouth, and being 
desired to take it out, when, either in the hurry to obey, or possibly from its 
disinclination to do so being quickened by a cuff, the foreign body slips into the 
wind-pipe, and produces serious mischief. In the well-known case of the late 
Mr. Brunei, the eminent engineer, whose life was endangered by an accident of this 
kind, it arose from his performing a conjuring- trick with a half-sovereign in his 
mouth, and the coin slipping into his wind-pipe. When the foreign body becomes 
fixed in the upper part of the wind-pipe or larynx, so as to obstruct the breathing, 
the patient becomes black in the face, and falls back apparently dead. This some- 
times happens during a meal, from a child or grown-up person happening to cough 
while eating, and thus drawing a piece of food into the air-passages. Whatever 
the cause, a bystander should, without hesitation, thrust his fore-finger to the 
back of the throat, and endeavour to hook up with it the offending body, and this 
can often be done, when the patient will at once breathe again. If this method is 
not successful, the patient, if a child, should be held up by the legs and be smartly 
thumped between the shoulders, when not improbably the foreign body will drop 
on to the lloor, and the child will then begin to respire and cry ; but if respiration 
is still suspended, cold water dashed on the chest will probably rouse it, or, if not, 
recourse must be had to artificial respiration, as described under the head of 
Suspended Animation (page 709). Of course, medical aid will be summoned at 
once in any case of serious choking, if possible, but the majority of these cases do 
very well without it. If, however, the foreign body is not dislodged by the efforts 
of bystanders, an operation will be necessary to save life, and every moment will be 
of importance. Even if the urgent symptoms have passed off, and the child appears 
to be restored to health, yet, if the foreign body has not been found, the advice 
of a surgeon should, nevertheless, be sought at once, as it may still be lodged in 
the deeper air-passages, where it may cause fatal mischief if not dislodged at an 
early period. 

Foreign bodies seldom lodge in the gullet, and such obstacles as fish-bones can 



716 DOMESTIC SURGERY. 



generally be got down safely into the stomach by swallowing a large mouthful of 
well-masticated bread. In cases where this does not succeed in removing the bone, 
a medical man should be sent for, who can, by a very simple treatment, get rid of 
the obstruction. The most serious obstruction is a set of false teeth, since the 
plate upon which they are fixed is apt to become entangled in the mucous 
membrane, and necessitate a serious surgical operation. The best way to avoid 
such an accident is for the wearers of artificial teeth on no account to go to bed 
with them in their mouths, since it is usually during sleep that the accident 
happens. 

Foreign bodies, such as coins, often pass into the stomachs of children, and give 
unnecessary alarm to their friends. In the great majority of cases such articles 
would pass through the intestines without any treatment, but certainly the worst 
treatment possible is to give the child purgative medicine, as is so often dona 
Either an emetic of mustard-and-water should be administered at once, so as to 
bring up the foreign body, or, if the case is seen too late for this, every effort should 
be made to cover it over with more or less adhesive food, so that it may pass readily 
through the bowels. Pins or needles when swallowed should always be treated in this 
Matter way. The best regimen for a child under these circumstances is plenty of 
bread-and-milk, with common hard dumplings and bread-and-cheese for his dinner, 
ind a careful avoidance of fruit, &c, until the indigestible body has come away. 



TEETHING. 

The Gwms and Teeth. — The proper care of the teeth as organs most essential for 
the preservation of health cannot be too strongly impressed upon parents. Many 
of the illnesses of childhood are directly connected with the eruption and develop- 
ment of the teeth ; and these will be more particularly referred to in other papers, 
the object of the present article being only to point out those facts in connection 
with the teeth which every well-educated father and mother should be acquainted 
with. Each individual has two sets of teeth, the temporary and the permanent ; 
the former being contained in the jaws at birth, and taking their proper positions 
within the first three years of childhood, the latter being at the same time developed 
in the jaws, and appearing from the sixth to the twenty-first years. The temporary 
teeth are twenty, and the permanent thirty-two in number. In the illustration 
(Fig. 23), taken from the jaws of a child of from six to seven years old, the whole 
of the temporary teeth are seen in their proper positions, and in addition, the 
crowns of four of the permanent teeth have appeared through the gum at the back 
of the temporary set. The remaining permanent teeth are those embedded in the 
jaws, and at present imperfectly developed. 

The teeth of the two jaws correspond in number and form, and the temporary 
teeth are as follows: — In the centre of each jaw are four cutting or incisor teeth ; on 
each side of these is a pointed canine or eye tooth ; and beyond these again two 
grinding or molar teeth. In the permanent set the teeth are of course larger, and 
are the following : — There are four incisors, two canine, and four small pre-molar or 
bicuspid teeth, as in the child ; but, in addition, there are on each side three large 



TEETHING. 



717 



grinding or mciar teeth, the last of which is called the wisdom-tooth, from its being 
cut only when years of discretion are supposed to have been reached. 

The period at which each tooth makes its appearance through the gum is pretty 
constant, though it will de- 
pend somewhat upon the 
growth and health of the 
child On an average, 
the central incisors are cut 
about the seventh month ; 
the lateral incisors from the 
seventh to the tenth month; 
the front molars from the 
twelfth to the fourteenth 
month; the canines from 
the fourteenth to the twen- 
tieth month ; and the back 
molars from the eighteenth 
to the thirty-sixth month. 
The permanent teeth appear 
in a different order, the 
earliest being the first mo- 
lars; and these appear in 
the sixth year, and take 
their places immediately 
behind the temporary teeth. 

The two middle incisors are cut about the seventh year, and these necessarily dis- 
place all four of the temporary teeth ; the two lateral incisors appear in the eighth 
year ; the first bicuspids in the ninth year ; the second bicuspids in the tenth year ; 
the canines from the eleventh to the twelfth year ; the second molars from the 
twelfth to the thirteenth year ; and the wisdom-teeth from the seventeenth to the 
twenty-first year. It is to be understood that the above enumeration applies to 
both jaws, but that the teeth of the lower jaw are usually a little earlier in their 
appearance than those of the upper jaw. 

Lancing the Gums. — When an infant is cutting its teeth its mouth is hot, and 
the gum is swollen and tender. Great relief may be afforded, and even its life may 
be saved, should it be subject to convulsions, by freely lancing the gums. This 
operation should of course be performed by a medical man, if one can be procured ; 

but, in case of urgent need, 




Fig. 23. 



Fig. 24. 



a parent would be justified 
in performing it himself, if 
provided with a proper in- 
strument, and having some knowledge of the subject. The gum-lancet is a steel 
instrument of the shape shown in Fig. 24, aiid may be procured of any surgical 
instrument maker. In lancing the gums of the lower jaw it will' be most con- 
venient to have the infant held against the breast of a nurse, and in the sitting 



718 DOMESTIC SUBGBBY. 




position, when the operator, sitting or kneeling in front, must steady the jaw with 
the left hand, as shown in Fig. 25, and with the right make a steady cut on the 
top of the inflamed gum down to the crown of the tooth, against which the edge 

of the lancet should be made to grate. In lancing 
the gum of the upper jaw, the infant may be 
most conveniently held on the knees of a nurse, 
and with the head fixed between the knees of 
the operator, who can then lean over and see 
clearly what he is about Lancing of the gums 
should only be resorted to when the tooth makes 
a prominence through the gum, and it will there- 
fore usually make its appearance in a day or 
two If, however, the gum has been lanced a 
little prematurely, no harm will have been 
done, the gum being more yielding after than 
before the operation, and the hemorrhage, 
which is never of any amount, serving to relieve the over-distension of the 
part. 

Cwre of the Teeth. — The temporary teeth require some supervision on the part of 
the parent, as the child is too young to do more than complain if he is in pain, 
Children who have suffered much from infantile diseases almost invariably have 
badly-developed and unsound first teeth, bat may, if well cared for, grow up strong 
and vigorous, and with sound permanent teeth. It is a common error to suppose 
that the administration of medicine has caused the early decay of the first set, or the 
unsightly markings sometimes present on the second set of teeth, whereas it is the 
disease for which the remedies were given which has left its trace behind. The 
molar teeth, both of the first and second set, are most liable to decay, and a child's 
mouth should be carefully examined from time to time to see if any of these teeth 
are discoloured or hollowed out If they are, the child should be at once taken to 
a dentist, to have the diseased tooth stopped before it becomes painful, so that it 
may not become necessary to extract it before its full time. As the permanent 
molar teeth take up their position behind the temporary teeth, it is most important, 
for the full development of the jaw and the proper arrangement of the teeth, that 
the temporary teeth should not be extracted too early. At the same time, if the 
jaw should be small, and the teeth are taking up irregular, and perhaps too pro- 
minent positions, it may be necessary to extract even some of the permanent teeth 
at once, in order to allow the others to take their proper places. For this purpose 
a parent should consult some respectable dentist, carefully avoiding all unqualified 
practitioners, and should be careful to see that all the directions he gives are carried 
out, and particularly that any mechanical arrangement which may be necessary in 
order to bring irregular teeth into position is fairly and fully attended to. 

Later in life, in addition to the oidinary cleaning of the teeth with tooth-brush 
and powder, or soap, it is well to pay an occasional visit to the dentist to have the 
" tartar," or earthy matter deposited by the saliva, removed from the front teeth, 
Even in the most cleanly mouths this is apt to collect and injure the gums, if it does 



TOOTHACHE. 719 

not the teeth also ; and, as it is very tenacious, it requires some skill for its removal. 
At the same time the dentist should be requested to inspect all the teeth, in o^der to 
detect the first inroads of disease, so that by careful " stopping " the mischiei may be 
arrested. The nature of the stopping to be applied in each case must of course be 
left to the discretion of the dentist, but a patient should on no account consent to 
the insertion of a cheap " amalgam " stopping into any of the front teeth, since this 
always leads to great discoloration of the teeth, and consequent disfigurement. When 
toothache supervenes upon decayed teeth, recourse must of course be had to the 
dentist, who may, in favourable cases, contrive to save the tooth by destroying the 
nerve and then carefully stopping the cavity. Extraction is the last remedy, and 
has recently been robbed of nearly all its horrors by the introduction into dental 
practice of the administration of the nitrous oxide gas as an anaesthetic. This gas, 
when carefully administered in its pure state, has the power, like chloroform, oi 
rendering the patient perfectly insensible, but has this advantage over chloroform, 
that the insensibility is much shorter, and that recovery from its influence is imme- 
diate, and unattended with sickness. Many dentists are in the habit of administering 
this agent for all cases of extraction of teeth, but no person should take this, or any 
other anaesthetic, without first consulting his ordinary medical attendant. 

Toothache is perhaps the most agonising pain to which one can be subject. If s 
from circumstances, immediate recourse cannot be had to a dentist, relief may some- 
times be obtained temporarily by the insertion of a pledget of cotton- wool soaked hi 
laudanum into the hollow tooth, and by the application of warm fomentations to the 
f&ce. Several specific remedies are sold, which are certainly efficacious as a tem- 
porary application in cases of toothache, and the introduction of a few drops of warm 
laudanum into the ear often does good. The formation of an abscess around a tooth 
may be known by the deep-seated throbbing pain it gives rise to, and the extraction 
of the tooth is the only certain way of obtaining relief. 

False Teeth are exceedingly healthful, by supplying the lost power of mastication, 
and no one who has lost his back teeth should hesitate to have the want supplied 
artificially, both for his own comfort and also for the preservation of the front teeth, 
upon which an undue amount of work would otherwise be thrown. Artificial teeth 
can be had of every price, but here, as elsewhere, we would say, avoid an unqualified 
dentist, w T hose cheap teeth would be dear at any price, since the purchaser would 
have no comfort in wearing them. The question of the necessity for extracting the 
stumps of teeth must be left to the judgment of the dentist ; but if, as often happens, 
it is advisable to remove some, it will be necessary to wait some weeks before the 
model of the mouth can be properly taken so as to ensure a proper fit. One caution 
only need be given with regard to false teeth, that they should always be removable 
at will, and should invariably be removed from the mouth when the wearer goes 
to bed. 

Inflammation of tlie Tonsils constitutes one of the common varieties of " sore 
throat." The sufferer experiences pain and difficulty in swallowing, and talks with 
a peculiar thick voice, which is very characteristic. On looking into the throat the 
back part of it is seen to be red and inflamed, and the tonsils are found to be almost 
"blocking up the passage. If there is much fever and constitutional disturbance, & 



720 DOMESTIC SURGERY. 



medical man should be consulted at once, but the best domestic treatment consists 
in frequently gargling the throat with hot milk-and-water, and the application of 
linseed-meal poultices round the throat. The bowels should be thoroughly relieved 
with an ordinary aperient, and the patient should be fed with nourishing food, in the 
form of soup or broth, and will probably be the better for a glassful or two of port wine. 
If an abscess forms in the tonsil, it may produce alarming symptoms of suffocation 
by its presence, and a surgeon should be at once called in to open it. An abscess 
may burst of itself into the throat, and thus give relief, but only after many hours' 
Buffering. 

Enlarged Tonsils are often found in young persons of delicate health, and give a 
peculiarly vacant appearance to the countenance by obliging the sufferer to keep the 
mouth constantly open, and to breathe heavily. A more serious consequence of 
enlarged tonsils is, however, the effect upon the chest produced by the imperfect 
admission of air to the lungs, the tendency to the deformity called " pigeon-chest " 
being common in these cases. The only effectual treatment is for the surgeon 
to remove a portion of each tonsil ; and this can be safely done even in young 
children. 

BUNIONS, AND AFFECTIONS OF THE FEET AND LEGS. 

Bunion is a painful deformity of the joint of the great toe, due to the wearing 
of narrow and ill-made boots, by which the toes are crushed together, and the great 
toe bent out of its proper position. If the affection is quite recent, and no 
alteration has been caused in the joint by the pressure, it will be sufficient to wear 
wide boots, and, in addition, to place a small piece of cotton-wool between the great 
toe and that one next, in order to restore the foot to its natural condition. Circular 
bunion-plasters of either leather or felt are very serviceable in such cases, as also 
with corns, in taking off the pressure of the boot. If, however, the pressure upon the. 
part has been of long continuance, the joint will be found to have become more or 
loss chronically inflamed and swollen, and if so, the application of the tincture of 
iodine to the skin for some time may be necessary in addition to the plaster, in 
order to restore the healthy state of the part. Occasionally acute inflammation of 
the part affected is set up, even running on to the formation of abscess, and, as this 
may be serious as regards the whole foot, the advice of a surgeon should without 
delay be obtained. Of corns we have already spoken in our articles on the 
Management of the Skin. 

Ingrowing Toe-nail is another result of sacrificing health and comfort to fashion, 
in the form of tight boots. The great toe-nail, when healthy, is very slightly curved, 
and is broad and thin, and this condition may be maintained by carefully cutting 
the nail from time to time straight across, providing sufficiently wide boots are 
habitually worn. When, however, the toes are crushed together, the nail of the 
great toe becomes more curved than natural, and presses into the tender skin on 
each side, and if the slight inconvenience at first experienced does not warn the 
sufferer to seek relief, he will find matters rapidly going from bad to worse, 
inflammation being set up on each side, and exuberant painful granulations 
springing up and overlapping the edges of the nail, as seen in Fig. 26. In the early 



BUNIONS, AND AFFECTIONS OF THE FEET AND LEGS. 



721 



stage of this disorder, when the nail first begins to excite irritation, the immediate 
abandonment of narrow boots and the careful insertion of a small pledget of cotton 
wool in the groove on each side of the nail will generally effect a cure j but if this 
is not enough, with a sharp pair of nail-scissors a small slip of the nail on each side 
should be removed, without going down to the matrix, or "quick." In many 
persons this occasional removal of a slip of nail is a necessary and painless operation, 
though some prefer to scrape away the centre of the nail, so as to thin it until it 
bends readily, which in our experience is both a painful and useless operation. A 
better plan is to let the nail grow long and to cut a notch in the centre of it— as 
shown in the illustration, Fig. 26— when the growth takes place chiefly at this spot, 
and the edges do not appear to encroach so rapidly upon the soft tissues. When 
the irritation has been allowed to go to the extent which we have shown in the 
illustration, the advice of a surgeon should be immediately sought, as it may 
possibly be necessary to remove part of the nail in its whole length— an excessively 




Fig. 



J ig. 27. 



painful operation, for which the adniinistration of chloroform, or some other 
anaesthetic, will be found necessary. 

Flat Foot occurs very generally in young persons who have had their strength 
overtaxed in carrying weights — for example, among nursemaids and errand-boys — 
though it may occur later in life, as is seen in the case of soldiers and policemen, 
and others who are on their feet during many consecutive hours. The sufferer finds 
the feet remarkably tender and painful after walking, and if it be neglected the 
distortion becomes so confirmed as to render him quite lame. In a flat-footed 
person, if he be made to stand up with bare feet, it will be seen that the arch of the 
foot has been more or less broken down, as shown in Fig 27, so that instead of the 
weight of the body coming upon the extremities of the arch — the heel and the ball 
of the great toe — the centre bones have fallen down and touch the ground, and 
hence the pain. The great object of treatment is to support the bones of the foot 
until the ligaments which have become relaxed shall have again become braced up. 
With this object in view, the sufferer should avoid much walking, and especially the 
carrying of heavy weights, and should have his foot carefully bandaged, as shown in 
a preceding paper. In order to restore the arch of the foot, the best plan is to have 
a piece of cork fitted to the inside of the boot so as to press up the fallen bones as 
much as the patient can bear without pain. After a time, as the foot improves, 
tjiis can be increased in thickness, and so eventually the arch of the foot will be 
48 



722 DOMESTIC SURGERY. 



restored. When this has been done, a metal spring in the " waist " of the boot, as 
in the " Flexura " boot, is useful in preventing a return of the complaint. 

Weak Ankles are common accompaniments of " flat foot," or may exist alone. 
The sufferer is found to "tread over" considerably in walking, and is often conscious 
that the ankles yield during walking, the foot having a tendency to turn on its 
side. The best remedy is well-made lace-up boots, with the sides made stiffer than 
usual, those with elastic sides giving no efficient support. In children who frequently 
suffer from enlargement of the ankle-bones, bathing with Ditman's sea-salt and 
water, or sea- water, and the administration of cod-liver oil, are very useful remedies. 

Bow Legs are common in "rickety" children who have been put upon their 
feet too soon, and are, therefore, more common among the poorer classes than 
among those who have attendants to carry them when young. The earthy material 
of the bones of these children being deficient in quantity, their legs bend with the 
weight of the body, and if not attended to the deformity will be permanent. The 
great point is to improve the little patient's health by sufficient and proper food, 
and particularly by supplying it with genuine and unadulterated milk and wheaten 
bread, both of which articles of diet contain the earthy salts necessary for the 
formation of bone. Fresh air and, if possible, the sea-side, are very advisable if 
they can be procured, and the medical treatment must be carefully carried out 
under the direction of a competent adviser. As regards the use of apparatus for 
the treatment of this and every other form of deformity, the parent should be 
guided by the advice of a surgeon, and not by that of a self-interested instrument 
maker. Many slight cases of bow legs do perfectly well without any apparatus at 
all, and in most cases a simple lath on the inside of the leg, with broad webbing 
straps and buckles, is as efficacious for the treatment, and better, because lighter, for 
the child, than complicated and expensive steel and leather supports. 

Knock Knees occur generally in youths who have somewhat overgrown their 
strength, and particularly in those who have been in the habit of walking or running 
a good deal. The ligaments of the knee-joints become weakened and gradually yield, 
and the lad finds that the knees are apt to touch in walking, causing the trousers to 
wear out on the insides of the legs, and giving to the individual a very ungainly 
appearance, with more or less pain in the knees themselves. The patient's health 
should bo improved, and he should avoid walking ; but if able to obtain horse 
exercise may avail himself of it with advantage, as it will tend to bow the knees out, 
as is seen in an exaggerated form in grooms and jockeys. With the same object in 
view, he may sleep with a pillow between his knees, and with the ankles fastened 
together by a silk handkerchief. A simple alteration in the sole of the boot is very 
useful in slight cases of this kind. It consists in having the heels of the boots 
prolonged on the inner side along the " waist " of the boot, the effect of which is to 
throw the foot slightly on one side, and thus counteract the in-bowing of the knees ; 
the boots should be strong lace-up ones, so as to well support the ankles, which 
might otherwise yield. In severe cases of knock knee, it will be necessary for the 
patient to be confined to the sofa, and wear proper apparatus under the direction of 
a surgeon. 

Housemaid' 8 Knee is, as its name implies, an affection common among domestic 



VARIOUS LOCAL AILMENTS, 



72$ 



servants who kneel to scrub floors, &c. The little bag, or " bursa," beneath the 
skin of the knee and in front of the knee-cap is apt to get inflamed and swollen 
from the pressure it sustains, and is then often very painful, and the part looks red 
and swollen. Hot fomentations and poulticing, with rest for a day or two, will 
generally effect a cure ; but if not, and the part 
throbs, the advice of a surgeon should be at once 
obtained, as possibly an abscess may have formed. 
In some cases there is no pain or heat, but a swelling 
is formed in front of the knee (as seen in Fig. 28), 
which gives inconvenience in kneeling. This will 
often subside by avoiding the practice which has 
given rise to it, and by painting the skin over it 
daily with tincture of iodine ; but if it does not dis- 
appear it should be shown to a medical man In all 
cases in winch it may be a matter of necessity that 
work should be continued as usual, the sufferer 
should be very careful to provide herself with a soft 
pad of carpet, or matting, to kneel upon, to prevent, 
if possible, any increase of the inflammation. 

Hip Disease is only mentioned here because its 
onset is so insidious as often to be overlooked until 
the disease has made considerable progress ; and as 
treatment, to be efficacious, must be early, it is im- 
portant that parents should have their attention 
called to the first symptoms of the disorder. The disease generally occurs in 
weakly children, and may date from a fall which gave rise to no special symptoms at 
the time. The child is noticed to have a slight limp, and complains very probably 
of pain in the knee, and not in the hip itself, unless that part is touched. These 
symptoms are quite sufficient to justify recourse to the surgeon, whose directions 
should be strictly carried out for many weeks, or even months, if necessary, to effect 




VARIOUS LOCAL AILMENTS. 

A Cold in the Eye. — This is a very common affection, and consists in an inflamed 
condition of the membrane covering the eye-ball and lining the eye-lids, and is 
often due, as the name implies, to exposure to a draught. The patient feels as if 
some dust had got into the eye, and can sometimes be hardly persuaded to the 
contrary ; the white of the eye itself is seen to be reddened, and there is a constant 
flow of blinding scalding tears. The best treatment is to foment the eyes with 
pure warm water, or better, with water in which two or three crushed poppy-heads 
have been boiled for half an hour, to extract their sedative qualities. A shade 
should be worn over the eyes in the intervals of fomenting, and a dose of rhubarb 
and magnesia should be administered If the inflammation dees not subside in a 
day or two a doctor should be consulted if possible ; but, if this is not possible, 
good will probably be done by dropping into the eyes, two or three times a day, 



724 DOMESTIC SURGERY. 



some solution of sulphate of zinc or white vitriol, in the proportion of one grain to 
two table-spoonfuls of water. 

Strumous children, especially when improperly fed, often suffer from another 
form of inflammation of the eye, in which the chief symptom is intolerance of light, 
the child using its hands to exclude the light as much as possible, or, if in bed, 
burying its head beneath the clothes. These cases require careful local and con- 
stitutional treatment, for which medical advice should be sought; but, wanting this, 
the little patient will be much relieved by having its eyes frequently bathed with 
cold water, and wearing a green shade over them. 

New-born children occasionally suffer from another disease of the eye, of which 
the chief symptom is a discharge of yellow fluid or pus from beneath the lids, which 
are apt to be glued together by the discharge drying on them. This is a very 
serious affection, since the sight of the eye may be utterly lost if it is neglected, and 
medical advice should, therefore, be obtained. In its absence the eye should be 
carefully washed out several times a day with warm water, and a lotion of alum, 
in the proportion of ten grains to an ounce of water, be thoroughly applied. In 
doing this the greatest care must be taken not to convey any of the yellow fluid into 
the eye of another person, since it is highly contagious, and will certainly lead to 
violent inflammation of any eye it may happen to touch. 

In washing a child's eye, the best plan is for one person to hold it firmly on its 
back, with its head secured between the knees of the nurse who is to wash it, and 
its body resting on the knees of the assistant Gently separating the eye-lids with 
the fore-finger and thumb, the nurse then lets the water or lotion trickle in between 
them from a small, clean, and soft sponge, then wipes the lids gently with the 
sponge, and repeats the operation on the opposite eye. When eye-drops have to 
be applied the same position should be adopted, and the drops may be conveniently 
extracted from the phial and inserted between the lids with an ordinary quill-pen, 
the nib of which has Ibeen rounded off. In making a shade for the eye, a piece 
of cardboard large enough to cover both eyes, and shaped out so as to fit the 
forehead, should be covered with green silk, and attached by a ribbon round the 
forehead. 

A Sty in the Eye is a little abscess formed at the edge of the eye-lid by the 
inflammation of one of the little follicles which lubricate its edge. It generally 
occurs in persons out of health, or in strumous children, and is apt to occur again 
and again until the health is improved. At the commencement of the disorder the 
part is sure to be swollen and red, and feels hot and uncomfortable to the patient ; 
then it begins to throb, and matter forms, as is shown by the yellow point in the 
centre of the "sty." When this is let out, or discharges itself, the inflammation 
subsides, and the lid gets well rapidly. In the early stage the only treatment is to 
bathe the eye frequently with hot water, and at night to put a bread-and-water 
poultice over it. When the matter forms it may be pricked and let out with a 
needle, if the patient will be steady enough to allow this to be done without danger 
to the eye, though there is a popular but unfounded prejudice that any interference 
with a sty leads to the formation of others. 

The formation of an abscess on the inner side of the eye, close to the nose, i* ft 



VARIOUS LOCAL AILMENTS. 725 



much more serious thing, as it involves the passage by which the tears reach the 
nose, and will require early and careful surgical treatment, or a very disfiguring scar 
may result. 

Whitlow is a very common affection, and one which, in its simpler forms, may 
be treated domestically without danger. The simplest kind of whitlow is that 
which forms about the root of the nail, and which may, or may not, depend upon 
some trifling injury, or upon the introduction of some irritating substance beneath 
the skin. At first the finger is found to be tender and hot, and soon a sense of 
throbbing is experienced in it. This is relieved by holding the inflamed part in hot 
water, and by poulticing ; but, in all probability, matter will form, and will be seen 
as a white fluid, either beneath the nail itself, or raising the skin around its root. The 
pain is now severe, owing to the matter being pent up, and immediate relief will be 
obtained as soon as it is evacuated. If beneath the nail, the best plan is to remove 
a small wedge-shaped piece ' of the nail with sharp-pointed scissors, so as to reach 
the point where the matter lies, and this can be generally effected without pain to 
the patient. If the skin around the nail is distended with the matter, it should be 
freely incised with a lancet or sharp and clean penknife, and this operation, though 
much dreaded by the patient, is absolutely painless, the skin having already lost its 
sensibility. 

The more severe forms of whitlow require prompt surgical attendance. In one, 
the end of the finger becomes violently inflamed and swollen, the mischief beginning 
in the membrane covering the bone. Then an early and free incision down to the 
bone is absolutely necessary, in order to save it from destruction ; but fortunately, 
even in neglected cases, it is seldom, if ever, necessary to perform amputation for 
this complaint, the surgeon being able to extract the piece of dead bone, and leave a 
very useful though somewhat shortened finger. In another and more severe form of 
whitlow, the matter forms in the finger and palm of the hand, both of which become 
immensely swollen ; and here a skilful incision is necessary, in order to evacuate 
the matter without damaging the important structures of the palm of the hand, or 
leading to stiffness of one or more of the fingers. In case the assistance of a 
surgeon cannot be obtained, it may be mentioned that the proper place to incise this 
form of whitlow is in the central line of a finger, and just at the point where it 
joins the hand. The incision should be not more than half an inch long, and should 
always be on the palmar surface, or under side of the finger. 

Abscesses may form in any part of the body, and are often only evidences of 
deeper-seated mischief, for which medical advice should be at once procured. In 
cases of disease of the spine, leading to projection of the bone, and what is commonly 
called " broken back," an abscess very commonly forms, without any special pain, in 
the upper part of the thigh, and the same kind of thing may be witnessed in other 
parts, the patient experiencing no pain, but having an elastic swelling, in which the 
peculiar and characteristic sensation due to the fluctuation of the contained fluid 
may be readily felt with the fingers. These chronic or cold abscesses should always 
be submitted to a medical man, as they may be of great importance, and their treat- 
ment requires skill and attention The more acute abscesses have much the same 
symptoms as whitlows, there being heat, redness, and tenderness of the part, followed 



T26 



DOMESTIC SURGERY. 



by a throbbing pain, and tension of the skin from the presence of matter within 
Poulticing and fomentations form the appropriate treatment, and, if pursued long 
enough, will no doubt lead to the breaking of the abscess and the relief of the 
patient. Many days will, however, be consumed in the process, during all which 
the patient will be worn out with pain and want of rest, whilst a momentary 
incision by a surgeon's skilful hand will give immediate and permanent relief. It is 
very mistaken kindness for the friends to abet a patient in refusing to submit to a 
moment's pain in order to obtain a cure ; and the patient is usually ready enough to 
express gratitude to those who have been " cruel only to be kind," the moment the 
relief is experienced. 

Milk Abscess is one of the most common forms of abscess, and is met with in 
mothers who either have been obliged to wean their child suddenly, or who suffer 
from " sore nipples," which incapacitate them from nursing. Sore or chapped 
nipples are more apt to arise after a first than after a subsequent confinement, and 
may be generally avoided by taking the precaution to harden the nipple by bathing 
it with weak brandy-and-water for a few days before the birth of the child. If the 
nipple is very much flattened, it should be drawn out with a breast-pump or glass, 
or a healthy child of a few months old may be put to the breast as soon as there is 
any milk. When the nipple has unfortunately become sore, the best plan is to 
protect it with a nipple-shield of glass, and to dry it thoroughly after being used. 
Almost any stimulating lotion will then effect a cure : borax, alum, or white vitriol, 
in solution, are all favourite remedies ; but perhaps the most successful is the appli- 
cation of a solution of nitrate of silver (two 
grains to the ounce of water) with a camel's- 
hair brush, three or four times during the day. 
When from any cause a mother is unable to 
nurse her child, the breast is apt to become 
gorged with milk, and unless this is got rid of, 
inflammation and abscess are pretty sure to 
follow. By the use of the breast-pump, or 
gentle and equable pressure with the hands, 
much relief can 6e afforded, and attention 
must then be directed to diminishing the flow 
of milk to the breast by rubbing it with warm 
sweet oil, or better, by smearing it with extract 
of belladonna mixed with equal parts of gly- 
cerine. At the same time the diet of the patient 
should be reduced, and a dose of Epsom salts 
given every morning. By these means a 




Vig. 29. 



milk-abscess 
larly 



may often be averted, particu- 



sling, 



if the breast is well supported in a 
arranged as follows: — A large hand- 
kerchief being folded so as to form a triangle, should be applied obliquely 
across the chest, with tLe straight part immediately below the breast, one end 
passing over the opposite shoulder^ and the other through the arm-pit of the 



VARIOUS LOCAL AILMENTS. ?2? 



same side, and the two being tied behind the back. The handkerchief being now 
slightly unfolded, can be made to support the breast comfortably at any height 
desired, and the top corner can be brought up over the shoulder, and fastened round 
the neck as shown in the illustration. But if an abscess unfortunately forms, as 
will be known by the occurrence of a shivering fit and the throbbing pain in the 
breast, the advice of a surgeon should be immediately sought, if it has not been 
before, in order that he may give relief by an early incision. The patient is often 
so much reduced by the pain she has undergone as to be unable to nerve herself to 
sustain this necessary operation, unless her friends are very firm in supporting the 
surgeon in doing his duty. A milk-abscess, like any other, may, as already 
mentioned, break under prolonged poulticing, but only at the expense of great 
suffering and very considerable permanent damage to the breast, owing to the 
matter burrowing in several directions. In some cases it may. be advisable to 
administer chloroform to the patient before interfering surgically, but the necessity 
and advisability of this must be left entirely to the medical man. 

Boils are very common, and very painful affections, and are usually found in 
persons who have got into a low state of health. A boil very generally begins in a 
little pimple, and if this is protected from irritation by being covered with a piece 
of soap-plaster, whilst the general health is improved by change of air and altered 
diet, very probably there will be no further trouble. If, however, a regular boil 
forms with a red surface and great tenderness, it had better be poulticed, and either 
allowed to break, or — a great saving of time and pain — a narrow knife or a sharp 
blade of a pair of slender scissors being pushed into the centre of it, and to the depth 
of half an inch, will allow the matter to escape with immediate relief. Prolonged 
poulticing of a boil is apt to bring out a crop of troublesome pimples around it, and 
it is well, therefore, to protect the surrounding parts with a piece of linen in which 
a hole is cut to fit the inflamed surface and allow of the poultice reaching it. 
When a boil has broken, it heals up readily enough under any simple dressing — 
either a little spermaceti ointment or a piece of wet lint under oil-silk. The 
nostrums vulgarly employed to " bring boils to a head " — such as soap and sugar, or 
the yellow basilicon ointment — are useless, and much better avoided, as they only 
serve to irritate the skin. 

Carbuncles are much more serious affections than boils, which, however, they 
much resemble, except in being larger, and therefore more dangerous to the patient. 
Carbuncles usually attack the nape of the neck, the back, &c, in old people, and as 
the most careful treatment of these affections is required from their very commence- 
ment, no time should be lost in consulting a medical man. 

Rupture or Hernia means the protrusion of a small portion of the bowels through 
an opening in the groin or at the navel. It occurs in children from violent efforts 
in crying, and in older persons from lifting heavy weights, coughing, &c. If a mother 
notices any swelling in the neighbourhood of the groin in her child (boys being much 
more liable than girls to this affection), she should lose no time in consulting a medical 
man, and ascertaining whether this is due to a rupture or to some other disease. In 
order to effect. \ cure of a rupture, it will be necessary for the child to wear a pro- 
perly-fitted c. .....-, for some months, and it will be well worth a mother's while to pay 



728 DOMESTIC SURGERY. 



every attention to this matter, so as to bring about a cure as soon as possible. It 
is not necessary that a truss should be worn at night, except in the case of an infant 
who cries as much at night as in the day, but the mother should see that the child, 
never runs about before the truss is put on in the morning, and must be particularly 
careful to see that the rupture is pushed back thoroughly before the truss is applied, 
which is most readily accomplished when the child is lying down. It is convenient 
in children to cover the truss with a linen cover, which can be changed when soiled, 
and the greatest care must be taken to prevent the instrument chafing the skin by 
powdering it thoroughly. In grown-up persons the occurrence of a hernia is of even 
more importance than in children, since it is more likely in them to become " strangu- 
lated," i.e., it cannot be pushed back by the patient himself ; obstruction of the bowels 
results, and this is followed by vomiting, and even by death, unless promptly relieved 
by the surgeon. In any case, therefore, where a rupture cannot be returned, or 
when after any exertion a lump has appeared in the groin, the advice of a surgeon 
should be sought. It unfortunately happens every now and then that a patient 
suffering from the bilious vomiting caused by a strangulated hernia conceals the 
real cause of the disease, either from ignorance of the connection between the two 
affections, or from a feeling of false delicacy. No one is justified in trifling with his 
or her own life in such a matter, and a medical man will rightly insist upon making 
the necessary examination if his suspicions are aroused by the symptoms, as they 
probably will be. When a surgeon finds that he is unable to return a rupture, 
it will be necessary for him to perform a slight operation in order to save the 
patient's life, and neither patient nor friends should have any scruple in consenting 
to this being done at once. Every minute is of importance in these cases, and though 
it is perfectly true that patients die after the operation for strangulated hernia, it is 
equally certain that they die in consequence of the operation having been delayed 
too long, rather than from the proceeding itself. 

Started Navel. — This is a not uncommon affection in young children, and if not 
properly attended to will lead to the formation of a rupture. The treatment consists 
in preventing the protrusion from taking place until the parts are in process of time 
restored to their natural condition, and this can only be effected by care and atten- 
tion on the part of the nurse and mother. The child being laid on its back, and the 
protrusion carefully returned with the finger, a pad made of a slice of a wine-cork 
half an inch thick, or a cent-piece, should be wrapped in a piece of soft linen and 
applied over the spot, and bound on firmly with strips of plaster half an inch wide. 
The strips of plaster (the common white strapping) should be about twelve inches 
long, and should be arranged star fashion ; they should be dipped in hot water in 
order to warm them, as they then stick much more firmly than if held to the fire. 
A roller of linen or fine flannel should be applied round the inf ant's navel over this. 
In cases of larger protrusion either in children or grown-up persons, a suitable 
abdominal support should be procured from an instrument maker, and should be 
worn with the same precautions as have been given for the use of a truss. 

Piles are often a very troublesome and painful affection, and are of various kinds, 
each of which requires a different treatment, for which a surgeon should be 
consulted. They are mentioned here principally in order to impress upon those who 



VARIOUS LOCAL AILMENTS. 729 



suffer from them and go on for years bearing pain, or even having their health 
undermined by constant loss of blood, that their disease is curable, and that they 
should not allow feelings of false delicacy to prevent their applying for relief. As 
a temporary means of relief, a sufferer may regulate the bowels with occasional 
doses of "lenitive electuary," and may employ an enema of cold water. Habitual 
sufferers from affections of the bowels frequently derive very great comfort from 
relieving the bowels at night rather than in the morning, so as to obtain some hours' 
rest in the horizontal position after an evacuation. 

Prolapse of the bowel in children should be gently returned after sponging with 
cold water. It may be simply the result of debility, or may be a symptom, in boys 
especially, of a much more serious affection — stone in the bladder — and the advice 
of a surgeon should therefore be obtained. 

Incontinence of Urine in Sleep is very common among weakly children, and is 
often the cause of great suffering to a child at school, when he is punished for 
what he is quite unable to help. Careful supervision will often effect a cure by 
avoiding too long intervals of unbroken sleep, and the use of a night-light will 
obviate the fear of rising in the night or early morning, which is often a cause of 
the disaster. As this affection may be only the evidence of more important 
diseases, it will be well to have medical advice if the occurrence appears to be 
becoming habitual. The opposite condition of things — retention of urine — is m uch • 
too serious an affection to be treated domestically, and immediate surgical attendance 
should be obtained for it, at whatever age it may occur. 



MATERIA MEDICA. 

INTRODUCTION. 

To that department of medical science which treats of the origin, preparation, 
and properties of drugs we apply the term "materia medica;" whilst by "thera- 
peutics " we mean a knowledge of the effects which follow their administration for 
the cure of disease. 

Medicines are obtained from many and various sources, all three kingdoms of 
nature being laid under contribution. Some, such as sulphur and lime, and the 
different salts of iron and mercury, are procured from the mineral kingdom ; others, 
such as aconite, and belladonna, and opium, from the vegetable kingdom ; whilst 
a few, such as cod-liver oil and cantharides, are furnished by animals. Minerals 
and plants are the chief sources from which we obtain our medicinal agents, a very 
small proportion of our modern drugs being of animal origin. We no longer us* 

4< Eye of newt and toe of frog, 
Wool of bat and tongue of dog, 
Adder's fork and blind worm's sting, 
Lizard's leg and owlet's wing " 

in the composition of our drugs, any more than we believe that snails eaten raw are 
a positive cure for consumption. 

Medicines are imported from all quarters of the globe, almost every country, 
civilised or uncivilised, furnishing some useful contribution to the healing art. 
Senna is obtained from India; opium from Asia Minor, Egypt, and Persia; jalap 
from Jalapa, in Mexico ; quassia from Jamaica ; bark from the cloudy slopes of the 
Andes ; and ipecacuanha from the Brazils ; whilst the animal which yields the musk 
is a native of the mountainous regions of Central Asia. Fortunately some of our 
most valuable and popular remedies are furnished by plants which grow at our very 
doors. Thus the well-known garden plant which, is called in this country monks- 
hood or wolfsbane, and in Ireland blue rocket, yields us aconite. Digitalis is 
obtained from the foxglove, whose long stately racemes of purple-coloured flowers 
are such familiar objects to many of us. The leaves of the thorn-apple or 
stramonium, when smoked in the form of cigarettes, have relieved the paroxysms of 
many a long-suffering asthmatic ; and the colchicum or meadow saffron has earned 
the gratitude of many a sufferer from gout. 

It is probable that every country spontaneously affords remedies for those diseases 
from which the inhabitants most frequently suffer, and that in the course of time 
many of our exotic drugs will be superseded by others which are growing, so to 
speak, under our very noses. It is now well known that our native willow yields 
us a product which, in the treatment of ague, is nearly equal in energy to the world- 
renowned quinine, and that, moreover, this tree flourishes vigorously in damp, 



732 MATERIA MEDICA. 



low-lying places, exactly where those diseases in the treatment of which it has 
proved beneficial are most common. Our marshes are overrun with different 
kinds of iris or flag, many of which should be valuable agents in the treatment 
of disease. A powerful emetic is yielded by a common species of buttercup, 
and the lilac, which, although not strictly a native, is found in every garden, 
gives us an extract which, were its properties investigated, would probably 
replace many an expensive product of foreign soil. There are few places in this land 
where plants having valuable medicinal properties cannot be found, often growing 
wild and uncared for, and frequently on waste lands where nothing else could be 
cultivated. 

AH parts of plants cannot be used indiscriminately as remedial agents. It often 
happens that the active principle is confined to one portion of a tree or shrub, the 
other part being absolutely or comparatively innocuous. A good example of this 
peculiarity is afforded by the Calabar bean or " chop-nut " of Western Africa, which 
for ages has been employed by the natives as a judicial test or state poison for 
the detection and punishment of the crime of witchcraft. The kernels of the bean 
contain a powerful poison, whilst the remainder of the plant, which in its general 
characters resembles our scarlet-runner, is absolutely inert, and may be eaten with 
impunity. We seldom find it advantageous in the preparation of our different 
medicinal infusions and tinctures to use the whole plant Sometimes we employ 
only the root, as in the case of ipecacuanha and gentian. Sometimes the leaves 
only are used, as in foxglove, monkshood, and senna. Occasionally we resort to the 
use of the wood — for example, the quassia wood, which is made into the little drink- 
ing vessels sold under the name of "bitter cups." In the case of nux vomica the 
active principle is yielded only by the tough horny seeds contained in the fruit, even 
the pulp in which they are imbedded being destitute of active properties. 

Some of our most useful drugs have been valued for their medicinal properties 
for many, many centuries. Carbon, in the form of wood charooal, must have been 
familiar to man from the most remote period of antiquity, and was probably known 
to the earliest inhabitants of the globe. Sulphur or brim £ tone was known in the 
time of Moses, and is mentioned in Genesis. The linseed or flax has been cultivated 
from the remotest ages, and its medical application, botl externally and internally, 
was well known in the time of Pliny. Many drugs nov in daily use are mentioned 
by name or described in the Bible. For example, i1 is usually supposed that the 
" wild vine " referred to in the Old Testament (2 Kings, iv. 39) was the plant which 
is known to us as colocynth. Its active purgative properties would fully justify the 
exclamation of the partakers of the pottage—" There is death in the pot ! " 

The spotted hemlock was the state poison of ancient Athens, and was used as the 
instrument of Socrates' death — a circumstance which conferred a distinction on the 
plant which time can never efface. Other drugs cannot boast of such antiquity 
Foxglove was apparently unknown till about the time of the Norman Conquest, 
although it seems strange that the ancients should have overlooked the valuable 
properties of a plant which is equally remarkable for its stately growth, its elegant 
flowers, and its powerful effects on the inimal economy. The broom was used in 
ancient Anglo-Saxon medicine, and tnde> he name of planta genista has not failed 



NEW DRUGS AND OLD DRUOB. 733 

to leave its mark on English history. Many valuable medicines, such as chloroform. 
the alkaloid quinine, and the now popular chloral, are productions of the present 
century. Almost every scientific discovery places in our hands new modes of treat- 
ment, and new methods of cure, some to supersede old remedies, some to be used for 
a time and then cast aside in favour of a more fortunate rival. Kecent discoveries 
in electricity have put us in possession of a powerful agent which is destined to 
occupy a prominent and a permanent place in our list of remedies. The battery and 
galvanic current have already proved an inestimable boon to many a helpless 
paralytic. 

Many drugs, such as rhubarb, senna, and quassia, require little or no preparation, 
for we have only to make an infusion, and they are ready for use. Others, such as 
morphia, chloral, and quinine, necessitate long and complicated chemical processes 
for their production. As a rule, only those drugs which are of vegetable origin are 
suitable for home preparation. Before collecting plants for medicinal use, it is 
necessary to acquire some knowledge of their botanical characters. The substitution 
of monkshood for horseradish root, for example, would be attended with disastrous 
consequences. A few hints may be given as to the time of gathering the plants, 
although this is a subject on which the collector's powers of observation and common 
sense will stand him in best need. In the first place, the leaves or other parts of 
the plant should be dry ; no one would think of collecting them if wet with rain or 
dew. They should, if possible, be obtained annually, and not kept indefinitely from 
year to year. Herbs and leaves should be gathered after the flowers have bloomed, 
and before the seeds are matured. Roots should be dug up in autumn, after the old 
leaves and stalks have fallen, and before the appearance of the new ones. Barks are 
advantageously procured in the spring, that being the season in which they are most 
easily separated from the wood. The plants when collected should be spread out on 
trays or shallow wicker baskets, and exposed to a gentle heat with a current of air, 
so that the moisture may be driven off, and they may dry. Finally, the most delicate 
parts, such as the leaves and flowers, should be placed in corked or stoppered bottles, 
and the remainder of the plant should be preserved in such a manner as to ensure 
its freedom from contamination by dirt or damp. 

We must now refer briefly to the mode of preparation of the different infusions 
and decoctions. Infusions are as a rule prepared by pouring boiling water over the 
drug, the time of infusing varying according to the solubility of the active 
ingredients — for example, if we wish to make an infusion of chamomile, or, in other 
words, chamomile tea, we take an ounce of the flowers and pour on them a pint of 
boiling water, and after letting it stand for a quarter of an hour, we strain it, 
when it is ready for use. In h, similar manner we can prepare an infusion of fox- 
glove, by steeping a drachm of the dried leaves in boiling water for an hour. There 
is no mystery in the process, the whole proceeding being every bit as simple as 
making tea. Some infusions contain more than one ingredient, and are then said to 
be compound — for example; the compound infusion of orange-peel is made by 
infusing together orange-peel, lemon-peel, and cloves. 

Decoctions are made by boiling the drug in water, a process which is admissible 
only in the case of medicines whose properties are not destroyed by so high a 



734 MATERIA MEDICA. 



temperature. To prepare a decoction of dandelion, for instance, we take an ounce 
of the sliced and bruised root, and boil it for ten minutes with a pint of water, and 
then strain it, adding at the same time a little more water to replace that which has 
been lost by evaporation. 

Infusions and decoctions must be prepared fresh, as they soon decompose on 
being exposed to light or air. 

Tinctures have the great advantage over watery solutions that they may be kept 
for an indefinite time without materially deteriorating, the spirit with which they 
are made serving to preserve them. They are most advantageously prepared on a 
large scale, the process involving a considerable expenditure both of time and 
trouble. 

Just as we use both simple and compound decoctions and infusions, so we in the 
treatment of disease sometimes use drags singly and sometimes combine together 
a number of them so as to constitute what we call a mixture. The activity of a 
drug is oftp-n greatly increased by giving, in combination with it, another drug 
having a similar action. Our ordinary " black draught " contains both senna and 
Epsom salts, and there can be but little doubt that the mixture acts more quickly 
and energetically, and causes less inconvenience, than would the same doses of the 
medicines given separately. At the same time it must be acknowledged that the 
practice of mixing together a large number of drugs is often carried to excess. In 
an old, and at one time very popular, remedy, known as Venice treacle, there were 
as many as sixty-five ingredients — enough to stock a chemist's shop. We can 
hardly suppose that each one of these sixty-five drugs produced a separate and 
distinct action upon the system. Now-a-days we seldom give more than two or 
three active drugs in our medicines, finding by experience that, to say the least, the 
patient's chances of recovery are not in proportion to the number of drugs he takes. 
Our mixtures usually contain flavouring agents, such as peppermint, or cinnamon, 
or syrup of oranges or lemons, which are used to disguise the taste of the other and 
more disagreeable ingredients. The mixture would be just as efficacious, though 
less palatable, without them. When the medicine consists of only a single drug 
mixed with water the taste is usually so slight that we need resort to no artificial 
means to disguise it 

It is obviously a matter of great importance that preparations of drugs should 
always be made in exactly the same way, and of a uniform and constant strength, 
for if such were not the case endless confusion would arise respecting the dose, and 
the quantities which should be administered in different diseases. To facilitate this 
object a work known as the " U.S. Dispensatory" is published, containing a list 
of medicines and their compounds, with the manner in which they are prepared. 
This work describes in detail the method of making the different infusions, 
tinctures, &c, and is extremely useful in affording those engaged in the preparatioL 
of medicines a uniform standard by which they can ascertain the composition of 
those substances. Medicines, and their preparations, which are mentioned in the 
u Pharmacopoeia" are said to be "officinal," all others being "unofncinal." The majority 
of drugs in common use are " officinal," but there are many possessing valuable 
properties which are not in the list of the "Pharmacopoeia." We are of course in no 



THE BRITISH PHARMACOPEIA, 



735 



way restricted to the use of the officinal drugs. A medical man would no more 
hesitate to use a drug because it was not mentioned in the " Pharmacopoeia," than he 
would refuse to visit a patient because his name did ttot happen to be in the " Elite 
Directory." 

We have already referred so frequently to the benefits resulting from the 
administration of drugs that it may appear almost superfluous to consider in detail 
a question which is often asked us, " Do we believe in medicines 1 " All we can say 
is that we believe as firmly in the beneficial effects resulting from a judicious 
administration of drugs as we do in the stability of the earth itsel£ The one rests 
upon as sure a foundation as the other. Unfortunately there is a good deal of 
scepticism respecting the action of drugs. There are few people, we trust, who 
would seriously maintain that medicines are absolutely powerless. A few doses of 
rastor oil would probably demonstrate the futility of their arguments. It must be 
/emembered that there are drugs so powerful, and poisons so subtle, that a single 
particle, hardly distinguishable by the naked eye, would, when introduced into the 
system, produce such effects as to endanger a strong man's life. For examples of 
the curative powers of medicines we need not seek far. The power of sulphur over 
the itch, the influence of bark or quinine on ague, and the almost instantaneous 
relief of pain by opium or morphia, are instances sufficiently familiar to any one of 
us who has much experience of- sickness and suffering. When we cannot cure we 
may often relieve. The indescribable agony of that terrible disease known as 
angina pectoris, or " breast pang," may usually be rapidly assuaged by the inhalation 
of a few whiffs of nitrite of amyL Fits, when treated by a perfectly harmless salt, 
bromide of potassium, gradually become less frequent, and less severe, until the 
sufferer is often enabled to return to the active duties of this life, and is to all 
intents and purposes cured. These are justly regarded as triumphs of medicine, and 
are ranked amongst her proudest achievements. Other examples of successful 
treatment are afforded by the benefit experienced from the administration of aconite 
in quinsy, of quinine or phosphorus in neuralgia, and ipecacuanha in winter cough 
and some forms of vomiting. 

Medicines may be classified, or collected into groups, according to the action 
which they excite upon the system, and certain terms are applied to these drugs to 
express the nature of this influence. 

Thus, laxatives are drugs which act moderately in relieving the bowels. 
Examples familiar to all of us are afforded by figs, prunes, tamarinds, sulphur, and 
castor oil. 

Pwrgatives are drugs which, in effecting the same object, act more energetically. 
Aloes, jalap, rhubarb, and senna belong to this group. Macbeth, it will be 
remembered, refers to the last two as purgatives, curiously enough in the very 
passage in which he says, "Throw physic to the dogs, I'll none of it" 

Emetics are drugs which are employed for relieving the stomach of its contents by 
exciting vomiting. They are of inestimable value in cases of poisoning, and have 
saved many and many a life by expelling the deleterious substance before it has 
been absorbed and has had time to exert its baneful influence on the system. 
Mustard and salt-and- water are most frequently used for this purpose, for they are 



TSfc MATERIA MEDICA 

always at liand in cases of emergency. When a choice is afforded in the matter 
ipecacuanha wine and white vitriol (sulphate of zinc) are, perhaps, preferable, 
but, at the same time, we have no intention of speaking disrespectfully of our 
household remedies, which have so often done good service. 

Bitters are drugs which, by acting upon the stomach, improve the appetite and 
aid the powers of digestion. Gentian, calumba, and quassia are used for this 
purpose, as are also hops, taken either as a medicine or in the more agreeable form 
of bitter beer. 

Tonics are drugs which brace up and give increased tone to the system. The 
best known and the most frequently employed are the different preparations of iron, 
bark, and quinine ; but there are many others of which we shall speak subsequently. 

Expectorants are medicines, such as carbonate of ammonia, squills, ipecacuanha, 
gad tar, which loosen the phlegm and ease the chest in cases of bronchitis and 
coughs. 

Narcotics or opiates are remedies which induce sleep, many of them having at 
the same time the power of relieving pain. The most prominent member of this 
group is, of course, opium, which has been called the " gift of God " to man, a title 
which, though poetical, is in the truest and highest sense of the word equally 
applicable to every plant that grows. Chloral must be reckoned among the narcotics, 
whilst lettuce and hops have long been known to possess sleep-producing powers. 
The custom of eating lettuce at bed-time and sleeping on a pillow of hops, for the 
purpose of obtaining a sound night's rest, is an old one, and one extensively resorted 
to in many parts of the country. 

Then, again, we have drugs whose energies are wholly devoted to one object, 
which are seldom used except for the accomplishment of this object. For example, 
we have medicines which have the power of destroying and expelling worms and 
other parasites which sometimes find their way into and develop within our bodies. 
The oil of male fern, the pomegranate root, and santcnica, a plant closely resembling 
and allied to common wormwood, belong to this class. There are other groups of 
drugs to which we shall refer as we have occasion to use them. 

There are many circumstances which modify the action of drugs upon the system. 
Foremost amongst these is the influence of habit. Habitual topers, as every one 
knows, are enabled to drink immense quantities of alcohol, in the form of wine, 
beer, and spirits, without exhibiting any of the ordinary appearances of intoxica- 
tion. A man who is accustomed to the use of the " weed " will smoke without the 
production of any unpleasant consequences a number of cigars or pipes which 
would quickly reduce a novice in the art to a state of prostration. The effects of 
habit in diminishing the powers of opium on the system are truly wonderful, a 
confirmed opium eater taking at a single dose, for the sake of its exhilarating 
influence, a quantity which would quickly prove fatal to a dozen ordinary people. 
Another example is afforded by the arsenic eaters of Styria. In that country there 
prevails amongst the peasants an extraordinary custom of eating arsenic, which is 
consumed by the men to improve the breathing and enable them to perform feats 
of strength, and by the women to give plumpness to the figure and beauty and 
freshness to the complexion. The quantity of arsenic taken by those beginning the 



INFLUENCE OP HABIT ON ACTION OP MEDICINES. 737 

practice is very small, but the dose is gradually and cautiously increased until the 
patient becomes accustomed to it. It is probable that if the attempt were made in 
this country, death would ensue before the requisite tolerance could be established. 

In many long-standing diseases which are kept in check by treatment it is found 
advantageous to occasionally abstain from taking the medicine. Many people suffering 
from fits derive considerable benefit from bromide of potassium, but after a certain 
time it is often found that the drug, by constant repetition, loses its effect. If now 
it be discontinued for a day or two and then resumed, its original power over the 
disease will be regained, and the patient will once more be in possession of a remedy for 
his complaint. Many people who habitually take medicine find it advantageous to 
abstain from so doing on one day in the week — to have a day of rest in this respect 
as in others. 

In connection with the subject of habit we may refer to certain peculiarities 
occasionally noticed with respect to the action of medicines. Every one must have 
met with people who, whilst able to digest beef and mutton easily, cannot eat even a 
morsel of the most tender chicken without suffering from indigestion. Just as there 
are people who are " upset " by chicken or eggs, or other ordinary article of diet, so 
there are people to whom the administration of the smallest dose of certain medicines 
would be followed by a general derangement of the system. Most of us could take 
four or five grains of a salt known as iodide of potassium without feeling any effects 
from it, but yet there are people in whom the very minutest dose would in the course 
of a few minutes give rise to all the symptoms of a very bad cold in the head. In 
some people the dust arising from ipecacuanha root, or even the smell of the drug, 
will bring on a severe asthmatic attack, whilst in others a similar effect is produced 
by the odour of roses, pinks, the privet, or even of a cat or dog. 

We have already seen that drugs differ greatly in their activity ; and from this 
it follows that some medicines must be given in smaller doses than others. No one 
requiring a purgative would think of taking the same dose of calomel as he would of 
Epsom salts. Many drugs which, in smaller or moderate doses, would act bene- 
ficially, would in large doses prove to be poisonous. In fact, startling as it might at 
first sight appear, there is no real difference between a poison and a medicine ; for a 
substance which in a large dose is a deadly poison, may be — and usually is — in a 
small dose a most valuable remedy ; and on the other hand, as we have already 
seen, a medicine given in too large a quantity or too frequently may cause 
symptoms of poisoning. For example, if we took thirty grains of arsenic it would 
in all probability speedily prove fatal ; but if we took the thirtieth part of a grain of 
the same substance we might, if suffering from certain diseases in which it is useful, 
derive considerable benefit from it. A large number of our most powerful and 
energetic poisons — such as monkshood, foxglove, and strychnia — have been pressed 
into the service of the healing art, and are ranked amongst our most valuable 
medicines. No general rules can be laid down respecting the doses of medicines, 
but a reference to the list of prescriptions will solve any difficulties which may 
be experienced on this point. 

It must always be remembered that children require smaller doses of medicines 
han adults — the younger the patient, the smaller the dose. It should also be 
47 



738 MATERIA MEDICA. 



borne in mind that some medicines — especially opium and its preparations, laudanum, 
paregoric, &c. — act very deleteriously on children, and often prove fatal in extremely 
small quantities. There can be no doubt that hundreds and hundreds of children 
are killed annually by patent medicines containing opium and other narcotics. On 
the other hand, calomel, grey powder, and other preparations of mercury, are usually 
well borne by young people. 

It is difficult to lay down any absolute rule for determining the relative doses to 
be given at different ages. As a rule, the dose should be increased in quantity from 
birth to the prime of life ; it reaches its maximum about fifty, and then gradually 
declines as age advances. The following table may prove of assistance in determining 
the dose to be administered : — 

Taking the dose for an adult as unity, 

A patient under 1 year of age would require from ^ to ^ of this 



M 


2 years 


» 


J 


» 


3 „ 


n 


* 


f» 


4 „ 


>» 


* 


» 


7 „ 


w 


ft 


» 


14 „ 


M 


i 


w 


20 „ 


n 


§ 


» 


from 20 to 50 


»» 


the full dose, or 1. 



It is not worth while trying to remember these figures, for there is a very simple 
rule by which the proportion may be found with sufficient exactness for all practical 
purposes. For children under twelve, the adult doses of most medicines must be 
administered in the proportion of the age to the age increased by twelve ; or, in 
other words, divide the child's age by the same number, plus twelve, and the required 
proportion will be obtained. For example, what proportion of the full dose must be 
given to a child four years old 1 

Child's age . . .4 

Add 12 to child's age . 16 — proportion \. 

The adult dose of bromide of potassium is about sixteen grains, and consequently 
we should give a child four years old only a quarter of this, or four grains. 

We must now speak of the different methods of measuring medicines. Formerly 
the apothecaries' or troy weight was exclusively used in pharmacy, and the ounce 
•ontained 480 grains. Now the avoirdupois weight is used. 

Weights. 

1 grain, gr — 1 grain. 

1 ounce, oz. or 3J — 437f grains. 

1 pound, lb. . . . — 16 ounces — 7,000 grains. 

It will be seen that there is no intermediate weight between a grain and an ounce. 
Nevertheless, when the term drachm (3j.) and scruple (9j.) are used in prescribing 
solid drugs, the former is to be regarded as equivalent to sixty grains, and the latter 
to twenty grains. Our weights and measures, it must be admitted, are somewhat 

complicated. 



WEIGHTS AND MEASURES. 739 



The fluid measures are as follows : — 



1 minim, TTtj- • 
1 fluid drachm, 3j. 
1 fluid ounce, Jj. 
1 pint, Oj. 
1 gallon, Cj. . 



- 1 

■=60 minims. 
e= 8 fluid drachms. 
« 16 fluid ounces. 
■» 8 pints. 



All fluids are measured, and never weighed. It is hardly necessary to say that in 
prescriptions it is seldom requisite to use the weights or measures above an ounce. 

For weighing solids a little pair of scales should be procured and reserved exclu- 
sively for medicines. It matters very little about their form so long as they are 
trustworthy. They should be kept clean, and on no account be allowed to get rusty. 
The dots on the small weights indicate the number of grains which they represent, 
whilst the symbols 3j-, 5j-> ana * 9j-> niean respectively, an ounce, drachm (60 grains), 
and scruple (20 grains). The symbols §ss, 5 SS > mean half an ounce and half a 
drachm. The double s is a contraction of semi, a half. 

For the measurement of fluids we use two glass graduated vessels, one for small 
doses and the other for large, the former known as a minim measure and the latter 
as an ounce measure. They may be obtained from a chemist for a very small 
price. The minim is approximately equal to a drop, bat drops vary very much in 
size, according to the shape of the glass or bottle from which they are poured. 

When the graduated glasses are not at hand we must have recourse to our 
ordinary domestic measures. 

A tea- spoonful is approximately equal to 1 fluid drachm. 



A dessert-spoonful 


i* 


ii 


2 ii » 


A table-spoonful 


ii 


ii 


* » » 


A wine-glassful 


i* 


ii 


from 1| to 2 fluid ounces. 


A tea-cupful 


i» 


n 


5 >i i* 


A breakfast-cupful 


ii 


n 


8 n ii 


A tumblerful 


ii 


ii 


from 10 to 12 „ „ 



There is a growing tendency on the part of the silversmiths to increase the size 
of our spoons. Some of our modern tea-spoons, for instance, hold nearly two 
drachms. 

There are several different ways in which medicines may be administered. The 
most usual method is, of course, to swallow it, and introduce it into the system through 
the medium of the stomach. Sometimes, however, medicines cannot be retained, 
and are rejected by vomiting almost as soon as they are taken. In such cases the 
medicine is often administeied by the bowel, in the form of an enema, or injection. 
Again, the medicine may be made into an ointment, and rubbed into the body 
through the medium of the skin. Occasionally the nozzle of a very small and 
delicate syringe, called a hypodermic syringe, is pushed under the skin of the arm 
or leg, and the medicine is then injected. These hypodermic or subcutaneous 
injections cause hardly any pain, and afford in many cases a very convenient mode 
of giving a remedy. The drug acts very quickly, the stomach is not upset, and by 
this means, moreover, a medicine can be given when a person is insensible or too 
ill to swallow, Hypodermic injections of morphia are frequently given for the 



740 MATERIA MEDICA. 



relief of pain, but they should never be resorted to unless under the advice and 
direction of a medical man. There are other methods of using medicines, as in the 
form of inhalations, or smoked as cigarettes ; but we shall refer to these as we have 
occasion to prescribe them. 

We will now proceed to speak of the medicine chest. The form which one 
adopts is a matter of the most perfect indifference. For our own part we do not 
see the necessity for a medicine chest at all, unless, perhaps, when one is travelling. 
The drugs may very well be allowed to stand on the shelf of a cupboard, or may 
be kept in any little cabinet, always, of course, under lock and key, and no one but 
a responsible person should have access to them. They should be kept dry, and 
should not be placed near any powerfully-smelling substance. Drugs are delicate 
things, and have to be treated with a certain amount of care. Of course the bottles 
must never be left uncorked, or the contents will speedily spoil. In dispensing 
medicines, when too much is poured out, it is safer to throw away the excess, and 
not to return it to the bottle. Every effort must be made to ensure freedom from 
admixture and contamination. 

What drugs should one get to begin with 1 It is impossible to lay down any 
very definite rules upon this point. It will depend a good deal upon your know- 
ledge, upon your distance from medical aid, and more particularly upon the probable 
nature of your cases. If you have ever used any particular drug, or seen it used, 
with success, get it by all means, and begin with that. Do not get more drugs than 
you want ; but when you do get a medicine, make yourself thoroughly acquainted 
with its action and mode of administration. The following are all very useful 
drugs, and you cannot go far wrong if you begin with them. 

Sulphate of Zinc. Tincture of Iron. 

Gallic Acid. Tincture of Quinine. 

Compound Rhubarb Pilli. Tincture of Aconite. 

Sal Volatile. Tincture of Belladonna. 

Essence of Camphor. Tincture of Opium (Laudanum). 

Bromide of Potassium. Ipecacuanha Wine. 

In sulphate of zinc and ipecacuanha you have emetics ; gallic acid is astringent* 
and stops bleeding ; sal volatile is useful in fainting, essence of camphor in choleraic 
diarrhoea, bromide of potassium in fits'; quinine is a tonic; iron cures anaemia, or 
bloodlessness ; aconite subdues inflammation ; and opium allays pain of all kinds. 
These drugs, with the exception of the essence of camphor, are officinal, and can be 
obtained from any chemist by simply giving the name. Should the essence of 
camphor not be kept in stock it will be sufficient to ask for Rubini's camphor, or to 
say that it is a saturated solution of camphor in rectified spirit. 

It is of no use laying in a big stock of drugs ; a couple of ounces of each of 
the liquids will last you a long time, except, perhaps, the tincture of quinine, of 
which you had better get a larger quantity. And what will they cost ? Yery 
little ; for a dollar or two you can get enough drugs to doctor a whole village, or to 
last you your lifetime. The quinine is the only one which is at all expensive. 
You should see that your bottles are all distinctly labelled, and the camphor, 
belladonna, aconite, and opium had better have in addition another label indicating 



ACIDS. 741 



that they are " poison." Of course, in small doses they may be given with perfect 
safety, but it is better to indicate that they cannot be taken ad libitum. As in 
cases of poisoning the sulphate of zinc is usually required without a moment's delay, 
it is better to weigh out an emetic dose (gr. xx.), and keep it wrapped in the form of 
a powder in case of emergency. 



ACIDS. 

There are several substances used in medicine for the sake of their sour or acid 
properties. Foremost amongst these are sulphuric acid (oil of vitriol), nitric acid 
(aqua for tis), and hydrochloric, or muriatic, acid (spirit of salt), all of which, 
though in a concentrated state powerful poisons, form, when largely diluted with 
water, valuable remedial agents. In the same category may be placed acetic, citric, 
and tartaric acids. Acidulated drinks are very acceptable to patients suffering from 
fever, and may be advantageously given to moisten the dry and parched mouth, and 
quench the intolerable thirst. A pleasant beverage may be made by boiling a couple 
of ounces of powdered cascarilla bark in a pint of water, and when cold adding 
twenty or thirty drops of either dilute nitric or hydrochloric acid. The degree 
of acidity may be regulated according to the taste of the patient, but the quantity 
we have indicated is generally sufficient. 

Hydrochloric acid is one of the constituents of gastric juice, and is often employed 
to assist digestion when there is a defective secretion of that fluid. Habitual 
sufferers from dyspepsia may obtain benefit from the gentian and acid mixture 
(Pr. 15). 

In ordinary cases of indigestion, the mixture should always be taken from ten 
minutes to a quarter of an hour after food, but if the complaint be accompanied by 
waterbrash, i.e., by the regurgitation of a sour-tasting fluid into the mouth, the 
medicine must be given the same time before meals. Attention to this point 
is of importance, for in cases of acidity of the stomach, taking an acid mixture 
after the meal would be but adding fuel to the flame, whilst the use of the same 
medicine before food would prove beneficial by arresting the secretion of the 
acid. 

Vinegar is sometimes taken surreptitiously in large quantities for the purpose of 
reducing obesity. It may possibly reduce the stoutness, but it will do so at the 
expense of serious injury to the health, and the practice is one which cannot 
be too strongly condemned. 

All our acids are astringent, as shown by the roughness produced in the 
mouth after swallowing any of the acid mixtures. A practical application of 
this property is afforded by the use of sulphuric and other acids in the treat- 
ment of diarrhoea. 

Choleraic Diarrhoea, so prevalent among us in summer, is treated advantageously 
with sulphuric acid in combination with laudanum and chloric ether (Pr. 28)-. 
The dilute sulphuric acid, which forms one of the constituents of this mixture, 
k made by cautiously adding one part of sulphuric acid to twelve parts of water. 



742 MATERIA MEDICA. 



Two table-spoonfuls should be taken every four hours until relief is obtained. 
A more elegant mixture may be made by adding rather less acid, and substituting 
acid infusion of roses for water. As this mixture contains laudanum, or tincture of 
opium, it must not be given to children. It is used in nearly all our city hospitals, 
hundreds of gallons being given away annually for the relief of diarrhoea. In 
many manufactories and large business houses, it is customary during the summer 
months, and particularly at times when sporadic cholera is prevalent, to place a 
bottle of this " diarrhoea medicine " in some convenient place to which the employes 
can have constant access. The practice is undoubtedly a good one, and does much 
to reduce the mortality from summer diarrhoea. The diarrhoea mixture is becoming 
with us quite an institution. 

Acids by reason of their astringent action are useful in bleeding from the stomach 
and lungs, or other parts of the body. A dose of any dilute acid or acid mixture 
may be used for this purpose. 

The profuse night sweating so frequently an accompaniment of that dire disease, 
consumption, may often be mitigated by sponging the body with any dilute acid 
solution, such as aromatic vinegar. The great objection to this practice is that it 
necessitates exposure of the patient, who thereby runs a certain risk of catching 
cold, with its attendant dangers. 

Citric acid is a crystalline body prepared from lemon-juice, or from the juice 
of the fruit of the lime. It is contained in grapes, tamarinds, gooseberries, red 
currants, and many other fruits. A solution prepared by dissolving thirty-four 
grains in two table-spoonfuls of water, closely resembles lemon-juice, and becomes 
mouldy on keeping. It enters with bicarbonate of potash into the formation of many 
of the purgative effervescing medicines now so commonly sold under different fancy 
titles. An effervescing mixture may be made by mixing in water fifteen grains of 
citric acid, or two and a half tea-spoonfuls of fresh lemon-juice, with twenty-nine 
grains of bicarbonate of potash. * 

ACONITE. 

This drug, one of our most active vegetable poisons, is yielded by the common 
monk's-hood, wolf's-bane, or blue rocket, the Aconitum napellus of the botanists. The 
plant grows wild in many parts of Europe, and is in this country so generally 
cultivated for ornamental purposes, that it is to be met with in almost every 
cottager's garden. It is familiar enough to every one resident in the country — at all 
events, by sight if not by name. It usually attains a height of from two to three 
feet, and its simple unbranched stem is covered with leaves, which are divided into 
five wedge-shape pieces, and are dark green on the upper surface, but paler below. 
The flowers which blow in May or June are of a beautiful blue or violet colour, and 
at the extremity of the stem are arranged in a long cylindrical spike. There are 
several varieties of monk's-hood, but those with blue flowers are alone used in 
medicine. % 

Its deleterious effects were well known to the ancients, who regarded it as the 
most virulent of all poisons, and attributed its origin to Hecate, who, they declared, 
caused it to spring from the foam of the many-headed dog, Cerberus. Aconite is 



ACONITE. 



743 



■aid to have been the principal ingredient in the poisonous cups mixed by Medea 
for Theseus, which ^Egeus, his own father, was to have administered. It was the 
poison employed in the island of Ceos to execute the barbarous law which condemned 
to death all who were no longer useful 
to the State, or were too feeble to defend 
themselves. Descending to more modern 
times, it will be remembered by those 
interested in the annals of crime that tinc- 
ture of aconite was the agent employed by 
Dr. Pritchard for the murder of his wife 
and mother-in-law, at Glasgow, in 1865. 

All parts of the plant are poisonous, 
but the root is especially noxious, and when 
the leaves have fallen it appears to possess 
its greatest virulence. On chewing a very 
small portion, of either the root or leaves, 
a sensation of numbness will, after a few 
minutes, be experienced in the lips and 
tongue, and will continue for some hours. 

Poisoning by the root of aconite is, unfortunately, by no means unfrequent. It 
has been eaten, on several occasions, in mistake for horse-radish root, and death has 
usually ensued. Only a few months ago several people died from eating aconite 
with their roast beef instead of the ordinary horse-radish. In one instance the 
unfortunate victim stated before his death that he was confident that the quantity 
he had taken was not greater than would go on the point of a table-knife. The 
characters presented by the two roots, aconite and horse-radish, are so essentially 
different that there should be no difficulty in distinguishing between them. It is 
probable, however, that most of the accidents have occurred more from want of 
thought than from want of knowledge. The following table will show at a glance 
the essential differential characters of the two plants : — 




Fig. 1. — ACONITE EOOT, LEAF, AND FLOWER. 



To Distinguish Aconite 
Aconite. 

1. Shape. — Conical, tapers rapidly to a point, 
and gives off a number of fine fibres. 

2. Colour Coffee coloured or brown on the 

outside. 

3. Smell.— Earthy. 

4. Taste. — At first bitter, but afterwards pro- 
ducing tingling or numbness. 



Root from Horse-radish. 

Horse-radish. 

1. Shape. — Slightly conical at the crown, then 
cylindrical, or nearly so, and almost of the 
same thickness for many inches. 

2. Colour. — White, or with a yellowish tinge, 
on the outside. 

3. Smell. — Pungent and irritating, especially 
on scraping. 

4. Taste. — May he hitter or sweet, hut is very 
pungent. 



The symptoms produced by eating aconite root are very striking. In one case 
where a small portion was eaten with the beef at dinner, they made their appearance 
in about three-quarters of an hour. The man first complained of burning and numb- 
ness of the lips, mouth, and throat, which soon extended to the stomach, and apparently 



744 MATERIA MEDICA. 



caused violent v and constant vomiting. The limbs were cold, but the chest warm, 
and the head was covered with perspiration. The mental faculties were not 
disturbed, and the patient complained of violent pain in the head, and trembled all 
over. Though exceedingly weak, there was never at any time paralysis. In spite 
of all treatment death ensued in about four hours from the meal 

The preparation of aconite most commonly used is the tincture, an over-dose of 
which produces symptoms similar to those already described. What is known as 
Flemming's Tincture of Aconite is a very powerful preparation, and as it is as 
deadly in its operation as prussic acid, it should never be used except by a 
medical man. In 1852 an excise officer lost his life by merely tasting it, under 
the supposition that it was flavoured spirit. He was able to walk from the Custom 
House over London Bridge, but died in about four hours after taking the 
poison. 

What to do in poisoning from Aconite, or Monk's-hood. — 1. Send for a doctor. 
2. Give the emetic draught (Pr. 27), or a tea-spoonful of mustard in a little hot 
water, and do all you possibly can to induce vomiting. 3. Give brandy and sal 
volatile. 

There are few drugs in our materia medica of more value than aconite. On it 
we place implicit reliance in the treatment of nearly all complaints accompanied by 
a feverish condition. In what we call acute diseases it is simply invaluable. 

In the first place, we will speak of it as an external application. In tic or 
neuralgia of the brow or face it often proves of the greatest use, relieving the 
distressing pain either permanently or, at all events, temporarily. As the relief 
afforded by aconite is usually speedy, it should always be tried at once, so that if it 
should prove unsuccessful, recourse may be had without delay to some other 
mode of treatment. It should be used in the form of the neuralgia liniment 
(Pr. 86). 

If applied to the painful part it will, after an interval, produce numbness and 
tingling of the skin, Care should be taken not to rub the application into 
wounds or cracks in the skin, and not to allow it to run into the eyes or 
mouth. 

The application of this liniment is of great service in sick headache, particularly 
when the attack is accompanied or followed by tenderness in the painful region. 
Not only is the pain eased, but the distressing sickness is usually relieved. 

A liquid sold as an external application, under the name " neuraline," has been 
analysed, and is said to consist of tincture of aconite mixed with chloroform and rose- 
water. It has been found to contain about a drop and a half of Flemming's tincture 
of aconite in each bottle. Considerable caution should be employed in using a 
preparation of this kind. It is unwise to use patent medicines in any form unless 
their composition is distinctly stated on the bottle. 

"We must now consider the uses of aconite when administered internally. Of 
course, when we deal with powerf u- medicines such as this, we give only small doses, 
but administer them frequently. Pr. 38 contains a drop of the tincture in each tea- 
spoonful, and may be used with perfect safety. 

The dose of this is, for an adult a tea-spoonful, and for a child, one-third of that 



ACONITE. 



745 



quantity. It must be given every ten minutes for the first hour, and subsequently 
hourly. The tincture of aconite here referred to is that of the "U.S. Dispensatory," 
which is of the strength of two and a half ounces to the pint. The mixture will 
not keep longer than a day or two. 

Aconite is highly esteemed for its power, which is almost marvellous, of control- 
ling inflammation and cutting short the accompanying fever. It is in the early stage 
of inflammation that it is so conspicuously serviceable. The medicine should be 
given as soon as possible, every hour lost being of value. For this reason tincture 
of aconite should always be kept in the house, of course under lock and key. There 
is necessarily a certain amount of delay involved in having to send to a chemist, and 
that delay may make all the difference between success and failure. 

The efficacy of the drug depends largely on the mode in which it is employed. 
For the first hour or two hours half a tea-spoonful of the mixture is to be given 
every ten minutes or a quarter of an hour, and after that a tea-spoonful is to be given 
every two hours. For children or even with adults in whom there is much prostra- 
tion a still smaller dose may be given. It is advisable to give the medicine on an 
empty stomach, so that it may be the more readily absorbed. It should always be 
given alone, and never mixed with any other drug. 

In quinsy or tonsillitis aconite should always be employed, and in the manner we 
have indicated. If commenced in the earliest stage, when the chill is still on the 
patient, the dry, hot, and burning skin becomes in a few hours comfortably moist, 
and in a little while later is usually covered with perspiration. "With the moistening 
of the skin comes speedy relief from many of the accompanying distressing 
symptoms, such as restlessness, chilliness, and pains and stiffness in the limbs, and 
at the same time the pulse is reduced in frequency, and the fever subsides. If you 
can catch a quinsy or sore throat just at the very beginning you can nearly alwa\s 
cut it short by aconite in from twenty-four to forty-eight hours. When you are 
afraid that you are going to have one of your bad sore throats get out your aconite 
bottle, for it is your only chance of arresting its progress. 

Aconite is equally serviceable in " a bad cold all over" when there is chilliness, 
aching of the limbs, a hot dry skin, and quick pulse. 

In the more severe forms of inflammation, such as pleurisy and inflammation of 
the lungs, the effects of this valuable drug, though not so rapid, are equally 
manifest. 

It is not to be supposed that aconite has the power of curing such diseases as 
scarlet fever and measles, but it nevertheless exerts a beneficial influence in these 
complaints, by inducing free perspiration, soothing the nervous system, and procuring 
sleep. Moreover, it has the power of subduing the inflammatory affections which 
often accompany these complaints, and by their intensity endanger life. It will 
moderate the severity of the sore throat in scarlet fever, and of the bronchitis in 



Aconite often does good in rheumatic fever. Sometimes, though not always, it 
shortens the duration of the disease. It is often of service in subduing the swelling 
and pain of the inflamed joints. 

In a sharp attack of gout a similar mode of treatment is useful. 



746 MATERIA MEDICA. 



Again, aconite is of marked service in erysipelas. When given at the very com- 
mencement it often at once cuts short the attack, and even when the result is less 
fortunate it will reduce the swelling and hardness, lessen the redness, and prevent 
the inflammation from spreading. 

Frequently in children, and occasionally in adults, the arm, some days after 
vaccination has been performed, becomes hot, red, tender, and swollen. The 
inflammation may continue for weeks, and may run down the arm, and even involve 
a portion of the chest This condition is usually quickly arrested by the aconite 
mixture, and even when it persists the redness is rendered less intense, and the 
swelling less hard and painful. 

In fine, aconite should be administered in the manner we have indicated in all 
cases in which the patient is feverish. 

ALKALIES. 

Alkalies are substances which, in their chemical properties, are diametrically 
opposed to acids. In this group we shall have to consider several salts which are in 
common use as medicines. Carbonate of potash and bicarbonate of potash, and the 
corresponding compounds of soda, are more or less familiar to us all 

Carbonate of potash, or salts of tartar, as it used to be ©ailed, was known in the 
earliest times, and was prepared from the ashes of vine twigs. The Arabs are 
generally supposed to have been the first to make this salt, but it is probable that 
the idea, if not the custom, was borrowed by them from the Hindoos. From whom 
the Hindoos derived their information we are not prepared to say. Nowadays 
potash, in an impure form, is made by burning plants, in countries such as North 
America, Russia, Sweden, and Poland, where forests are most abundant. The ashes 
so obtained are treated with water and lime, the resulting solution when evaporated 
in iron pots constituting what is known as " black salt." This product, when fused 
and cast into cakes, constitutes the " potashes " of commerce, whilst " pearlash " is 
made by transferring the " black salt " from the pots to a large oven-shaped furnace, 
where the flame is allowed to play over it and burn off the black impurities. The 
carbonate of potash used in medicine is formed by washing pearlash with its own 
weight of water, pouring off the clear solution, and evaporating it to dryness. 
It is a white crystalline powder, of a caustic taste, and readily soluble in water, 
the solution effervescing or sparkling freely on the addition of any acid, such as a 
spoonful of lemon-juice. 

The bicarbonate of potash contains more carbonic acid in its composition, and is 
made by passing a stream of carbonic acid gas into a solution of the carbonate. 

Potash, or caustic potash, is made by boiling in a clear iron or silver vessel a 
solution of carbonate of potash with quick lime. When intended for use as a caustic 
the potash is cast into little pencils or sticks, which are conveniently carried in a 
caustic case. 

Carbonate of soda, or natron, the common washing soda, is obtained in large 
quantities from sea-salt This is first mixed with pounded coal and chalk, and then 
heated in a reverberatory furnace. The crude mass so obtained is next treated with 
water, and the solution evaporated until the carbonate of soda crystallises out 



ALUM. 747 

Bicarbonate of soda is made on a large scale by moistening carbonate of soda, 
and exposing it, spread on cloths, to the action of carbonic acid gas. 

The alkalies have several valuable therapeutical applications. In many forms of 
indigestion they, like the acids, are of great service. The member of this group 
most generally resorted to in these cases is the bicarbonate of soda, which should 
be taken in fifteen-grain doses. Alkalies given to increase the formation of the 
gastric fluid, and thereby to promote digestion, must be taken a short time before 
meals, for if given after food they will neutralise the acid of the gastric juice and 
effectually retard and impede digestion. When, however, the indigestion lakes the 
form of heartburn and acid eructations, it may be concluded that the troubles are 
due to an excessive formation of acid, which will be neutralised, and the symptoms 
removed, by taking the alkali soon after the meal. 

The gentian and soda mixture (Pr. 14), is a most valuable remedy for 
indigestion. Two table-spoonfuls should be taken, either before or after meals, 
in accordance with the directions here given. 

An alkaline lotion (Pr. 90) often proves serviceable in allaying the itching of 
nettle-rash and other skin diseases. It should be applied to the skin several times a 
day with a small piece of sponge. Occasionally it will be found to irritate the skin, 
an indication that it is too strong. The addition of a little water will remove this 
difficulty. 



ALUM. 

In the preparation of alum, finely divided clay, which has been recently roasted, 
is mixed with half its weight of oil of vitriol, and heated for three or four days. 
The alum is then dissolved out of the mass, and, after being freed from iron and 
other impurities, is ready for use. 

It forms transparent, white, regular eight-sided crystals, which, by slowly evapo- 
rating a concentrated solution, may be made to attain a large size. A group of 
octahedral crystals of alum usually forms one of the stock show specimens of the 
chemist's window. The taste of alum is acid, sweetish, and somewhat astringent. 
When strongly heated it fuses, and the water of crystallisation being driven off, 
forms a light, spongy mass ; which is known as dried alum. 

Alum is a powerful styptic, and as such is commonly employed to stop bleeding. 
It has this great advantage over other substances used for a similar purpose, that it 
is always at hand, there being few households in which alum is not to be found. To 
check the bleeding from piles, leech bites, or slight cuts, the part should be first wiped 
dry, and then dusted over with powdered alum. Bleeding from the gums may be 
checked by dissolving alum in cold water, and then holding it in the mouth until 
it has had time to exert its astringent action. Bleeding from tlie nose is often 
quickly arrested by using powdered alum as a snuff. In bleeding from the stomach 
or lungs alum is also useful. In these cases there is usually no time to weigh ^at 
or measure the salt. A spoonful may be thrown into a glass of water, and the 
liquid tossed off as soon as any of the alum has been dissolved. 

Another example of the application of the astringent properties of alum ? m 



748 MATERIA MEDICA, 



afforded by its use in relaxed sore throats. The alum gargle (Pr. 81) should be 

ased at least three or four times daily. 

Dried alum applied several times a day will quickly heal ulcers of the gums 
occurring in children. 

Alum has long been highly esteemed as a remedy for whooping cough. It is 
useful only in uncomplicated cases — in cases, that is, in which the patient is not 
feverish, and in which there is no chest mischief, and no irritation as the result of 
teething. In cases of this description it rapidly reduces the number and severity of 
the fits, and in a few days effects a cura Alum also proves extremely useful in the 
spasmodic cough that often remains after the disappearance of whooping cough. 
For children alum should be dissolved in a little water, and given in six-grain doses 
every three hours, or a smaller dose may be given more frequently. The addition 
of a little simple syrup to the mixture serves to make it more palatable. 

In ozcena or "stink nose" irrigating or washing out the nose with a lotion 
made by dissolving a tea-spoonful of alum in a pint of water often proves extremely 
useful. 

The ordinary dose of alum for an adult is from ten to twenty grains. In larger 
doses it acts as a purgative. The dried alum is for external use only. 



ALOES. 

There are several varieties of aloes, of whicli the most valued are the Barbadoes 
and Socotrine. The plant yielding Socotrine aloes is a native of the Cape of Good 
Hope and of the Island of Socotora ; but it is now commonly cultivated in the 
West Indies. It has, when fully grown, a stem three or four feet high, usually 
terminating in a cluster of leaves, each of which, some foot or more in length, is 
shaped like a sword, sharply pointed at the apex, and coarsely jagged at the 
margins. The flowers are red, tipped with green, and are borne in clusters on 
long stalks, which rise erect from among the leaves. The plant yielding the 
Barbadoes aloes has yellow flowers, arranged in an elegant loose spike. These 
plants are very readily cultivated artificially, and being incapable of parting rapidly 
with water, flourish well in pots filled with lime rubbish mixed with a little 
ordinary soil. They will thrive in any ordinary greenhouse the temperature of 
which in winter can be kept constantly at or above 40°. In summer no artificial 
heat is required, but they must be abundantly supplied with water, although in 
winter, when not in a state of activity, they do better without any. Specimens 
are frequently brought to London from the West Indies by sailors, who, for 
convenience of transport, cut off the top of the stem, tying tightly over it a tarred 
cloth, to prevent the escape of the juices. If suspended by a cord from the ceiling 
of a room, these plants, even when so mutilated, will continue to live for years, 
throwing out after a time a fresh crop of leaves. 

There are several processes adopted for preparing the drug, differing, 
however, only in detail. Usually the leaves are cut off near their bases, and 
thrown with their severed ends downwards into a tub or bucket, when the juice 
which they contain rapidly exudes. ♦ 



ARNICA. 749 



When a sufficient quantity has been collected it is allowed to evaporate in the 
Bun until it becomes consistent, when it is poured into the gourds in which it is 
imported. 

Barbadoes aloes as ordinarily met with in the shops occurs in yellowish-brown 
or dark brown opaque masses, having a bitter nauseous taste, and a strong, 
heavy, disagreeable odour. The smell of Socotrine aloes is fruity and far less 
disagreeable. 

Aloes is employed chiefly for its purgative properties, its effects being exerted 
mainly on the lower bowel. It produces bulky motions, a little softened, but not 
watery. Its action is slow, and six, twelve, or even twenty-four hours may elapse 
before it operates. There are several forms in which it may be conveniently 
administered, the compound decoction of aloes — or " baume de vie," balm of life, as 
it is sometimes called — being as good as any. It is composed of Socotrine aloes, 
myrrh, saffron, extract of liquorice, compound tincture of cardamoms, carbonate of 
potash, and water, and is given in three or four table-spoonful doses. Aloes is well 
suited for cases of habitual costiveness, for constant use does not lessen its activity, 
and sometimes even the dose may be gradually decreased. Pr. 64 is a very excellent 
pill for cases of chronic constipation. 

The extract of aloes is a constituent of the " dinner pill " (Pr. 65), so frequently 
taken by people preparatory to over-gorging themselves. An old gentleman is 
going to a big City dinner, and knowing that he is incapable of resisting the 
temptation to eat and drink more than is good for him, and that he will assuredly 
suffer for it the next morning, he takes time by the forelock, and treats liis 
complaint before acquiring it. The pill may even enable him to eat another plate 
of turtle, or dispose of an extra glass or two of hock or madeira. 

Aloes in combination with iron is often used in cases in which the periods have 
from any cause been suppressed. The " aloes and iron pill" is an officinal prepara- 
tion, and may be obtained from any chemist. It should be taken three times a day 
for a week before the time of the expected period. 



ARNICA 

Arnica [Arnica montana) is a plant somewhat resembling jthe common marigold, 
and growing abundantly in the northern parts of Europe. Its use is almost 
universal as an external application to bruises and swellings, resulting from blows, 
falls, or other forms of mechanical violence. It appears to exert a special or specific 
influence on the muscles. It is often administered internally in these cases. Many 
kinds of muscular pain arising from over-exertion in those who are unaccustomed to 
severe or prolonged physical exercise may be relieved by this drug. A common 
example of this pain is the " stitch in the side," resulting from prolonged walking or 
running. Many of these comparatively trivial complaints have a natural tendency 
to get well, but still in severe cases it will be found advantageous to resort to the 
use of arnica. 

In the preparation of the tincture, sometimes the whole plant is employed, and 



750 MATERIA MEDICA, 



sometimes only the root. It is made with rectified spirit, and is of the strength of 
one part in twenty. 

The mi x ture (Pr. 42) and lotion (Pr. 94) may be employed simultaneously. 

ARSENIC. 

The substance to which we ordinarily apply the term arsenic, or white arsenic, is 
in reality a combination of the metal with oxygen, and is known to the chemists as 
arsenious acid. It is prepared in Cornwall by roasting arsenical iron pyrites. It is 
a heavy white powder, very slightly soluble in water, or in any of the ordinary 
beverages. It is almost tasteless, for it has been frequently administered in all 
descriptions of food in fatal doses without being detected by the victim. 

Arsenic, as is well known, is a powerful irritant poison, and on account of its 
freedom from colour and taste has long been a favourite with both murderers and 
suicides. It is stated, on good authority, that in India alone hundreds of people die 
annually from the secret administration of this substance. Fortunately, it is now 
far less readily procurable in this country than formerly. By a wise regulation it 
is provided that no arsenic shall be sold retail without being previously mixed with 
either soot or indigo, so that its presence in food may be readily detected. The 
prescriptions of medical men are by a special clause exempted from the restrictions 
imposed by this extremely salutary act. 

The most convenient form in which to administer arsenic for medicinal purposes 
— and arsenic is largely employed in the treatment of disease — is in the form of the 
arsenical, or, as it is sometimes called, Fowler's solution. This consists essentially 
of a solution of arsenious acid in carbonate of potash, coloured and flavoured with 
lavender. 

The symptoms produced by large doses of arsenic are very severe. The person 
soon after taking the poison experiences a feeling of faintness and depression, 
followed by sickness and an intense burning pain in the stomach. Vomiting is soon 
associated with purging, both being violent and incessant, and affording no relief. 
There is constant straining, and the evacuations are mixed with blood. There is a 
sense of constriction with a dry burning heat in the throat, accompanied by the 
most intense and agonising thirst, which nothing relieves. The skin is sometimes 
pungently hot, and at others cold and clammy. The patient is in excruciating pain, 
which is described as being like a fire raging within the body. There are severe 
cramps in the calves of the legs, and the breath is drawn with difficulty on account 
of the painful condition of the stomach. A state of insensibility usually supervenes, 
and the scene closes with paralysis, or death is ushered in by convulsions. The 
picture is a most horrible and painful one. 

Curiously enough, very large doses of arsenic have been occasionally taken with- 
out causing death. A man wishing to commit suicide bought and swallowed two 
ounces of arsenic. The quantity was so large that it was immediately rejected, and 
the patient recovered with but little treatment. 

What to do in Arsenic Poisoning. — 1. Send for a doctor. 2. Send to a chemist 
for " moist peroxide of iron, for arsenic poisoning" or make it by adding ammonia or 



ARSENIC. 751 



sal volatile to tincture of steel, and collecting the deposit. Give as much of it as the 
patient can be made to swallow. 3. If the patient has not vomited, shake up a tea- 
spoonful of sulphate of zinc in hot water, and give it in two doses, or induce vomiting 
by draughts of hot water, hot mustarcl-and-water, salt-and- water, or in any other 
way. The emetic draught (Pr. 27) may be used for this purpose. 

In cases of slow poisoning by arsenic, the symptoms are much less pronounced. 
In addition to some of those already mentioned, there are usually inflammation of 
the eyes with an inability to bear the light, an eruption on the skin, and general 
debility and exhaustion. 

There are many different ways in which arsenic may be introduced into the 
system. For instance, " emerald green," which is a compound of arsenic and copper, 
is usually found in children's paint-boxes, and is frequently used to colour sweets, 
and spread over confectionery. It is very largely used for making the various kinds 
of decorative papers which adorn the walls of our bedrooms and sitting-rooms. So 
extensively are these papers used that one London manufacturer alone, according to 
his own statement, at one time used never less than two tons of arsenic weekly. 
There is not the slightest doubt that living or sleeping in a room covered with 
arsenical paper produces upon many people the most pernicious effects. Even the 
workmen who hang these papers or remove them from the walls suffer from slow 
arsenic poisoning. Arsenic has been frequently detected in the dust on books, 
picture frames, and the furniture in rooms so papered. In Germany, the manu- 
facture, sale, or use of these dangerous preparations was long ago prohibited 
under heavy penalties. Many cases of chronic illness or ill-health have been 
traced to the previously unsuspected presence of arsenic in the wall-paper. The 
symptoms produced usually resemble those of a very bad cold. There are commonly 
dryness and irritation of the throat, smarting of the eyes, shortness of breath, languor, 
headache, loss of appetite, colicky pains, and irritability of the bowels. When the 
majority of these symptoms have been long present, and have resisted all ordinary 
treatment, it would be well to turn one's attention to the paper covering the 
walls of the room. The results of the investigation may prove negative, 
but still it is a point not to be neglected. It may seem a trifle, but a little 
thing like this may make all the difference between ill-health and good health, 
between misery and comfort. 

We must now pass on to the consideration of the subject of arsenic eating. 
A f tar our statement that arsenic is a powerful irritant poison, the necessity for any 
audi consideration may naturally excite surprise. In some parts of Lower Austria, 
however, in Styria, and especially in the hilly country towards Hungary, there 
prevails extensively amongst the country people an extraordinary custom of arsenic 
eating. The statement has been often affirmed, and as frequently denied, but the 
whole subject has been recently investigated by competent and trustworthy observers, 
and there can be now no question as to the correctness of the facts. The practice 
of eating arsenic, it appears, is of considerable antiquity. By many it is used daily 
through a long life, and the custom frequently becomes hereditary, and is handed 
down from father to son. The drug, we can hardly in these cases say poison, is 
known by the name of hidri, and is sold to the people by itinerant pedlars, and 



752 MATERIA MEDICA. 



herbalists. It is consumed chiefly for two purposes, by the women to increase their 
charms, and by the men to improve their " wind," and enable them to climb the 
steep mountains without difficulty. It is said to give plumpness to the figure, 
clearness and softness to the skin, and beauty and freshness to the complexion. 
Fortunately there is no need for American women to take arsenic with this 
object. These young female arsenic eaters are described as being remarkable for 
their clear and blooming complexions, for full plump figures, and for a general 
appearance of health. Their temporary charms are, however, dearly purchased, for 
they frequently fall victims to their vanity, and die a painful death. The effect on 
the men is equally surprising. It not only makes them handsome, but considerably 
increases their physical strength. A small piece of arsenic is put in the mouth and 
allowed to dissolve very slowly. The effect is astonishing, the partaker feels at 
once invigorated, and easily and rapidly ascends mountains which he could not 
otherwise surmount without the greatest difficulty and distress of breathing. 
People in this country exhibit no inclination to climb mountains after taking a 
dose of arsenic. 

The directions for arsenic eating are simple, but they are only applicable to 
Styrians. The quantity of arsenic taken by those who are beginning the practice 
varies with the age, sex, and condition, but never exceeds half a grain. The dose 
is taken on alternate days, in the morning before breakfast, until the patient 
becomes accustomed to it. The dose is cautiously increased as that previously taken 
loses its effects. No unpleasant symptoms are produced, it is said, if care is taken 
in the regulation of the dose. But if, after a time, from want of material, or other 
cause, the habit be discontinued, considerable distress is experienced, so that a return 
to the practice is necessitated. The habit never amounts to a passion like that 
of opium eating, and is not an intense pleasure which cannot be resisted, but 
nevertheless, when once acquired it is seldom abandoned. 

It is well known that arsenic is frequently given to horses to improve the 
sleekness and condition of their coats. The custom is very prevalent in many 
parts of the Continent. A pinch is either sprinkled amongst the oats, or a piece 
the size of a pea is wrapped in linen, and tied to the bit before being put in the 
horse's mouth. It is stated that the practice may be continued for years without 
producing any injurious effect, but if the animal unfortunately comes under the care 
of one who is unacquainted with his arsenic proclivities, and fails to give him his daily 
quantum, he soon becomes low-spirited, and visibly declines in health and strength. 

Arsenic made into a paste with starch or flour is frequently used for the 
destruction of large warts, and the removal of cancers and twmours of all kinds. 
The advertising " cancer curers," who profess to remove malignant tumours 
" without the use of the knife or caustic," usually employ arsenical paste for that 
purpose. It is a perfectly safe remedy in the hands of an experienced surgeon, 
but becomes a very dangerous weapon when entrusted to those who are ignorant 
of its properties and mode of manipulation. Many people have fallen victims to 
this treatment through the absorption of the arsenic into the system in quantities 
sufficiently large to destroy life. An untoward result such as this can occur only 
jwhen certain well-known precautions are neglected. 



ARSENIC. 753 



Internally arsenic is best given in the form of the arsenic mixture (Pr. 40), the 
dose being a tea-spoonful every three or four hours. 

Of course in the treatment of disease arsenic is given only in very small doses, 
and not the slightest fear or hesitation need be felt in using it in the manner 
here indicated. Each tea-spoonful of the above mixture contains about -j-^th part 
of a grain, but this dose is, in most diseases, capable of effecting all that is possible 
by the use of arsenic 

This mixture should, as a rule, be given after meals* as when axlministered 
upon an empty stomach it is apt to induce nausea and irritate the bowels. 
Children above the age of five will take almost as large a dose of this medicine 
as adults. Itching or smarting of the eyes and puffiness of the lower eyelid are 
to be regarded as an indication that the dose is greater than is required, and it 
should be decreased, though it need not be discontinued, 

Arsenic enjoys a high reputation in the treatment of ague, and should 
always be used when bark or quinine is not obtainable, or in cases in which they 
have been employed unsuccessfully. Arsenic has been used for ages by the 
Chinese in the treatment of this complaint. It was the active ingredient in a 
once popular quack medicine known as the " tasteless ague drop." 

Arsenic is an excellent remedy in many diseases of the lungs. It frequently 
proves useful in asthma, a circumstance which we naturally associate with its 
use by the Styrians to improve the breathing. It often gives relief to people 
who, on catching the slightest cold, are troubled with wheezing at the chest and 
difficulty of breathing, especially on exertion or at night, so that they have to be 
partially propped up in bed. It is especially indicated in these cases when there 
is an eruption on the skin, or when a skin disease has been recently cured. It 
proves least successful in these cases when they are associated with the expectoration 
of large quantities of phlegm. 

There are many people who are seized every day, or even several times a day, 
with an attack of persistent sneezing, accompanied by profuse running from the 
eyes and nose, and sometimes accompanied by severe pain over the forehead. The 
sneezing is generally attended with itching of the nose, which may be confined to a 
small spot just inside the nostrils. Each attack may last for several hours, and the 
patient may have been subject to the complaint for years. Again, every one knows 
people who are extremely liable to colds, and who when attacked suffer from severe 
and repeated fits of sneezing, accompanied by pain across the forehead, and a profuse 
watery discharge from the nostrils. Very frequently the cold spreads down into the 
chest, and the unfortunate sufferer has, in addition to his previous troubles, to com- 
plain of a sore throat, wheezing, and shortness of breath. In all these cases tea- 
spoonful doses of the arsenic mixture, given every hour, will prove useful. The 
attacks of sneezing, wheezing of the chest, and general embarrassment of breathing 
to which children who have recently recovered from bronchitis are often subject, are 
relieved by arsenic. The mixture should be given hourly in from ten to twenty 
drops every hour, according to age. This mixture proves also very useful in hay 
fever. 

Arsenic is frequently used in certain disorders of the stomach and digestive 
48 



754 MATERIA MEDICA. 



apparatus. In ulcer and cancer of the stomach it often proves successful in allaying 
the pain and checking the vomiting when every other remedy has proved useless. 
In that form of vomiting in which after almost every meal the food rises or regur- 
gitates into the mouth and is vomited without pain, and with hardly any feeling of 
sickness, the arsenic mixture should be used. Tea-spoonful doses of this mixture, 
taken shortly before meals, will almost infallibly arrest the distressing vomiting 
of drunkards and others who indulge too freely in spirituous liquors. This form of 
vomiting is accompanied by great straining and distress, and usually occurs the first 
thing in the morning before breakfast. Generally very little, and sometimes nothing 
at all, is rejected, and then it is called " dry vomiting." The vomited matter is 
intensely bitter and sour, and of a green colour. "We have indicated arsenic as a 
remedy for this condition, but a far more certain cure is afforded by the discontinuance 
of the habit on which it depends. 

Arsenic always proves of service in that form of indigestion which is characterised 
by the following symptoms : — There is a nasty sinking in the pit of the stomach, which 
is promptly relieved by food, but immediately on eating anything the unfortunate 
sufferer is seized with an urgent desire to relieve the bowels, and is obliged to leave 
the table and his unfinished meaL This is repeated over and over again, the patient 
being reduced to a condition in comparison with which the sufferings of Tantalus 
must have been happiness itself. By a few days' use of the arsenic mixture, the 
interval between the meal and the evacuation becomes prolonged, and usually in 
about ten days the complaint is cured. One or two tea- spoonfuls of the mixture 
should be given shortly before each meaL 

The arsenic mixture often proves useful in other obstinate forms of diarrhoea, 
and has been used with considerable success in cholera. 

In many diseases of nervous origin arsenic proves of considerable value. In 
St. Vitus' s dance especially, we may rely with confidence upon this remedy. It proves 
most successful in simple uncomplicated cases. Of course, should there be any fever, 
this must be subdued by appropriate remedies, or should the patient be anaemic, the 
condition of the blood should be improved by iron in the manner already indicated. 
These complications being removed, the use of arsenic may be resorted to with con- 
fidence. Should the ordinary one or two tea-spoonful doses of the mixture not effect 
a cure, the quantity may, in this disease, be increased, even in children, to a table- 
spoonful every four hours. 

The smaller doses often prove extremely useful in neuralgia. 

Arsenic is used largely in the treatment of many skin diseases, more especially 
the scaly forms. The first effect of the arsenic is occasionally to increase the 
severity of the disease — a fact which should be borne in mind, or it may be 
discontinued just as it is beginning to do good. 



BARK AND QUININE, 

Cinchona bark, the bark par excellence, is the plant from which we obtain our 
quinine. Many stories are told of the mode in which its properties were first dis- 
covered. By some it is said that an Indian was cured of an ague by drinking at a 



BARK AND QUININE. 



755 



pool into which some cinchona trees had fallen. It may be so, although it is unfor- 
tunate that these trees never by any chance grow on the borders of lakes or ponds. 
By others it is related that the Indians observed that the American lions, when ill 
with ague, eat the cin- 
chona bark We are only 
surprised that these ani- 
mals should not have 
extracted the active prin- 
ciple, instead of using the 
drug in its crude state. 
Another story is that the 
Jesuits had noticed the 
extreme bitterness of the 
bark, and being of an 
enterprising disposition, 
had, with a self-denial 
which cannot be too highly 
commended, administered 
it without the slightest 
fear or hesitation to a 
brother of another order 
who happened to be ill 
The treatment proved suc- 
cessful, and they received 
the credit which they so 
richly deserved. It would 
appear that bark was first 
introduced into En rope 
about the year 1632. It 
is usually stated that 
we are indebted to the 
Countess of Chinchon for 
the importation, and the 
drug from that circum- 
stance acquired the name 
of " Cinchona bark," or 
" Countess's powder." As 
there appears to be some 

doubt as to which Countess of Chinchon is referred to, we take this oppor- 
tunity of stating that the lady in question was the wife of Count Chinchon, 
Don Geroninio Fernandez de Cabrera Bobadella J. Mendoza. After this ex- 
planation we proceed with the history of the drug. About ten years later it 
was carried by the Jesuits to Borne, and by them distributed among the mem- 
bers of their order, by whom it was taken to their respective stations, and 
used with great success in the treatment of agues. One of the most active in 




Pig. 2.<— CHINCHONA CALISATA. 



756 MATERIA MEDICA. 



promoting its employment was Cardinal de Lugo, and in this way it acquired 
the names of "Jesuits' bark" or "Jesuits' powder," and " Pulvis Cardinal de 
Lugo." In time, however, it, like many another drug, fell into disuse, and its 
very existence appears to have been forgotten by most people. But not by every 
one, for a few years later Sir Robert Talbot acquired a great reputation for 
the cure of ague by a secret remedy, which when purchased for a large sum by 
Louis XI Y. turned out to be nothing more than our old friend the cinchona bark. 
From this time forth the drug was known in France as " Talbot's powder " or the 
" English remedy." 

The genus yielding the bark has been divided into a large number of different 
species, twenty-one being enumerated by one botanist alone. Innumerable books, 
memoirs, and pamphlets have been written about these different species without any 
one being a bit the wiser. It is now generally admitted, however, that there are 
three chief kinds of bark — the yellow, the pale, and the red. The different species 
of cinchona are natives of the Andes, growing chiefly on the eastern face of the 
Cordilleras. The .cinchonas have been acclimatised in India, and of late years its 
cultivation has been so immensely extended that British India bids fair to compete 
at no distant period with Central and South America as a source of quinine. The 
cinchonas themselves seldom form an entire forest, but are collected into more or 
less compact groups, distributed in different parts of it, and sometimes even they 
grow separately. The characteristics of these forests are of a tropical nature. 
Palms are nearly always abundant, and in many parts form their chief feature. 
In addition, there are tree ferns, gigantic climbers, bamboos, plaintains, and other 
plants. 

The men who cut the cinchona trees in the forest, and others who are employed 
in the same trade, are known as cascarilleros. They gather the bark all the year 
round except during the rainy season, which corresponds with our winter, when the 
process must be suspended on account of the physical obstacles to its continuance. 
A great deal of skill and practice is required on the part of the cascarillero to 
detect the presence of the cinchona trees in the dense forests. If the position be 
favourable the tops of the trees first attract his notice, a slight mevement peculiar ^ 
the leaves of certain species, or a particular colour of the ftxiage, enabling him to 
distinguish the object of which he is in search from a distance of many miles. Very 
frequently the dry leaves found on the ground are sufficient to indicate the direction 
in which the search should be prosecuted. In order to strip the tree of its bark, it 
is felled by being cut through with a hatchet a little above the root. The bark is 
previously removed from this part, so that nothing may be lost ; and as at the base 
of the tree the bark is thickest, and therefore most profitable, it is customary to 
remove the earth from around the trunk, so that the barking may be more complete. 
The tree seldom falls at once when cut through, for it is sustained either by climbing 
plants or by the adjacent trees. When at length the tree is down, and the useless 
branches have been cut off, the outer coat is removed by striking it with a mallet, 
and the inner bark so exposed is often further cleaned by a brush. The bark is then 
divided by regular incisions circumscribing the pieces which are to be removed, and 
these are separated from the trunk with a knife, the point of which is carried as 



BARK AND QUININE. 



757 



closely as possible to the sulj^^ wgo& ILa ainiensions and regularity of the 
pieces necessarily depend more or less on the position in which the tree has fallen 
and other circumstances, but generally, for the convenience of transport, they are 
made from fifteen to eighteen inches long and four or five inches wide. The bark is 
usually dried in the sun, and is in some cases submitted to pressure to induce it to 
retain its shape and prevent it from curling up into quills. 

Quinine is prepared from cinchona on a large scale, the different barks yielding 




Fig, 8.— OOIXECTOTG CIHCE03A BABE. 



from three to ten per cent. It is met with in beautiful, silky, snow-white crystals, 
having a pure intensely bitter taste. It is but slightly soluble in water, but soon 
dissolves on the addition of a few drops of acid. It is the chief alkaloid or active 
principle contained in bark, the use of which it has to some extent superseded. The 
smallness of the dose required is a great advantage, a grain or a grain and a half being 
equal to a drachm of the bark. 

When very large doses of bark or quinine are administered, a condition is 
induced which is known as " cinchonism " or " quinism." The symptoms to which 
collectively this term is applied are headache, noises in the ears, deafness, flashes 
of light before the eyes, confusion of sight, giddiness, and sometimes even slight 



758 MATERIA MEDICA, 



delirium. Usually the headache is dull, heavy, and stupefying, but when a dose 
of twenty-five or thirty grains has been given, it is often agonising. Fortunately 
these symptoms are of short duration, and usually all pass off in a few hours. 
Some people are very susceptible to the action of quinine, and in them a compara- 
tively small dose may produce the above symptoms. These unpleasant effects need 
not lead to the abandonment of the drug, a reduction in the quantity or in the 
frequency of administration being all that is requisite. 

Bark has been long known to us as a most powerful and valuable tonic, and it 
may be administered with confidence in that large class of cases to which we apply 
the general term debility. It is useful when there is want of tone, as indicated by a 
general feeling of weakness, an incapacity for exertion, impaired appetite, and dys- 
peptic symptoms. In fact, when people are over-worked, bothered, and feel regularly 
out of sorts, they cannot do better medicinally than take bark or quinine. 

Then, again, bark is useful for people who have been pulled down by a long, 
painful illness, who have been knocked " clean off their legs" and "can't pick up 
again." It is often given as a preparation for, or after surgical operations. It is 
common enough to hear medical men say, " We'll give you a little ammonia and bark, 
and that'll soon put you all right again," and nine times out of ten it proves success- 
ful. The ammonia and bark mixture (Pr. 13) is a powerful tonic, and may be 
employed with confidence. 

It is not a veiy nice mixture, perhaps, to look at, but as it is intended to take, 
and not to be looked at, this is a matter of very little consequence. It may be 
objected even that it is not very nice to take, but even taste is quite a matter of 
opinion, and any man with the slightest imagination can persuade himself that 
it is very nice indeed, if he will only remember that it will do him good. It is not 
at all a bad plan to take it in half a glassful of port wine. It is often said that this 
is spoiling two good things, but you can but follow it by a dose of each separately if 
you do not like <;he combination. Do not imagine that any wine is good enough for 
medicine. You cannot make a greater mistake. Take the best bottle of wine in 
your cellar — do not hesitate, it will do you good. 

The tonic quinine mixture (Pr. 9) is an excellent restorative. We call it the 
" tonic " quinine mixture, because, as we shall presently see, we use a stronger 
quinine mixture — not as a tonic, but in the treatment of certain diseases, such as 
blood poisoning. As we have already seen, quinine dissolves veiy slightly in water, 
and the acid is consequently added to make a clear solution. Would not the quinine 
dc any good if taken in the insoluble form 1 Yes, it would answer just as well, for 
the gastric juice secreted by the stomach is, as you know, acid, and this would very 
soon dissolve up the quinine. Then, after all, there is not much good in the acid 1 
Well, perhaps there is not, it is more a matter of convenience, and for the sake of 
appearance, than anything else. 

Then, again, in ague quinine is a specific — a positive cure. The treatment of 
ague by quinine has already been fully discussed (see Ague), the best mode of 
administration, the time, and the dose in which it should be given, <fec. 

There is a very nasty form of neuralgia known as " brow ague." People who 
have had ague, perhaps years before, sometimes suffer from this when they get out 



BELLADONNA. 759 

of health. It is neuralgia of the brow, a pain just over the eyebrow, and 
sometimes it is periodic, that is, it always comes on just at the same time of the 
day. It is generally pretty punctual, and does not often forget its engagements. 
A watch is almost superfluous to people who suffer from this complaint. Fortunately 
it is nearly always cured by large doses of quinine, which should be given about 
half an hour before its expected visit. The strong quinine mixture (Pr. 10) will 
have to be used for this purpose, as the dose in the tonic mixture is too small. 

Sometimes in these cases of neuralgia the quinine taken " little and often " will 
do more good. Send for half a drachm of sulphate of quinine, and take as much as 
will adhere to the top of your finger every five or ten minutes. It is like drinking a 
glassful of wine a sip at a time — " sweet sorrow long drawn out." Blood poisoning, 
or, as it is technically called, pycemia, is often treated by this quinine mixture 
given every four hours, and sometimes even much larger doses are given. The 
same method of treatment is often followed with advantage in other diseases 
attended with fever, such as inflammation of the lungs, typhoid fever, typhus fever, &c. 
The quinine reduces the temperature, or, in other words, brings down the fever and 
the preternatural heat of the body. 

For noises in the head quinine may be given with advantage. Some people are 
perpetually troubled with a noise in their ears like the ringing of bells, or the 
rumbling of distant machinery. This condition is curable by the quinine mixture 
(Pr. 9), ten drops being taken every ten minutes for the first hour, and subsequently 
hourly. This mode of treatment nearly always proves successful. It would be 
impossible to enumerate all the uses of bark and quinine — their number is legion — ■ 
but we have, we trust, said enough to indicate the class of case for which it should 
be used, and, in conclusion, we can only wish you every success. 



BELLADONNA. 

The atropa belladonna, dwale, or deadly nightshade, belongs to the natural 
order Solanacese, the family which yields us our potato. It grows in many parts 
of Britain on calcareous soil, but it is not by any means common. It is generally 
found in shady lanes and hedges in the neighbourhood of villages and ancient ruins. 
It produces flowers in June and July, and ripens its fruits in September. The 
medicinal properties of belladonna depend on a peculiar principle which has been 
named atropia, a substance in needle-like crystals of a brilliant white colour, with- 
out taste or smell, first discovered in the leaves by M JBrandes. 

It is difficult to say why it is, but the belladonna is always associated with 
something romantic. Even in the name there seems to be a spice of romance. 
Atropa is derived from Atropos, the goddess whose duty it was to cut the thread 
of life without regard to sex, age, or quality, and it is supposed to be indicative of 
the inevitable fate of those who yield themselves to its influence. The Venetian 
ladies used water distilled from the plant as a cosmetic, from which circumstance 
it acquired its name, bella donna, beautiful woman. 

We must enter somewhat fully into the consideration of the botanical character 
of the plant, as it is often confounded, even by those who ought to know better, 



760 



MATERIA MEiniJL 



"with the Solarium dulcamara, or woody nightshade. The whole plant is of a 
lightish green colour, except the flowers, which are large and of a dingy brownish- 
purple, and the berries, which are of the rich deep black of black cherries. The 
root is thick, fleshy, and much branched ; the stem grows about two feet high, and 
the leaves are oblong, tapering to each end. The flowers are bell-shaped, larger 
than those of the harebell, and placed singly in the bosom of the leaves. The border 
of the corolla is cut into five equal lobes, and there are five stamens and a tapering 
pistil with two cells. The odour of the whole plant is nauseous and oppressive, 

as if to give warning of its venomous 
nature. 

Belladonna when taken in poisonous 
doses produces dryness of the mouth, 
thirst, and difficulty of swallowing; the 
face becomes flushed, the eyes bright, the 
pupils dilated, and the sight dim and hazy. 
Very frequently the whole body is covered 
with a bright red rash, resembling scarlet 
fever, and it is even sometimes followed 
by peeling of the skin. The mind and 
senses become peculiarly affected, and a 
form of madness is produced. The ideas 
become incoherent and extravagant, and 
there is often decided delirium, with 
pleasing illusions. Sometimes the unfor- 
tunate patient is possessed with constant 
restlessness, keeps continually moving, 
and cannot be quieted. The delirium 
may be furious and dangerous, and occa- 
sionally under the influence of this drug 
people have become so unmanageable that 
they have had to be confined in a mad- 
house. It has been supposed that it is 
to the madness produced by belladonna that Banquo refers when lie asks Macbeth- 




Fig. 4.— BELLADONNA. 



" Or have we eaten of the insane root , 
That takes the reason prisoner ? " 

This may or may not be, but there is no doubt that the poisonous properties of 
the plant have been long known, for Buchanan, the Scottish historian, states that 
the Danes were treacherously defeated by the troops of Macbeath, who during a 
truce sent Sweno bread and a mixture of wine and ale containing poison, which 
from the description of the symptoms produced can have been none other than our 
belladonna. 

During the Parthian war the troops of Mark Antony were greatly distressed for 
provisions, and belladonna is probably the plant referred to by Plutarch in the 
following passage : — 



BELLADONNA. 761 



" Those who sought for herbs and pot-herbs obtained few that they had been 
accustomed to eat, and in tasting unknown herbs they found one which brought on 
madness and death. He that had eaten of it immediately lost all memory and 
knowledge ; but at the same time would busy himself in turning and moving every 
stone he met with as if he was upon some very important pursuit. The camp was 
full of unhappy men bending to the ground ; and thus digging up and removing 
stones till at last they were carried off by a bilious vomiting, when wine, the 
only remedy, was not to be found." 

What to do in Belladonna Poisoning, — 1. Send for the doctor. 2. If there 
have been no vomiting, give an emetic — a tea-spoonful of ipecacuanha wine, or five 
grains of sulphate of zinc every few minutes till the desired result is obtained, 
or salt-and-water, or mustard-and-water. The emetic draught (Pr. 27) may be 
used. 3. Give stimulants — hot brandy-and-water, sal volatile, &c. 

Quite recently a drug has been introduced into this country which is said to be 
a true antidote for belladonna. It is a native of South America, and is known as 
jaborandi It is hardly likely to be at hand in cases of emergency, although it is 
readily procurable from the better known chemists in New York and other large 
towns. The tincture of jaborandi may be given in a tea-spoonful dose, or, if the leaves 
are obtained, two drachms should be broken up and infused, and the resulting 
liquid and its dregs taken Cases of belladonna poisoning are so common that it 
would be a great advantage to have an antidote on which implicit reliance could 
be placed. 

The preparations of belladonna are, for internal administration, an extract and 
a tincture ; whilst for external application there are a plaster, a liniment, and an 
ointment. 

For the relief of pain in the muscles and over-sensitiveness of the skin, few 
applications prove more efficacious than the belladonna liniment. It should be 
rubbed over the tender and painful spot several times during the course of the day. 
For pains in the side and lumbago, a large belladonna plaster may be used with 
benefit. It should be applied smoothly and carefully, and may be worn with 
advantage for several days, or even weeks. 

Belladonna has the power of checking and ultimately arresting the secretion of 
milk, a property of which advantage may be taken by mothers who, having a 
good breast of milk, are yet from any cause unable to suckle the child. The 
breast in these cases often becomes greatly swollen and exquisitely painful, a condi- 
tion which, if not relieved, may go on to the formation of milk abscesses. Belladonna 
speedily gives relief and obviates this danger. Either the liniment, extract, or 
ointment may be used, and should be well rubbed in several times a day, especially 
in the neighbourhood of the nipple. The earlier the application is made, the more 
speedy will be the relief obtained ; but even should inflammation have set in, the 
continuous application of belladonna for twenty-four or forty-eight hours will, even 
under these adverse circumstances, usually arrest the formation of matter. - 

Not only has belladonna the power of arresting the flow of milk, but it also 
checks excessive sweating. The belladonna liniment used two or three times a day 
will completely check the perspiration of the head and face of young children^ which 



762 MATERIA MEDICA. 



is often so profuse as to soak their hair and the pillow upon which they have been 
sleeping. Many people are all their lives troubled with profuse sweating of the 
hands and feet, a complaint which may be gradually diminished, and sometimes 
completely arrested by rubbing in the belladonna liniment three or four times a day. 
Sometimes the perspiration secreted by the feet is not only in excess, but is also of 
an extremely offensive nature. An agreeably-smelling and extremely efficacious 
application may be obtained by requesting the chemist to use eau de Cologne instead 
of spirit in the preparation of the tincture of belladonna. It should be applied 
several times daily. The internal administration of belladonna is often effica- 
cious in arresting the night sweating which is so great a trouble to consumptive 
patients. 

Belladonna administered internally is a very valuable remedy for sore throat, 
and in many cases will effect a positive cure. It is especially useful when there is 
much heat and pain on swallowing, with bright redness of the affected parts, flushed 
face and headache. 

Belladonna is very conveniently given in the form of the mixture (Pr. 39) 
-^a tea-spoonful every quarter of an hour for the first hour, and subsequently 
hourly. 

In the sore throat of scarlet fever this mixture will often prove of considerable 
value, mitigating the severity of this distressing symptom. It is often claimed for 
belladonna that it acts as a kind of charm against scarlatinal contagion, and prevents 
people from catching the fever. This is open to question, and such a statement 
must be received with a good deal of caution ; but at the same time there can be 
no possible harai in taking the above mixture as directed when scarlatina is 
prevalent, or breaks out in a household. 

The tincture of belladonna is often useful in certain forms of headache. The 
indications for its use are when the pain is situated over the brows and in the eyeballs, 
and when they seem to the sufferer as if they were too large for the Jiead and would be 
forced out of the skull. 

Belladonna often succeeds in allaying both the cough and oppressed breathing of 
asthma. It is essential for ensuring success to employ large doses. Fifteen drops 
of the tincture should be given every two or three hours, and if this produces no 
unpleasant symptoms, the quantity may even be increased. The same dose given to 
children every hour is one of the best remedies for whooping-cough. It must be 
remembered that children are not very susceptible to the action of this drug, and 
that they will take almost as large a dose as an adult. 

The tincture of belladonna is both speedier and more certain in its action than 
any other remedy for that troublesome and distressing complaint of children wetting 
the bed. From ten to twenty drops must be given three times a day in a little 
water. The treatment has often to be continued for a fortnight before it proves 
successful. 

A celebrated French physician was very successful in the treatment of constipa- 
tion and torpidity of the bowels by belladonna. He gave it in the form of pills, 
each containing \ grains of extract of belladonna, and the same quantity of the 
powdered belladonna leaf. One of these pills must be taken in the morning 



BISMUTH. 763 



before breakfast, the dose being gradually increased to three or four pills if the 
desired effect is not previously obtained. As soon as the stools become regular, 
the belladonna must be discontinued and the organs allowed to act without 
assistance. 

BISMUTH. 

There are two salts of the metal bismuth used in medicine — the subnitrate and 
the carbonate. The former was long known under the title of "magistery of 
bismuth" or "pearl white," whilst the latter has been comparatively recently 
obtained. The term "white bismuth," which was formerly applied to the sub- 
nitrate, is no longer distinctive, as both salts are fine white powders insoluble in 
water. They are blackened by that gas of rotten-egg-like odour which we call 
sulphuretted hydrogen, a fact to be borne in mind by ladies who simultaneously use 
bismuth as a cosmetic, and indulge in the use of sulphureous waters. It would be 
unpleasant to suddenly turn black in the face whilst taking your afternoon tumbler 
at the springs. 

Internally the bismuth preparations are used almost exclusively in diseases of 
the stomach and digestive apparatus. Bismuth is essentially a stomach medicine. 
Pain in the stomach, whether dependent on disease or merely arising from that 
somewhat irritable organ being a little " upset," is generally eased by a bismuth 
mixture (Pr. 18). The dose is two table-spoonfuls every four hours. The use of 
the tragacanth is to suspend the insoluble powders in the liquid and to prevent 
them from settling to the bottom. The mixture should be shaken before being 
used. In this, as in all other cases, the bismuth mixture is to be taken before meals. 
It will do no good if poured into the stomach already distended with food. 

This mixture alleviates the pain arising from cancer, ulcer, and chronic inflamma- 
tion of tlie stomach. 

It proves beneficial in that form of irritable stomach which is so often a con- 
comitant of habitual indulgence in ardent spirits. It subdues the pain, checks the 
vomiting, and enables the patient to take food. It need hardly be said that a more 
effectual remedy is afforded by the discontinuance of the habit on the existence of 
which these symptoms are dependent. It may also be given with advantage in cramp 
in (lie. stomach. 

That form of dyspepsia or indigestion which is accompanied by the return of a 
little fluid from the stomach into the mouth is often amenable to bismuth. 
Flatulence or wind in the stomach is often cured by the bismuth and charcoal 
powders (Pr. 75), one to be taken three times a day half an hour before meals. 

Carbonate of bismuth is a very valuable remedy for some forms of chronic 
diarrhoea. It is especially useful in that intractable diarrhoea which so often proves 
fatal to patients in the last stage of consumption. It is absolutely necessary to use 
large doses. Half a drachm or a drachm of the subnitrate of bismuth must be given 
several times a day. It should be administered in a little milk, and when so taken, 
rarely upsets the stomach or causes any inconvenience. We have no hesitation in 
saying that bismuth, used in this manner, has prolonged the life of many a sufferer 
whose career the diarrhoea and consequent exhaustion would soon have brought to 



764 MATERIA MEDICA, 



a close. In these cases bismuth is our sheet-anchor. Not only will it subdue the 
diarrhoea, but it sometimes effects so great an improvement in the general health, 
that those whose speedy death seemed inevitable rally, and ultimately return to the 
ordinary duties of life. 

Obstinate diarrhoea occurring in children may be checked by bismuth. A grain of 
the subnitrate of bismuth may be given every hour, and its value is greatly enhanced 
by the addition to each dose of one-sixth of a grain of grey powder. 

Bismuth is sometimes administered in the form of a colourless liquid known as 
citrate of bismuth and ammonia, the dose of which, given in water or some simple 
infusion, is from one to three tea-spoonfuls. Its action is probably the same aa 
the more commonly used preparations of bismuth, to which there is no evidence to 
show that it is in any way superior. 

BOX. 

Box is at present but little used as a medicinal agent, but as it has been re- 
cently strongly recommended as a remedy for hydrophobia, we need, we are sure, 
offer no apology for giving a short account of its properties. 

It is so well known that it would be superfluous to enter into any detailed account 
of its botanical character. 

Within England it grows so abundantly that it has given its name to Box Hill, 
in Surrey ; Boxwell, in Gloucestershire ; and Boxley, in Kent. The wood, which 
is the only European wood which sinks in water, has long been famed for its 
density. " The most massie and fast wood, and therefore the weightiest of all 
other, by judgement of men, is that of the ebone, or the boxe," says an old writer. 
Its value in the manufacture of mathematical instruments, and more especially its 
use by the wood engraver, will always command attention to its cultivation and 
protection, and ensure a supply of the leaves greater than will ever be required for 
medicinal purposes. Except as a remedy for hydrophobia, it is probable that box 
is of little value in the treatment of disease. There appears to be a very general 
opinion, however, that it has the power of stimulating the growth of the hair. In 
illustration of its efficacy, we cannot do better than quote the following account, 
always, however, with the proviso that we do not guarantee the truth of the 
statements contained therein : — 

" A young woman of Gimberg, in Lower Silesia, having had a malignant dysen- 
tery, which occasioned the falling off of all her hair, was advised by a person, some 
time after her recovery (as her hair was not likely to grow again of itself, her head 
being then as bare as the hand), to wash it all over with a decoction of boxwood, 
which she really did, without the addition of any other drug. Hair of a chesnut 
colour grew on the head, as she was told it would do, but having used no precaution 
to secure her neck and face from the lotion, they became covered with red hair to 
such a degree that she seemed little different from an ape or monkey." 

We have no intention of entering into a discussion as to the efficacy of box in 
producing specimens of the " missing link," but we have no hesitation in saying that 
it is the remedy on which we should rely in the treatment of hydrophobia. Box is 
not usually kept by chemists, but there is never any difficulty in obtaining it. It is 



BROMIDE OF POTASSIUM. 765 



best used in the form of an infusion, which may be made as follows : — Take two 
ounces of box-leaves, chop them finely, and after boiling them in a pint of water 
down to half a pint, strain and press out the liquid. Pound the leaves in a mortar, 
or otherwise bruise them, and then boil them again in a pint of milk down to half 
a pint, when strain as before. Mix both the liquids, when there will be a quantity 
sufficient for three doses. A dose should be given three times a day. There is no 
objection to flavouring the medicine by the addition of sugar or any other pimple 
substance. This mode of treatment has proved successful in a large numHr of 
cases. 

BROMIDE OF POTASSIUM. 

Bromide of potassium is prepared from bromine, a dark red liquid of intensely 
disagreeable odour, obtained from sea-water and sea-plants. Bromide of potassium 
very closely resembles iodide of potassium, although its curative powers are of a 
totally different order. A formula for a bromide of potassium mixture has already 
been given (Pr. 31). 

Many people who are actively engaged during the day find it excessively incon- 
venient to constantly carry with them a half-pint bottle of medicine, and yet are 
unable to dispense with its assistance. Two or three doses may be carried without 
much trouble in a small sherry flask, but the difficulty is, perhaps, more readily 
overcome by taking the bromide of potassium in its natural state, and not in the 
form of a mixture. An ounce of the salt when powdered may be readily divided 
into thirty equal portions, each of which will be a dose equivalent to two table- 
spoonfuls of the mixture. The powders may be carried in a little box in the 
pocket, and a dose of the medicine may at any time be taken by dropping one of 
them into a glass of beer, milk, or water, or any other liquid which may be at 
hand. 

In the case of children it is often a great advantage to be able to give them 
medicine witliout their knowledge. With the bromide there is no difficulty, for it 
may be powdered and placed in the salt-cellar with an equal quantity of common 
salt, and taken at meals in the ordinary way. The little patient will regard the fact 
of his having a salt-cellar " all to himself "as a delicate mark of attention, and if 
generously disposed will probably offer to share it with the other members of the 
family. 

Bromide of potassium is a nervine sedative, that is, it exerts a soothing or 
calming influence on the nervous system. It is a drug which has fluctuated greatly 
in the estimation of medical men, but no doubt can now be entertained as to its 
inestimable value in many diseases of a spasmodic character. 

Bromide of potassium is undoubtedly the most valuable remedy we possess for 
epileptic fits or falling sickness. The mixture, if taken three times a day, will some- 
times completely cure this complaint, and even in cases in which the cure is not 
complete it proves extremely valuable in reducing the frequency and severity of the 
fits. By the use of this medicine the patient is enabled to ward off his attacks, so that 
instead of occurring several times a day he may be free from them for weeks or months, 
or even years. It must be remembered that epilepsy is often an old-standing complaint, 



766 MATERIA MEDICA, 



and that such cases are not cured in a day. The disease had secured a firm hold upon 
the organism, and nothing but a prolonged course of treatment will serve to shake 
it off. The bromide of potassium must be persevered in week after week, and 
its use should never be rashly abandoned because its beneficial effects are not 
at once apparent. When the drug has to be continued for any length of time it is 
advisable to regularly suspend its use on one day in the week, or at longer intervals 
for several consecutive days, for if this precaution is neglected the system becomes 
accustomed to its use, and its influence over the disease is greatly impaired. When 
the fits occur only at night, two doses of the mixture may be taken together at 
bed-time, and none during the day. 

In convulsions in children a tea-spoonful of the mixture may be given every four 
hours with advantage. 

In whooping-cough tea-spoonful doses will often effect a cure, though this 
medicine usually proves of no avail when the child is at the same time cutting his 
teeth. 

In somnambulism, night-screaming, and nightmare, this mixture usually proves 
beneficial when given at bed-time in doses of two table-spoonfuls for an adult, and 
two tea-spoonfuls for a child. Many people who have been over-worked or have 
over-taxed their brains, so that they cannot sleep at night from & feeling of worry 
and anxiety, obtain relief from the bromide of potassium mixture taken at bed-time. 
It calms the excitement, so that a refreshing night's rest is obtained, and strength 
recruited for meeting the troubles of the morrow. 

Bromide of potassium is the remedy for spermatorrhoea. You can get half an 
ounce of bromide of potassium from any chemist for a few cents. Put it in a pint 
bottle full of water, and shake it for a few minutes. Take three table-spoonfuls 
three times a day. * 

In delirium tremens, bromide of potassium is often given with marked benefit ; 
it quickly removes the delusions, calms the delirium, and induces sleep. The mixture 
should be given in two table-spoonful doses every two hours until the desired effect 
is produced. The happiest results may be looked for when the case is taken early, 
particularly before the furious maniacal delirium has set in. The longer the use of 
the medicine is delayed, the less likely is it to prove of servica 

The uninterrupted use of this medicine for long periods, as is sometimes neces- 
sitated in the case of sufferers from epilepsy, occasionally gives rise to a condition 
known as " bromism." Its occurrence is usually indicated by lowness of spirits, a 
feeling of depression, and disinclination for work, accompanied by an eruption of 
spots on the face and back. These symptoms quickly disappear on the suspension 
of the medicine for a few days. 

BRYONIA. 

The common or red-berried bryony {Bryomaa dioica) is a wild plant belonging 
to the cucumber family. It is found plentifully in Kent and many other counties 
in England, climbing by means of its tendrils over the hedges by the wayside. The 
leaves, which are borne on long foot-stalks, are large, hairy on both sides, and 
divided into five lobes. The flowers, though not by any means striking objects, are 



CALABAR BEAN. 767 



of a yellowish-white colour, and are elegantly streaked with green veins. The fruit is 
a small, round, red berry, about the size of a common pea. The root, which is the 
part used in medicine, is large and fleshy, and is often as thick as a man's thigh. It 
has an extremely disagreeable odour and a particularly nauseous taste, both of 
which, however, can be removed by frequent washing with cold water. 

There are many diseases in which the use of bryonia has been strongly recom- 
mended, and it exerts a marked influence over the serous membranes which line the 
large cavitibs of the body. Thus, it is especially extolled for its powers of absorbing 
the fluid from the chest in cases of pleurisy. 

It is often used in a bad cold on the chest, the indications for its use being heat 
and soreness beneath the breast-bone, and an irritating, shaking cough attended 
with but little expectoration. In inflammation of the lungs considerable benefit has 
been experienced from its employment. 

In some forms of headache it proves useful ; for instance, in congestive headache, 
which is characterised by pain in the forehead, relieved by pressure, but much in- 
creased by stooping down. It also does good in headache confined to one side, and 
accompanied by retching and bilious vomiting. 

Indigestion, particularly when indicated by weight at the pit of the stomach, 
eructations, and water-brash, may be relieved by this drug. 

Bryonia is usually given in the form of a tincture, one part in ten, of which the 
dose is a drop every hour, or a smaller quantity more frequently repeated. A drop 
of the tincture is contained in each tea-spoonful of the bryony mixture (Pr. 49). 



CALABAR BEAN. 

The Calabar beau {Physostigma venenosum), or ordeal bean of Western Africa, 
belongs to the family of plants which yields us our ordinary domestic peas and beans. 
The portion used in medicine is the seed, which is of a brownish-red or pale chocolate 
colour, and closely resembles a large horse bean. It contains two white kernels, 
which are unclistinguishable in taste from a haricot bean. Its use by the natives of 
Calabar as a judicial test has been already mentioned. The common belief is that if 
it is rejected by the accused he is innocent, but that if it is retained and proves fatal 
he is guilty, and that it served him right. So strong is the popular belief in the 
test that a suspected person often voluntarily takes a dose with the view of establish- 
ing his innocence, probably under the impression that he will leave the court without 
a stain on his character, but finds only too late that he is the victim of misplaced 
confidence. Physostigma, when taken in poisonous doses, produces paralysis, chiefly 
by its action on the spinal marrow, death ultimately ensuing from deficient action of 
the muscles by which breathing is ordinarily performed. A few years ago at 
Liverpool, from fifty to sixty children were accidentally poisoned by these beans. It 
vas ascertained that the sweepings of a ship from the western coast of Africa had, 
with a carelessness which was almost criminal, been thrown on a heap of rubbish, 
where the children had found the beans and eaten them. Fortunately, death ensued 
in only one case. 

Calabar bean is undoubtedly the most valuable remedy we possess for paralysis 



768 MATERIA MEDICA. 



of the limbs, especially when the legs only are affected In very old-standing cases, 
where the patient has been helpless for years, little or no benefit will in all pro- 
bability be experienced, although if the disease is progressing, every hope may be 
entertained of arresting its course. In cases in which the disease is of recent origin 
the happiest results are often obtained by the use of this drug. 

The preparation of Calabar bean used for medicinal purposes is an extract — the 
extract of physostigma. It should be made up into little pills, each containing J^th 
of a grain, one of which should be taken every two hours. The following is the 
formula : — Calaba/r Bean Pills. — Extract of physostigma, -g^th of a grain. To be 
made into a pill. One to be taken every hour. 

It must be remembered that a complaint of this nature is not readily cured, and 
that the use of the pills will have to be persevered in for weeks or even months 
before any decided improvement is noticeabla The patient must not despair because 
his progress towards recovery is very gradual 

In an allied complaint, known as locomotor ataxy, or the stamping palsy, this 
method of treatment proves equally efficacious, the results being, in many cases, 
very striking, especially when the complaint is taken in an early stage. 

In writers' cramp, the pills employed in the manner indicated will often effect a 
cure, even in esses apparently hopeless. 

In the general paralysis of the insane, Calabar bean has proved markedly useful, 
not only arresting the progress of the disease, but also improving the mental and 
physical condition of the patient. Several cases of tetanus, or lockjaw, have been 
cured by large doses of extract of physostigma, a quarter of a grain or more being 
given every hour. It is obvious that a drug which exerts a beneficial action on 
diseases of so serious a nature must be regarded as one of the most valuable in our 
armament, particularly as until its introduction we knew of no trustworthy means 
of arresting their progress. 

CALUMBA. 

Calumba is a good, old-fashioned tonic, and one of our pleasantest and most 
agreeable bitters. It improves the appetite, assists digestion, and is often retained 
by the stomach when bark or quinine would be at once rejected. 

It is the sliced root of a plant known botanically as the Coccuhu pabnatut. Its 
history and native country were for many years involved in obscurity, although it 
was supposed that its name was derived from Colombo, the principal town in the 
island of Ceylon. It is now ascertained that our supply is obtained entirely from 
the dense forests of Mosambique, on the east coast of Africa. It is not cultivated? 
as the spontaneous produce is sufficient to meet the demand. The oflsets of the 
root of the " kalumb," as it is called by the natives, are dug up in the hot season, 
cut transversely in slices, and then carefully dried. 

We usually receive it in circular or oval pieces about the size of half a dollar, 
but somewhat thicker. It is a light yellow colour towards the centre, but is 
surrounded externally by a darker part, having a brown wrinkled appearance. A 
good specimen should be solid and heavy, and not spongy or worm-eaten. The odour 
is faint, and somewhat aromatic, whilst the taste is very bitter. Two preparations 



CAMPHOR. 768 



of calumba are in common use, a tincture and an infusion. The infusion is made by 
macerating, for half an hour in a covered vessel, half an ounce of calumba root, cut 
small, with half a pint of cold water, and then straining. Unfortunately this infusion 
will not keep, and in a day or two becomes mouldy. The dose of the tincture is 
from a half to a tea-spoonful, and of the infusion two table-spoonfuls. 

The infusion may be given with advantage in cases of general debility, loss of 
appetite, and indigestion. Like all medicines intended to improve the appetite, it 
must be given shortly before meals. It is of all bitters the least likely to disagree 
with the stomach, and during convalescence after a serious illness it is an excellent 
preparative for a more powerful tonic, such as bark. Calumba may be conveniently 
given in combination with acids or alkalies. It has a great advantage over most 
other tonics, that it does not form a black unsightly mixture when administered 
with iron. 

From a closely allied species, Cocculus indicus, berries are obtained, which it is 
rumoured are largely used for two illegal purposes — firstly, to intoxicate fish, so that 
they may be readily captured, and secondly, to adulterate beer. They are said to be 
very extensively employed by the brewers in the manufacture of porter, giving it an 
inebriating quality which passes for strength. It is a powerful poison, and its 
effects on the system are most injurious. 

CAMPHOR. 

Camphor is obtained from a large forest tree with evergreen shining leaves, 
which grows wild in Japan. The drug is diffused throughout all parts of the plant, 
and is procured from the wood, root, and branches, which are first cut into chips, 
and then distilled. The crude camphor so obtained is separated from its impurities 
by being mixed with lime and sublimed into thin glass vessels, which, on being 
broken, yield us the pure substance in the bell-shaped masses in which we usually 
see it in the chemist's window. It is white, translucent, tough, and crystalline, and 
has a powerful penetrating odour, and a pungent, bitter taste. It floats readily on 
water, and, when lighted, burns with a clear brilliant flame. It is poison to fleas, 
bugs, and other insects, a property by no means to be despised. The Chinese use 
the fragrant white wood of the camphor tree in making trunks and cabinets for 
protecting articles of clothing from the ravages of moth. 

The preparation of camphor most commonly used is the spirits of camphor, made 
by dissolving one ounce of camphor in nine fluid ounces of rectified spirit. Some- 
times it is advisable to use the stronger " essence of camphor." It is a saturated 
solution of camphor in spirit, and is made by dissolving an ounce of camphor in an 
ounce and a quarter of rectified spirit. Rubini's preparation contains about a grain 
in a drop. Camphor is not usually regarded as a very active poison, but the strong 
preparations must be used with a certain amount of caution. 

We now proceed to speak of the cases in which its use is indicated. 

Camphor, when employed at the very commencement of the attack, exerts 
a decidedly beneficial influence on that annoying complaint, " a cold in the head." 
Even when it fails to effect a cure it diminishes the pain over the forehead, and 
49 



770 



MATERIA MEDICA. 



restrains the sneezing and running at the nose. There are people who are subject to 
periodical fits of incessant sneezing, accompanied by a profuse watery discharge 

from the eyes and nose. For 
either of these complaints the 
patient should take from four 
to six drops of spirits of cam- 
phor (the weaker of the two 
preparations we have men- 
tioned), in a little water, 
every fifteen minutes for the 
first hour, and subsequently 
hourly. In addition, he should 
snuff some powdered camphor 
up the nostrils, or inhale some 
spirits of camphor from a 
pocket-handkerchief. 

Camphor is par excellence 
the remedy for cholera and 
summer diarrhoea. Four or 
five drops of essence of cam- 
phor (the strong preparation) 
should be given in a tea- 
spoonful of brandy, every ten 
minutes, until the urgent 
symptoms are relieved, and 
should then be continued 
hourly. It usually at once 
checks the diarrhoea, prevents 
cramps, and restores warmth to the extremities, It is very desirable that it should 
be given at the very commencement of the attack, every hour lost being of 
importance. 

There are many forms of diarrhoea not allied to cholera, which are, nevertheless, 
readily controlled by camphor. Thus, it usually restrains the diarrhoea excited by 
the effluvia from bad drains, and the diarrhoea from which many women suffer when- 
ever they happen to catch cold. The weaker preparation (spirits of camphor), 
administered in the doses we have indicated, answers admirably for these cases. 




Fig. 5.— CAMPHOB. 



CANTHARIDES, OR SPANISH FLY. 

There is no doubt that the Greeks used some insect for the purposes of blistering, 
but whether it was our Spanish fly is a point on which there is some difference of 
opinion. Some authorities have shown that it was the identical animal, whilst 
others have proved with equal clearness that it was a different kind of beetle 
altogether. It is really a matter of very little importance, for we know that 
cantharides is a powerful medicinal agent. 



CANTHARIDES, OR SPANISH FLY. 771 

The scientific name of the Spanish fly is Cantharis vesicatorum — ratlier a big 
name for so small a creature. They are procured in Russia and Siberia, but chiefly 
in Hungary. They seldom are seen in England, except as an article of commerce, but 
some forty years ago they are said to have been for a time quite common in Essex 
and Suffolk. Their life is a short one — for it is stated that they live only eight or 
ten days. They swarm upon the trees about May or June, especially on the ash, 
lilac, and privet. They exhale a strong foetid and penetrating odour, by which then- 
presence is at once detected, and which is so offensive that the public walks are 
usually deserted until they have disappeared. They are readily caught, either early 
in the morning or in the evening, when they are not very active. Large cloths are 
spread under the trees, which are then shaken by men armed with long poles. The 
beaters usually cover their faces, and protect their hands with thick gloves. Various 
methods have been recommended for killing the bettles when caught, but the plan 
usually adopted is to plunge the cloths containing them into hot vinegar-and-water. 
They are then placed on hurdles covered with paper, and dried in the sun, or in a 
warm room. 

They are from half an inch to an inch long, the wing-sheaths are of a beautiful 
green colour, and encase two thin brownish membranous wings. They should be 
preserved, if possible, in tightly stoppered bottles, but they are subjected to the 
ravages of no less than four different kinds of insects, by which they are rapidly 
destroyed, unless a little acetic acid, or camphor, or some similar substance, be added 
to keep away these unwelcome visitors. Spanish fly is not unfrequently adulterated 
— sometimes pieces of glass of the shape and colour of the beetle have been added to 
increase the weight, and sometimes the active principles have been extracted with 
ether, and the worthless residue sold as genuine. 

Spanish flies produce a well marked effect when used either externally or 
internally. When applied to the skin they cause at first a sensation of heat, 
accompanied by pain, redness, and slight swelling, and this soon goes on to the 
formation of a blister. 

Cantharides is not often administered with the view of committing murder or 
suicide, but several cases of accidental poisoning have occurred. On one occasion a 
man took a tea-spoonful of the powder flies by mistake for jalap. The case is also 
recorded of a coachman who poisoned a whole family by mixing tincture of 
cantharides with their beer, the only explanation he was able to afford being, that 
he thought it would be a " lark." He was acquitted on the ground that he had no 
malicious intention. The law was shortly afterwards amended, and people are no 
longer permitted to play " larks " of that nature with impunity. 

The symptoms produced by a poisonous close of cantharides are usually very 
severe. At first there is a burning sensation in the throat, with great difficulty of 
swallowing, violent pain in the abdomen, with nausea and vomiting of fluid 
streaked with blood. Then there is great thirst and dryness of the throat ; and 
after a time a heavy dull pain is experienced in the loins. There is an incessant 
desire to pass water, but only a little blood, or blood mixed with urine, is voided 
at each effort. Purging sometimes supervenes, being accompanied with griping 
and straining, the evacuations being mixed with blood. When the drug has been 



772 MATERIA MEDICA. 



administered in the form of powder, little shining particles can be detected in the 
vomited matter, and this usually leads to the discovery of the nature of the case. 
The treatment too frequently proves of no avail. When vomiting exists it should 
be promoted by warm demulcent drinks, such as thick linseed tea or strong gum 
and water, but if absent emetics and castor oil should be given — the object being, 
of course, to get rid of the poison. Olive oil was formerly regarded as an antidote, 
but it is now known that this is a ready solvent of the active principle of the poison, 
and that its use is injurious. 

There are several preparations of cantharides, the majority, however, being 
solely for external application. Of these 'the blistering paper and blistering fluid 
are the most useful. When a speedy action is required the fluid must be used, and 
if applied freely it will usually produce a well-marked blister in from twenty 
minutes to half an hour. The paper is a much milder preparation, and may usually 
be applied for an hour without causing much more than redness and irritation of 
the skin, a result which in many cases proves as effectual as the blistering produced 
by the more energetic preparation. 

Irritation of the skin, or counter-irritation as it is usually termed, is an 
extremely valuable mode of treatment in many diseases. It is employed in various 
morbid conditions of the deep-seated organs. Thus, in inflammation of the lungs 
the solution of cantharides lightly painted over the back will frequently lessen the 
pain and improve the condition of the patient, by subduing the accompanying 
restlessness. In pleurisy a blister applied to the chest often promotes the absorption 
of the fluid. Sometimes it serves to cut short an attack of asthma, and will relieve 
the shortness of breath accompanying chronic bronchitis. The blistering should 
never be severe, though it may with advantage be frequently repeated. The 
blisters, as soon as they form, should be covered with a layer of cotton wool. 
It is never necessary or advisable to open them, and should they burst they should 
be carefully protected, and on no account should any irritant be applied, with the 
view of keeping up the discharge. All the good they accomplish is done by 
irritating the skin, the subsequent draining of the fluid serving only to weaken the 
patient. In neuralgia of the face, or tic, as it is usually called, relief is speedily 
obtained by the application of a piece of blistering-paper, about the size of half-a- 
crown, behind each ear or to the temples. In neuralgia of the side left after 
shingles, a complaint not uncommon in elderly people, a blister often does good. 
Blisters are of the greatest service in sciatica. They should be applied every second 
or third day over the seat of the pain, and reaching down to the knee. In this 
complaint free blistering often succeeds when no benefit has been obtained from 
slight counter-irritation. The limb after the application should be swathed in a 
large sheet of cotton wooL 

Blistering paper applied behind the ear often does good in inflammation of the 
eye. A similar mode of treatment is useful in earache. 

Cantharides is the active ingredient in nearly all the preparations so extensively 
lauded for promoting the growth of the hair. It may be taken for granted that an 
application which is warranted to produce a heavy crop of whiskers on the smoothest 
face in the short space of six weeks contains cantharides. This drug, by acting as an 



CARBON, OR CHARCOAL. 773 



irritant, induces a determination of blood to the part, and in this manner may aid 
the development of the hair. Of course such a preparation should be used with 
caution. One might apply it to only one side of the face at a time, the other being 
used as a standard of comparison. 

Administered internally, cantharides exerts a specific action on the urinary organs. 
It is a valuable remedy for inability to retain the water. This complaint is most 
frequently met with in young people. There are many women, however, especially 
middle-aged women, who suffer from a frequent desire to pass water. There may 
be nothing wrong with the urine itself, and the act of micturition may be 
unattended with straining or other trouble, there is simply an inability to retain 
the water for the proper length of time. Some people cannot help passing a little 
urine on the slightest exertion, even on sneezing or coughing, or laughing. These 
complaints are very distressing, particularly as from a feeling of delicacy they are 
too frequently not brought under the notice of the medical attendant. They are 
usually readily cured by cantharides, taken as indicated in Pr. 47. 



CARBON, OR CHARCOAL. 

Carbon, or charcoal, can be made either from wood or from the bones of animals. 
When made from wood it is known as wood or vegetable charcoal, whilst that procured 
from bones is called animal charcoal or bone-black. Wood charcoal is readily made by 
setting fire to a pile of wood, and then covering it with turf and ashes, so that from 
want of air it smoulders away instead of bursting into flame. The woods most 
usually preferred for this purpose are oak, beech, hazel, and willow. The wood 
charcoal thus prepared may retain the shape of the piece of wood from which it 
was formed, or it may be reduced to powder. Animal charcoal, or bone-black, is 
extensively prepared for the use of sugar refiners, and is made by heating bones to a 
red heat without access of air. Either form may be used medicinally. Carbon is 
quite insoluble in water, and fortunately belongs to that class of medicines which 
are destitute of smell or taste. 

Carbon is usually taken with advantage in diseases and disorders of the stomach. 
It will often relieve the pain arising from ulcer of the stomach, although it cannot be 
supposed that it has the power of curing that complaint. People who suffer from 
flatulence, or wind, often derive very considerable benefit from its use. Carbon 
proves especially beneficial in cases in which after meals the " wind " is formed and 
discharged in very large quantities. It will often succeed in arresting this disagree- 
able condition, after almost every other remedy has been tried in vain. Either form 
of charcoal may be used, in doses of from half a tea-spoonful to a table-spoonful. It is 
often sold in the form of charcoal biscuits, of which two or three may be taken as a 
dose, and is sometimes made into lozenges. For the relief of flatulence it may be 
used with the greatest advantage at those times when the formation of wind is most 
troublesome. 

Its power of absorbing deleterious gases into its pores has received other appli- 
cations. It is often made into a poultice with bread and linseed-meal, and used as 
a dressing for foul-smelling ulcers and sores. Small flat muslin bag'* filled with 



774 MATERIA MEDICA. 



charcoal and placed in contact with disagreeably-smelling surfaces often make the 
confinement of the sick chamber less unpleasant both to the patient and to those who 
undertake the duties of nursing. 

The disinfectant properties of charcoal have also been turned to account in the 
manufacture of respirators, which it was at one time hoped would serve to destroy 
the organic matters which propagate disease, and prevent their entrance into the 
system. 

Charcoal is frequently used as a tooth powder, it not only removing adhering 
foreign substances, but also, to some extent, counteracting the unpleasant odour of 
the breath arising from decayed teeth. The areca-nut charcoal is most esteemed for 
this purpose, on account of the hardness of its particles. 



CASTOR OIL — CROTON OIL. 

Castor oil is expressed from the seeds of the castor-oil plant, which in found 
native in almost all parts of the East and West Indies. In our gardens it never 
attains any great size, but in warmer climates the " palma christi," as it is 
sometimes called, is a large well-formed tree. The croton-oil seeds must have 
been known from the most ancient times, for they have been found preserved with 
mummies at least 4,000 years old. 

The oil is usually obtained by crushing the seeds, which are about the size 
of small beans, blunt at the extremities, of a light ash colour, and marked all 
over with dark spots and lines. The characters of this oil are well known; it 
is viscid, colourless, of a pale straw-yellow, and, if not rancid, has a flavour 
which is not very unpleasant. It does not solidify, even at the freezing point 
of water, but when exposed to the air slowly dries up into a kind of varnish. 

It is a mild, speedy, and certain purgative, producing two or three motions with 
little straining or griping. It does not derange the digestive functions as stronger 
aperients do, and hence it is admirably suited for children, and people who object to 
have their digestive apparatus unnecessarily disturbed. Curiously enough, there are 
many people who imagine that unless a purgative gripes them it can by no possibility 
do them any good. 

Castor oil is not a good purgative for habitual constipation, for it increases the 
torpidity of the bowels. In irritable diarrhoea, from the presence of indigestible 
matter, it forms an appropriate remedy. The dose for infants is a small tea-spoonful, 
for young children from one to two fluid drachms, and for adults from one to three 
table-spoonfuls. It may be taken floating on milk, or orange wine, or in beef-tea 
highly peppered and well salted, or it may be beaten up with an equal quantity of 
the froth of porter, and tossed off before the constituents have separated. 

Croton oil is a very much more powerful and energetic drug than castor oil, and 
must be used with considerable caution. Dangerous symptoms have, in children, 
been produced by a single drop taken internally. We refer to it chiefly because it 
is occasionally mixed in small quantities with castor oil, and sold, usually in capsules, 
as " concentrated castor oil." The seeds from which it is obtained are not unlike 
those of the castor-oil plant, but are smaller and duller in colour. They are so 



CATECHU — KINO — RHATANY ROOT. 775 

powerful that even the dust arising from them in emptying the packages has pro- 
duced copious purging. A year or two ago a number of these seeds were washed 
ashore near Waterford from a vessel which had foundered at sea, and were picked 
up and eaten by the country people, twenty-four of whom shortly afterwards 
suffered from symptoms of poisoning. When a person is insensible, in a fit, for 
example, and cannot swallow bulky purgatives, a single drop of croton oil placed on 
the tongue will serve to relieve the bowels. It must be washed down with a little 
castor oil, milk, or some other liquid. 



CATECHU KINO — RHATANY ROOT. 

These substances are all three astringents, and their properties depend mainly on 
the tannic acid they contain. 

Catechu is obtained chiefly from a climbing shrub, known as the " Gambier 
Shrub," a native of the East Indian Archipelago and Ceylon. The leaves are boiled 
in water until their astringency is all extracted, and the decoction is then thickened 
and cut into pieces to dry. It is usually obtained in tubes about an inch in 
diameter, which are porous, externally of a reddish-brown colour, and internally of 
an ochre-yellow or pale brick-red. There are, however, other varieties of catechu 
which do not present these characters. Thus, the black or acacia catechu is met 
with in brownish, irregular masses, often weighing many pounds. This variety is 
a great favourite in India, where it is known as " cutch," or " kut ;" and formerly the 
term " Terra Japonica " was applied to it, on the supposition that it was an earth 
obtained from Japan. All kinds of catechu agree in one character, for they have all 
an extremely bitter, disagreeable, astringent taste. 

Kino is the dried juice obtained from a lofty tree known as the " kino tree," 
growing in Ceylon and the adjacent parts of India. It is obtained from making 
incisions into the trunk of the tree, which is replete with a red watery juice which, 
as it exudes has the appearance of red currant jelly, but after a few hours' exposure 
to the sun dries into a brittle solid. It has no odour, but the taste is very astringent, 
and when chewed it tinges the saliva blood-red. 

Rhatany root, or kramaria, as it is sometimes called, is the root-stock of a tree 
or large shrub which grows spontaneously in Peru. It is largely employed by 
the Spanish and Portuguese for improving the colour, astringency, and richness 
of red wines. A saturated infusion of the root in brandy is known as " wine 
colouring," and is said to be greatly valued for the deep, rich colour it imparts 
to port wine. The root has no odour, but the powder has a sweetish, astringent 
taste. 

These three drugs are frequently employed for obstinate diarrhoea. The dose of 
the officinal tincture is in each case from half a tea-spoonful to a tea-spoonful in 
water. Half a tea-spoonful of tincture of catechu added to two table-spoonfuls of 
chalk mixture forms an efficacious, though extremely disagreeable, diarrhoea medi- 
cine. Few people would regard an attack of diarrhoea as a trifle if they had 
always to take a dose of this mixture. Catechu, or kramaria, when slowly chewed is 
said to be good for a relaxed throat, but the remedy is almost as bad as the disease. 



T76 MATERIA MEDICA. 



CHAMOMILE. 

The chamomile (Anthemis nobUis) is too well known to call for any detailed 
description. It grows wild in many parts of England, and it is a common object 
in almost every cottage garden. 

It is a useful remedy in many complaints of women and children. It appears to 
exert a special influence over the disorders which attend the process of teething, and 
when administered to children does much to mitigate the fretfulness and peevishness 
from which they so frequently suffer at that important period of their existence. 
In the diarrhoea which often accompanies teething, and is usually characterised by 
green, slimy stools, chamomile proves useful, especially when given at the com- 
mencement of the attack. It is, of course, a perfectly harmless remedy, and is not 
to be placed in the same category as the so-called " teething powders." Chamomile 
effectually relieves the cramj)s and pains in the legs from which women frequently 
suffer during the last months of pregnancy. It frequently acts as a sedative to 
people who have been " upset," and made ill by worry and vexation. An infusion 
is easily prepared by steeping a few heads of chamomile flowers in a tea-cupful of 
boiling water for an hour. The dose is a tea-spoonful every hour, or oftener. 



CHLORAL. 

Chloral is a drug which, during the last few years, has obtained a great 
reputation for the treatment of all diseases in which pain or sleeplessness is 
a prominent symptom. It is a useful drug, although it must be admitted that it 
has not maintained its early reputation. 

It is prepared by the action of chlorine gas on alcohol It is generally met with 
in small colourless crystals, having a pungent and rather bitter taste, and an odour 
which has been compared to that of pears. It is soluble in water, and is often sold 
in solution. 

The sleep produced by a moderate dose of chloral, say from ten to fifteen grains, 
is usually calm, refreshing, and dreamless. It is not profound, and the patient, 
when roused, will often take a hearty meal, then lie down again and at once resume 
his nap. It comes on sometimes in a few minutes, but more frequently in about half 
an hour after taking the dose. It should be given at bed-time, and the patient 
should remain quiet and avoid excitement, for otherwise it may produce restlessness 
instead of sleep. 

The after effects of chloral are usually slight ; sometimes it produces on the 
following morning a good deal of heaviness and sleepiness, and occasionally 
frightful dreams, excitement, intoxication, and delirium. As a general rule, how- 
ever, it causes no giddiness, headache, nervous depression, constipation, sickness, or 
loss of appetite. 

It is to be feared that the practice of taking chloral for every little ache and pain 
is greatly on the increase. Many ladies never think of travelling without it, and 
carry it in their dressing cases with as much carelessness as if it were so much eau- 
dfr-cologne. Perhaps the greatest objection to its constant use is that it is apt to 



CHLORAL, 777 

cause sudden death. 8ome two or three years ago an inquest was held on the body 
ef a confirmed chloral eater, who was found in such a position as to show that 
he must have died whilst in the very act of stepping into bed. About the same 
time a gentleman in Canada was charged with the murder of his wife. He had 
been in the habit of taking chloral, in large doses, for some weeks. This was with- 
drawn suddenly. He then became irritable and unnaturally violent, and in a fit of 
passion, for some trivial cause, threw a petroleum lamp at his wife. Her dress caught 
fire, and she was burnt to death before his eyes. He had previously always been a most 
affectionate husband, and at the time of the commission of the act w~as, apparently, 
hardly conscious of what he was doing. The medical men consulted in the case stated 
that die long-continued use of chloral might produce a diseased condition of the brain, 
which, on the sudden withdrawal of the narcotic, might render a person temporarily 
irresponsible for his acts. People who, without medical sanction, habitually use 
chloral, should at once rid themselves of a dangerous and pernicious habit. 

In cases of poisoning by an over-dose of chloral, the following treatment should 
be adopted : — 

Treatment of Chloral Poisoning. — 1. Send for a doctor, saying what is the 
matter. 2. Give the patient an emetic — such as a table-spoonful of mustard in a 
tumbler of tepid water — and promote vomiting by every means in your power. The 
emetic draught (Pr. 27) may be used for this purposa 3. Keep the patient 
constantly moving about. 

Chloral is usually administered in the form of a syrup. Syrup of chloral is 
made by dissolving eighty grains of chloral in half an ounce of water, and then 
adding simple syrup to make it up to an ounce. Each drachm contains ten grains, 
and the usual dose of the syrup is from half a drachm to two drachms. 

As we have already said, chloral is used to produce sleep, and for the alleviation 
of pain. Thus it subdues the sleeplessness of old people and the wakefulness induced 
by excessive mental exertion. The sedative draught (Pr. 37) may be employed. 
In delirium tremens, chloral not only removes the most prominent symptoms, but if 
given at the very commencement of an attack, often averts a serious illness. In 
this disease from twenty to thirty-grain doses may be given every four hours, 
and should the patient make any objection to taking his medicine, it may be 
adiu mistered in a glass of stout without fear of detection. 

Chloral is now often used to cause sleep in labours, having for this purpose 
to some extent superseded chloroform. A drachm and a half of the syrup is 
given when the pains become very urgent, and the dose is repeated if necessary 
in twenty minutes. The patient becomes drowsy, and passes through her troubles 
almost w-'thout her knowledge. 

Chloral is often used for the relief of the pain of neuralgia, chronic rJieumatism, 
cancer, colic, &c. In asthma some very satisfactory results have been obtained. 
It has been loudly praised for its influence on sea-sickness, but there is at present 
little evidence to show that it is to be regarded as a core for this complaint 



778 MATERIA MEDICA. 



CIMICIFUGA. 

This plant is the Actcea racemosa, or black snake root. It is an American 
indigene, and it grows abundantly in the open woods and on the hill-sides through- 
out the United States, from Canada to Florida. It is a herb from three to five 
feet high, bearing whitish flowers, and closely resembling in its main features our 
baneberry. 

The root is the only part used medicinally, and of this a tincture is prepared 
of the strength of four ounces to a pint of rectified spirit The dose is five drops 
given <*very hour. 

Actsea exerts its influence chiefly on the womb, and can be relied on for relief 
of symptoms depending on a disordered condition of that organ. It has the 
power of restoring the periods when they have been suddenly checked by cold, 
shock, or mental emotion, and it will also remove the pain in the head, back, 
and limbs which often accompanies this condition. It may be taken with ad- 
vantage when the periods are attended with pain and general disturbance of the 
system. It will relieve the pain under the left breast which is as constant an 
indication of some disturbance of the womb as is the pain in the shoulder that 
the liver is out of order. It is also serviceable in that distressing headache from 
which many women suffer at each period, and particularly at the change of life. 
When the headache is also accompanied by severe aching pains in the eyeballs 
it is more especially indicated. 

Many people are martyrs to the following complaint : The joints, which may be 
enlarged or not, are stiff and are racked with pain, which flits about from limb to 
limb in a manner which is infinitely more distressing than if it were to confine its 
attention wholly to one spot. It is aggravated by cold or wet, and is usually worse 
at night, so that the rest is much broken. In these cases the tincture of actsea 
racemosa should be tried, and its use is especially indicated when the sufferer is a 
female, and the symptoms can be traced to some previous derangement of the womb, 
as the sudden stoppage of the periods, a miscarriage, a painful or difficult labour, or 
the change of life. 

Again, in cases of this description actsea is signally useful : The patient is first- 
troubled with rheumatic pains in the joints, unattended with swelling ; after a 
short interval the disease settles in one part, such as the wrist, or hand, the tissues 
become thickened, and the bones enlarged, till finally all movement is lost, and the 
member becomes useless. Warmth usually allays the pain, which is almost always 
easier at night. Instant relief is in these cases given by the drug now under 
consideration, even when everything else has been tried in vain. 

It will be seen that the therapeutical virtues of actsea racemosa are by no means 
despicable. 

COD-LIVER OIL. 

Cod-liver oil has long been used as a popular remedy in Sweden and other parts 
of Northern Europe. Nearly a century ago it was introduced into this country as a 
remedy for chronic rheumatism, but it is only during the last twenty -five years that 



J 

COD-LIVER OIL. 779 



it has been so extensively employed, and has obtained such a wonderful reputation, in 
the treatment of consumption and other wasting diseases. Cod-liver oil is, or 
should be, the oil extracted from the fresh, liver of the common cod, a fish which 
abounds on the coast of England, France, Iceland, and Norway, but especially off 
Newfoundland ; other species of oil-yielding fish, such as the dorse, the ling, and 
the whiting are, however, sometimes employed. The very best cod-liver oil is 
prepared as follows : — The livers are collected daily, so that decomposition may not 
have ensued, and after careful examination to remove all traces of blood and 
impurity, they are sliced and exposed to a moderate temperature till all the oil has 
drained away from them. This is filtered and exposed to a lower temperature to 
congeal much of the solid fat, which is then removed by filtration, the oil being put 
into bottles well secured from the action of the air. Other and rougher methods 
are sometimes adopted, by which inferior kinds of oil are obtained. Thus, on the 
coast of Newfoundland it is customary to use a number of tubs bored with holes at 
the bottom. The livers are piled upon a layer of fir twigs, and allowed to remain 
exposed to the sun and air until they undergo decomposition. The oil runs out 
through the holes in the bottom of the tubs into vessels placed beneath to receive it. 
Cod-liver oil obtained in this way is often brown, rancid, and nauseous. There are 
three different varieties of cod-liver oil, the pale, the light brown, and the dark 
brown. The pale is the officinal form, and is undoubtedly infinitely superior to 
either of the others. The difference in colour in the oils depends upon the 
circumstances attending the preparation, more particularly on the amount of heat 
employed, the state of freshness or putridity of the livers, and the length of 
exposure to the atmosphere. The dark brown oil is more impure than the other 
forms, and has a taste and odour which to most people are peculiarly disagreeable 
and offensive. Respecting the relative value of the different forms of oil in the 
treatment of disease, it may be stated that the evidence is entirely in favour of the 
pale variety. 

The beneficial effects produced in different diseases by the administration of 
cod-liver oil have been ascribed to the minute quantities of iodine and phosphorus 
it contains. This is clearly a mistake, for equally good effects are not obtained 
from the use of these substances alone. 

Cod-liver oil when first taken often excites nausea, vomiting, and disagreeable 
eructations, and occasionally the difficulty in overcoming the distaste for the 
medicine is almost insuperable. On the other hand, many people soon learn to like 
the oil, and look forward to medicine time with the utmost eagerness. Many an 
old consumptive will toss off his allowance of oil with as much gusto as other people 
exhibit after taking a glass of some rare old vintage. 

There are several ways in which cod-liver oil may be given, for instance, floating 
on orange or ginger wine, or on a little weak brandy-and-water. A most excellent 
plan is to take it with the gentian and soda mixture (Pr. 14). The oil should be 
poured out on the surface of the medicine, so as not to touch the sides of the glass, 
and when taken in this manner it is almost destitute of taste. 

The following are also convenient vehicles for the administration of the oil: — 

1. Dilute phosphoric acid, half an ounce ; tincture of cascarilla, one and a half 



780 MATERIA MEDICA. 



ounces ; syrup of ginger, one ounce ; compound infusion of orange-peel, to eight 
ounces. A table-spoonful with each dose of the oiL 

2. Dilute phosphoric acid, half an ounce ; solution of strychnia one drachm j 
tincture of orange-peel, one ounce \ syrup of ginger, one ounce ; compound infusion 
of orange-peel, to eight ounces. A table-spoonful with each dose of the oil. 

A very good plan is to take the oil in stout. A glass of stout is poured several 
times from tumbler to tumbler till it is in a good froth. The oil is then carefully 
dropped on to the surface of the stout, where it will remain completely hidden by 
the froth. The stout can now be drunk at a draught without any indication of 
the presence of the oil. 

It is a mistake to give large doses of cod-liver oil, for it is not absorbed, and 
passes off by the bowels unaltered. To commence with, a dose of a tea-spoonful 
even for an adult is quite sufficient, and it is very rarely necessary to take more 
than a table-spoonful at a time. Many people seem to think they cannot have too 
much of a good thing, and take the oil in absurdly large quantities. We knew a 
labouring man who for many months spent nearly half his wages in the purchase of 
cod-liver oil, without deriving the slightest benefit from his extravagance. The oil 
should be taken soon after meals. 

Cod-liver-oil bread and cod-liver-oil jelly are prepared, but the results obtained 
from their use are not usually satisfactory. 

Cod-liver oil is employed in the treatment of a vast number of diseases. It is 
of special service in scrofula, removing the various manifestations of the disease, 
such as discharge from tlce ears and nose, inflammation of the eyes, strumous 
abscesses, &c. In the treatment of consumption and other wasting diseases it is pre- 
eminently useful. Some of the happiest and most striking cases of arrested 
consumption are due to the judicious administration of this oil. It is also useful 
in other diseases of the lungs, such as chronic bronchitis, asthma, <fcc. Many 
obstinate skin diseases, dependent on a consumptive or scrofulous taint, get well 
under the use of cod-liver oil. In rickets, and other diseases of children, it is given 
with advantage. Many sufferers from chronic gout or r/ieumatism are benefited by 
the same treatment. 

COFFEE. 

The coffee tree is generally regarded as a native of Arabia, but by some it is said 
to derive its name from Caffee, a province in Narea in Africa, where it grows in 
great abundance. It usually attains a height of from fifteen to twenty feet, and is 
covered with a dark green shining foliage, The trunk is erect, but seldom exceeds 
two or three inches in diameter. The flowers are white in colour, and diffuse a most 
delicious, harmless fragrance, in the midst of which the natives fix their habitations. 
The fruit, which contains the seeds, is something like a cherry, and is at first red, 
though it subsequently becomes purple. The coffee tree is frequently cultivated in 
this country, in hot-houses, as an ornamental evergreen, and, under favourable 
circumstances, will both blossom and mature its fruit. 

It is evident that we are indebted to the Arabians for the use of this pleasant 
beverage, for the first rite of Eastern hospitality is the presentation of a bowl of 



COLCHICUM. 781 



coffee. A curious story is told of its introduction to notice. It is said that in 
ancient times a poor dervish, who lived in a valley in Arabia, observed a strange 
hilarity in his goats on their return home every evening. To find out the cause of 
this he watched them during the day, and observed that they eagerly devoured the 
blossoms and fruit of a tree, which hitherto he had disregarded. He tried the 
effects of this food upon himself, and was thrown into such a state of exhilaration 
that the neighbours thought that the old gentleman had been making too free with 
the brandy-bottle. He revealed to them his discovery, and they agreed that Allah 
had sent the coffee plant to the faithful as a substitute for the forbidden wine, in 
Europe coffee is said to have been first used in Italy, and it appears to have been 
introduced into this country about the middle of the seventeenth century. Ordinary 
coffee is usually mixed with chicory, the roasted root of the wild endive. At first 
this substance was used only as an adulteration by fraudulent dealers, but the process 
gradually extended itself so widely, that the admixture has been legalised. 

In many exhausting diseases " nutritious coffee " proves of value as a stimulant 
and article of diet. It is prepared as follows : — " Dissolve a little isinglass in 
water, then put half an ounce of freshly-ground coffee into a saucepan, with one 
pint of new milk, which should be nearly boiling before the coffee is added, boil 
both together for three minutes ; clear it by pouring some of it into a cup, and 
dashing it back again, add the isinglass, and leave it to settle on the hob for a few 
minutes. Beat up an egg in a breakfast cup and pour the coffee upon it ; if 
preferred, drink it without the egg." 

Coffee is not only a valuable article of diet, but it is a therapeutical agent of no 
mean power. When coffee is used as a medicine it should be made very strong and 
taken in small quantities. It is frequently administered in cases of opium poisoning, 
with the view of warding off sleep. In spasmodic asthma it is an old-standing 
remedy. In many cases cafe noir proves extremely beneficial. It should be taken 
very hot and strong, and on an empty stomach. Asthmatics who derive benefit from 
it should not use it as a daily beverage, but reserve it for the time of an attack. 
In nervous headaches not dependent on a disordered stomach coffee is a valuable 
remedy. It nearly always effects a cure or affords palliation. In many forms of 
neuralgia it proves useful. 

COLCHICUM. 

Meadow saffron {Colchicum autumnale) is a native plant, growing abundantly in 
many of our moist, rich meadows. The leaves appear early in the spring, and the 
flowers late in the autumn, from which latter circumstance it has been called the 
harbinger of winter. Our supply is derived chiefly from Gloucestershire, but Hamp- 
shire and Oxfordshire not unfrequently furnish a fair quantity. In Scotland it is 
not by any means common. The flowers are of a pale purple or lilac colour, and so 
closely resemble those of the autumn crocus that an inexperienced observer might 
readily mistake the one for the other. The crocus, however, has only three stamens 
and one style, whilst the colchicum has six stamens and three styles. In many 
parts of the country the flowers are known as " naked ladies." The parts used for 
medicinal purposes are the seed and the bulb, or root, as it is commonly called. The 



782 MATERIA MEDICA. 



seeds, which should be collected when fully ripe, are about the size of black mustard 
seeds, odourless, and have a bitter taste. The bulb is as large as a chestnut, and of 
a somewhat similar shape. It is readily distinguished from the crocus and the bulbs 
of most other plants which resemble it by being solid and not composed of separate 
layers or shells like an onion. It should be collected in July. The preparation 
most commonly used for internal administration is the wine, which is made as 
follows : — " Macerate four ounces of colchicum conn, sliced, dried, and bruised, in a 
pint of sherry for seven days, with occasional agitation, press, and strain through 
calico, and then add sufficient sherry to make it up to a pint. This is by far the 
best preparation to keep for ordinary use. The dose is thirty drops three times a 
day, in a little water." 

Colchicum is undoubtedly the most valuable remedy we possess for the treat- 
ment of gout. It is often stated that colchicum exerts its peculiarly beneficial effect 
on gout simply by purging the patient. This is not the case, for colchicum will 
often effect a cure when administered in doses far too small to have any purgative 
action ; and, on the other hand, other purgatives may be given till the patient is 
well-nigh exhausted without his experiencing the slightest benefit. There are two 
ways in which colchicum wine may be given for gout — either frequently in moderate 
doses, say, thirty drops three times a day, or in one large single dose of a tea-spoonfuL 
The large dose usually cures more quickly than the small, and when the patient is 
suffering much pain, and is extremely anxious to get rid of his enemy, it is better to 
employ this method. When, on the other hand, the patient has only "a little 
touch " of the gout, he can afford to use the smaller doses, and effect a more leisurely 
cure. The tea-spoonful dose of colchicum soon excites a feeling of warmth at the 
stomach, with a glow and outbreak of perspiration all over the body. The effect of 
this large dose is generally very rapid, for it will often remove the severest pain of 
gout in one or two hours, and very soon after the heat and swelling subside. It 
must be remembered, however, that colchicum is merely a palliative — that it eases 
the sufferer's pain for the time, but that it has no power to effect a permanent cure, 
or to ward off future attacks. 

Not only in gout itself does colchicum afford relief, but its administration proves 
beneficial in almost all complaints from which gouty people suffer. Thus, if a gouty 
person is suffering from a bad cold, or from asthma, or from indigestion, or even 
from a skin disease, he will probably obtain more speedy relief from colchicum than 
from any other drug. 

Colchicum less frequently effects a cure in rheumatism than in gout, though there 
are many pains in the limbs and joints, not gouty in origin, which are benefited by 
the drug. Five-drop doses of colchicum wine will not unfrequently cure that 
obstinate complaint called crick in the neck. 

In using colchicum, the requisite number of drops of colchicum wine should be 
dropped into a glass, and taken with about two table-spoonfuls of water. 

COLOCYNTH. 

Colocynth is the fruit of the " Bitter Apple," a plant belonging to bhe fanily 
which yields us the melon, gourd, and cucumber. It grows abundantly in India 



DIGITALIS. 783 



and on the shores of the Mediterranean. It is about the size of an orange, though 
somewhat lighter in colour, and is covered with a hard, thick rind. It is usually 
peeled before being sent to England, so that we receive only the white, spongy 
portion, which forms the pulp or pith. This is frequently used as a show specimen 
in chemists' windows, being met with in white balls, which are tough, but at the 
same time light and porous. The smaller variety of the fruit is considered the best, 
and is usually imported with the seeds removed. 

Colocynth is a powerful purgative, producing copious watery evacuations. It is 
seldom given alone, from its tendency to cause griping, but is used to increase 
the action of other apd milder purgatives. It usually operates mildly, certainly, 
and effectually. The "compound colocynth pill " is a favourite aperient, and 
may be given with safety in all forms of obstinate constipation. It contains, 
in addition to colocynth, Barbadoes aloes, scammony, sulphate of potash, and oil 
of cloves. 

It is often advisable to combine colocynth with a little blue pill, as in Pr. 60. 
The pill should be taken at bed- time, and may be followed in the morning by a dose 
of the white mixture (Pr. 25). 

DIGITALIS. 

This, our common " foxglove," is not only one of the most beautiful and conspi- 
cuous of our indigenous plants, but also one of the most valuable articles of the 
materia medica. It is so well known that it would be superfluous to enter into 
any detailed description of its characters. It grows wild in almost every county 
in England, Norfolk and Suffolk being the most conspicuous exceptions. 

It would seem probable that both the Latin and English names bear reference 
to the shape of the flowers, although it is supposed by some that foxglove is a cor- 
ruption of " foxes' glew " or " foxes' music," in allusion to an Anglo-Saxon musical 
instrument consisting of bells arranged on an arched support. All parts of the plant 
have at different times been used in medicine, but the leaves only are now officinal. 
As doubts have been expressed as to the activity of the cultivated varieties, it is 
advisable to use the wild plant if it can be as readily obtained. The roots collected in 
the autumn or winter of their first year are possessed of active properties, as are also 
the seeds. The leaves should be gathered when the plant is in its greatest perfec- 
tion — that is just before or during the period of flowering, and those are to be pre- 
ferred which are full-grown and fresh. They may be placed in baskets and dried in 
the sun, or gradually before the fire. They should be preserved in well-stoppered 
bottles covered externally with black paper, and kept in a dark cupboard. As they 
in time degenerate and lose their active properties, the supply should be renewed 
annually. 

The preparations of the digitalis used in medicine are the tincture and infusion. 
The infusion is made by steeping thirty grains of dried foxglove leaves in half a pint 
of boiling water for an hour, and then straining. Digitalis is a powerful drug, and 
it is not by any means a matter of indifference of what strength the infusion is 
made. A young man recently nearly lost his life from the careless preparation and 
use of this drug. He filled a quart pitcher with the leaves of the foxglove, and 



784 



MATERIA MEDIO*. 



poured over them as much water as the jug would hold. At bed-time he took a tea- 
cupful of this strong infusion, and on the following morning a similar dose of the 
then still stronger infusion. He soon felt dizzy and heavy, began to stagger, 
then became unconscious, and had to be conveyed homa He vomited almost 
continuously, the vomited matter being of a grass-green colour, and on recovering 
consciousness he complained of excruciating pains in the bowels. His pulse was low, 
bo low indeed that it was feared that every moment would be his last. Fortunately, 
however, he rallied, and under appropriate medical treat- 
ment was gradually, though very slowly, restored to 
health. 

What to do in cases of Poisoning by Foxglove.— 1. 
Send for a doctor. 2. Keep the patient lying down flat 
on his back. 3. Give frequent stimulants, such as hot 
brandy-and-water and sal volatile. As a rule, it is un- 
necessary to give an emetic, as the digitalis causes vomiting. 
For medicinal purposes the fresh and well made in- 
fusion should be used in preference to the tincture. In 
all treatment the object should be to obtain the greatest 
possible effect by the use of the smallest possible dose of 
medicine. This is especially the case with a drug like 
digitalis, which may have to be administered for consider- 
able periods of time, so that there might be a danger of 
its gradually accumulating in the system and producing 
untoward results. It is advisable in most cases in which 
the use of the foxglove is indicated to begin with half tea- 
spoonful doses of the infusion three or four times a day, 
and to increase the quantity gradually only when the drug 
appears to be losing its influence. 

Digitalis is especially a heart remedy — a remedy that 
stands us in good service in cases of need. Sufferers from 
giddiness, tendency to fainting, breatJUessness on exertion, 
and pah citation of the Jieart, will do well to take the infu- 
sion of foxglove in the cautious manner we have indicated. 
When this condition is also attended with anaemia (paleness, or poorness of the 
blood) the digitalis may be advantageous, combined with an iron mixture. In 
Pr. 8 we have the formula for such a combination. 

Digitalis is one of our best remedies for dropsy, whether dependent on Bright's 
disease or on some affection of the heart. It greatly increases the flow of urine, and 
in this manner drains off the fluid from the limbs. Half tea-spoonful doses of the 
freshly prepared infusion will usually be found efficacious. It is not as a rule 
desirable to continue the medicine after the swelling has subsided. 

Digitalis is a useful remedy for spermatorrhcea, although in the majority of cases 
bromide of potassium, as already recommended, is to be preferred. The infusion of 
digitalis may be taken in tea-spoonful doses three times a day lor a week. Strict 
attention must be paid to the general health. 




Fig. 6.— DHHTALX1. 



EPSOM SALTS, AND OTHER SALINE PURGATIVES. 785 

The foxglove is useful in headache when confined to the foreliead, and of a heavy 
throbbing character ; and it is especially indicated when this condition is combined 
with buzzing in tlie ears, dimness of sight, and tJie presence of sparks and colours 
before tlie eyes. The best plan is to give five or ten drops of the infusion of digitalis 
every hour, or of tener, until relief is obtained. 



EPSOM SALTS, AND OTHER SALINE PURGATIVES. 

From the mildness and safety of its operation, its ready solubility in water, 
and its cheapness, sulphate of magnesia, or Epsom salts, was for many years the 
most commonly employed purgative, both by the public and their doctors, although 
its popularity is now apparently somewhat on the wane. Its most familiar name is 
derived from its original discoveiy in 1675 in a spring at Epsom. Epsom has lost 
much of its original reputation as a watering-place, although a good many people 
still make a pilgrimage in that direction about the last week in May. 

Sulphate of magnesia is now usually procured from dolomite or magnesia 
limestone, which is used for building purposes, and occurs in different counties in 
England in quantities sufficient to purge the whole human race for centuries to 
come. The characters of Epsom salts are known to most of us. It occurs in 
minute colourless transparent crystals, having a nauseous bitter taste. Some people 
have really a liking for Epsom salts, and will take it in any form, even spread on 
bread and butter. 

As a mild and efficacious purgative it is useful in all cases in which something 
stronger than a mere laxative is required. It should be taken fasting, preferably 
before breakfast, and largely diluted with water. The ordinary dose is from a 
quarter of an ounce to an ounce, but some people have apparently an unlimited 
capacity for Epsom salts, and can take it ad libitum. 

The white mixture (Pr. 25) contains both Epsom salts and carbonate ot 

^nesia. 

Sulphate of magnesia enters largely into the composition of many of our 
popular purgative waters, more especially the Pullna and FriedrichshalL 

A salt which in its purgative properties closely resembles Epsom salts is sulphate 
of soda, or Glauber's salts. Large quantities of it are formed as a residue in the 
manufacture of hydrochloric acid (spirit of salt) from common salt. It is an essential 
constituent of the Cheltenham and Leamington waters, and is also found in Carlsbad 
salts. The dose is from a quarter of an ounce to an ounce, but it is not very often 
used, as its taste is even more nauseous than that of Epsom salts. 

Acid tartrate of potash, or cream of tartar, is another member of this group. In 
the fermentation of wine a crystalline crust is deposited on the sides and bottom of 
the casks, and is known as "argol," or, according to its colour, as red or white 
"tartar." It is dissolved in water, and during the ensuing process of evaporation 
the purest crystals are skimmed off the top, forming " cream of tartar," the substance 
now under consideration. Its dose as a laxative is from four to six drachms, but it 
is usually administered in combination with other drugs — for example, in the form 
of compound jalap powder, or as confection of sulphur, 
50 



T86 MATERIA MEDICA. 



Prepared from cream of tarter is tartarated soda, or " Rochelle salt," so called 
from having been discovered by an apothecary of that city. It is a mild aperient, 
and often acts as a good supplement to stronger purgatives. It enters into the 
composition of the Rochelle draught (Pr. 26), and the ever-popular Seidlitz powder, 
which contains in the blue paper carbonate of soda 40 grains, and Rochelle salt 
120 grains; and in the white paper, tartaric acid 37 grains. 



ERGOT. 

Ergot is a diseased condition of the seed or grain of the rye and some other plants, 
caused probably by the presence of a fungus. When the rye undergoes this change 
it is known as " spurred rye." It is seldom that the whole of the ear of the rye is 
affected, usually a few only of the grains suffering. * The ergotised grains retain very 
much the shape of the ordinary undamaged grains, except that they are a little 
curved, and often cracked. They are of a deep purple or brown colour, and are 
covered more or less by a bloom. They are readily broken across, and the interior 
will be found to be whitish, or of a pink colour. The odour in each individual grain 
is hardly detectable, but in considerable quantities it is distinct and somewhat 
disagreeable. 

According to the older writers on medicine, the most horrible effects have been 
produced by eating ergotised bread. The ergot is said to have produced gangrene of 
the limbs, and ultimately falling off of the legs and feet. In the case of a Sussex 
family the limbs appear to have been shed quite copiously, presumably as the result 
of eating bread made from " rivets," or " bearded " wheat. We fancy there must 
have been some exaggeration in these statements, or that the facts were wrongly 
interpreted, for now-a-days the preparations of ergot are given in large doses, and for 
an indefinite length of time, without the production of any untoward results. 

There are two preparations of ergot in ordinary use for medicinal purposes, the 
liquid extract and the infusion. The former is a very efficient and reliable preparation, 
but in many cases of labour, where it is important to obtain the full action of the 
drug, it is better to use the freshly-prepared infusion. This is made as follows : — 
A drachm of the powdered ergot is thrown into a tea-cupful of boiling water, and 
allowed to stand on the hob for five minutes, with occasional stirring. It may be 
sweetened to taste, and should be taken in two doses, a half at a time, the grounds 
and all being swallowed. It is very important that the drug should be fresh, 
and it should be always kept in a tightly-stoppered bottle. Many medical men, who 
are liable at any moment to be called away to attend a case of midwifery, find it 
advantageous to cany the powdered ergot wrapped in leaden paper in their pocket- 
book or instrument-case. 

Ergot exerts its influence chiefly on the womb, and care must be taken not to 
administer it to pregnant women, for fear of producing a miscarriage. In cases of 
labour the delivery of the child is often facilitated by the administration of ergot, 
but caution is requisite in its employment, and it should be given only under the 
superintendence of a medical man. In first labours and cross births its administra- 
tion is inadmissible, and in the latter case its injudicious use may prove speedily 



FERN BOOT SANTONINE POMEGRANATE SPIRITS OF TURPENTINE. 787 

fatal to both mother and child. In flooding it often proves of inestimable value, 
and by its agency many lives have been saved, when recovery appeared almost 
hopeless. It is best to give a half tea-spoonful dose of the liquid extract of ergot at 
once, and not to lose time in making an infusion. 

In cases of diabetes insipidus, a disease characterised by intense thirst, and the 
passage of very large quantities of urine, the most beneficial results are obtaiued by 
the constant administration of this drug. Twenty drops of the liquid extract of 
ergot should be given three times a day in a wine-glassful of water. No fear need 
be entertained of any injurious effects resulting from its use. 



FERN ROOT — SANTONINE — POMEGRANATE — SPIRITS OF TURPENTINE. 

These substances are used in medicine chiefly for the destruction and expulsion 
of the different kinds of worms which infest the human body. 

The male shield-fern (Aspidium felix mas.) is one of the commonest of the 
British ferns. It is found in woods and shady situations, and on moist banks in 
many parts of the country. The root should be collected in July, August, or 
September, and after the removal of the black portions, fibres, and scales, it should 
be dried and powdered, and then preserved in stoppered bottles. It is made into 
a liquid extract with ether, and in this form is administered for the expulsion of the 
tape-worm. It is contained in the tape-worm draught (Pr. 35). 

Santonica belongs to the same genus of plants as the wormwood or absinth. 
It is obtained chiefly from the Levant, the unexpanded flowers being imported in 
large quantities. These flowers in general appearance closely resemble seeds, and 
have a strong odour and a bitter camphoraceous taste. They yield a white 
crystalline principle, known as santonine, in which form the medicine is usually 
given Patients who have been taking it for any length of time often see every- 
thing tinged yellow or green. It proves very efficacious in the treatment of 
thread-worms, but is inoperative in expelling the tape-worm. Santonine may be 
conveniently mixed with sugar, so as to form a powder, as in Pr. 79. One 
of these is the dose for a child of from two to ten years of age; for an adult 
two should be given. It may be necessary to repeat the dose on two or three 
consecutive days. Sometimes it is advantageous to give the santonine dissolved in 
a tea-spoonful of castor oil instead of in powder. It is occasionally made into 
lozenges, or into little cakes resembling ginger-bread, the more readily to impose on 
the infant mind. 

One of these powders, or even a half or a quarter of a powder, given at bed-time 
often proves successful in arresting the tendency exhibited by many children to 
wet the bed. This method of treatment may succeed even when others have been 
tried in vain. 

The pomegranate (Punica granatum) is a native of the south of Europe, of 
Arabia, Persia, and Japan It was well known to both the Greeks and the Romans, 
and is frequently mentioned in the Bible. It is largely grown in India and Ceylon, 
cniefl/7 for the sake of its fruit. It frequently attains a height of from eighteen to 
twenty feet, and bears large flowers of a beautiful rich scarlet colour. It blossom* 



788 MATERIA MEDICA. 



luxuriantly, even in this country, but here the fruit is seldom obtained in perfection. 
In its native countries the fruit is as large as an orange, and the juicy rose-coloured 
pulp which it contains proves very grateful to patients suffering from the distressing 
thirst of fever. The flowers and the rind of the fruit were employed by the ancients 
for their astringent properties, and are still used in India in the treatment of 
diarrhoea and dysentery. The Chinese, Hindoos, Greeks, and Romans have from time 
immemorial regarded the bark of the root as a specific for tape- worm. They direct 
the maceration of two ounces of the bruised bark of the fresh root for twenty-four 
hours in two pints of water, which is then boiled down to one-half, strained, and 
divided into three doses, which are to be taken at half -hour intervals. Vomiting 
often ensues, but this should not prevent the administration of the whole quantity. 
The treatment should be repeated daily for four or five days. In this country we 
usually obtain the dried root imported from the south of Europe, and it must be 
admitted that it not unfrequently fails. 

Oil of turpentine, or spirits of turpentine, is a clear colourless fluid obtained by 
distillation from the crude turpentine which exudes from the trunks of different 
species of pine. 

It is very efficacious in the treatment of the tape- worm, nearly always killing the 
animal before expelling it. When used for this purpose it should be administered 
in one dose of two or three tea-spoonfuls, which may be given in milk. It usually 
acts as a purgative, but as it is in this respect somewhat uncertain, it is better to 
combine it with a little castor oil. A full dose of turpentine, if not quickly expelled 
from the system by purging, is apt to produce excitement, giddiness, and confusion 
of sight — in fact, a condition closely allied to intoxication. 

Turpentine has, however, other uses irrespective of its power of destroying 
worms. It is a valuable remedy for bleeding of all kinds, whether it be from the 
stomach, bowels, lungs, nose, womb, kidneys, or bladder. It is very conveniently 
given in five-drop doses, frequently repeated, but when the symptoms are very 
urgent it is better to administer it in one large dose of half a tea-spoonful or even 
more. It probably exerts some special influence over the kidneys, for the urine of 
patients taking this remedy acquires an odour which is compared by some to that of 
violets, and by others to mignonette. Large doses often cause the urine to become 
bloody, but this soon disappears on discontinuing the use of the drug. 



-BALSAM OF PERU — BALSAM OF TOLU. 

There are several substances used in medicine known as balsams. Thus we have 
the balsam of Peru and the balsam of tolu, both having very similar properties. 

The balsam of Peru is obtained from a lofty tree growing in Central America. In 
the first place, the bark is bruised by striking it with the back of an axe, so as to 
promote its separation. In a few days it is charred by placing a lighted torch in 
contact with it, with the view of increasing the flow of the balsam. In a week 01 
ten days the bark drops off, or is, at all events, so loose that it can be readily 
detached. Hags are inserted in apertures and crevices in the tree, and soon become 
saturated with balsam. They are then removed and boiled, the balsam being 



FBIAR's BALSAM — BALSAM OF PERU — BALSAM OP TOLU. 



789 



Bkimmed off the surface of the water. Thus obtained, it forms a thick, viscid, 
almost opaque substance, somewhat resembling treacle. 

Balsam of tolu is procured by making incisions in a lofty evergreen tree, a native 
of New Granada. It is a soft tenacious solid, having a fragrant balsamic odour, and 
somewhat resembling in appearance the balsam of Peru. 

Both these substances were at one time extensively employed as application to 
ulcers, cuts, wounds, and abrasions. It was argued that, as they promoted the union 
of external surfaces, they might be used with advantage for many diseases of the 
internal organs. The argument may not have been a sound one, but, nevertheless, 
both balsam of Peru and balsam of tolu act beneficially in some cases of chronic 
bronchitis and winter cough. 

Balsam of Peru is best administered in doses of about half a drachm, made into 
an emulsion with mucilage or yolk of egg. 
The syrup of tolu, in tea-spoonful doses, is 
frequently used as a flavouring agent for 
cough mixtures. 

Benzoin is obtained by making inci- 
sions in the bark of the Benjamin tree, 
growing in Sumatra, Borneo, and other 
islands of the Eastern Archipelago. The 
compound tincture of benzoin, or Friar's 
balsam, is an old favourite, and is known 
by a variety of names. Thus it is called 
indifferently " Tincture of Benjamin,'' 
" Balsam for Cuts," " Jesuit's Drops," and 
" Commander's Balsam." It is made as 
follows : — Macerate two ounces of benzoin 
in coarse powder, one and a half ounces 
of prepared storax, half an ounce of balsam 

of tolu, and one hundred and sixty grains of Socotrine aloes, in one pint of rectified 
spirit for seven days, with occasional agitation, then filter and add more spirit to 
make one pint of the tincture. 

As everybody knows, a piece of soft rag soaked in this preparation forms excellent 
protective for cuts and sores. Internally it is taken in tea-spoonful doses, beaten up 
with milk, usually for bronchial affections and old-standing winter coughs. The 
storax mentioned as entering into the composition of Friar's balsam is a resinous 
body of the consistence of bird-lime, obtained from the bark of a tree growing in 
Asia Minor. 




Fig. 7.— TOLU. 



GENTIAN. 

The yellow gentian (Gentiana lutea) grows abundantly on the Alps of Switzer- 
land and Austria, on the Apennines and Pyrenees," in the mountainous forests of 
many parts of Germany, and in North America. It thrives well in this country in 
a deep, rich loamy soil, and flowers about the end of June or the beginning of 
July, few plants being more stately and ornamental. The flowers are large and 



790 



MATERIA MEDICA. 




Fig. 8.— GENUA*. 



handsome, and yellow in colour, and are placed in whorls upon long stalks. The 
name of the genus was, it is said, conferred in commemoration of Gentius, a king of 
Illyria, who lived many years before Christ, and discovered the virtues of the plant. 
The portion of the plant used in medicine is the root, which is 
imported from Marseilles and other French ports. It is met with 
in long cylindrical pieces, wrinkled longitudinally, and often twisted. 
They have a sweet odour, and bitter taste, are brown externally, 
and yellow and spongy within. There are four officinal prepara- 
tions of the drug — an extract, a mixture, a tincture, and a com- 
pound infusion — all of which, with the exception of the extract, 
contain some other bitter. Thus the infusion contains, in addition 
to the gentian, orange-peel and lemon-peel ; the mixture contains 
orange-peel and coriander-fruit ; and the tincture, orange-peel and 
cardamoms. The extract is often used as a basis for tonic pills, 
and the other preparations are used as bitters, either alone or in 
combination with acids or alkalies. The dose of the tincture is 
from half a tea-spoonful to a tea-spoonful, and of the infusion and 
mixture from two to three table-spoonfuls. It will be remembered 
that the compound infusion enters into the composition of our 
gentian and soda (Pr. 14), gentian and acid (Pr. 15), and gentian and senna 
(Pr. 16) mixtures. Gentian is one of our best stomachic tonics, and is used to 
increase the appetite and promote digestion. It should be given about half an hour 
before meals, 

GUAIACUM. 

Guaiacum has at different periods of its career enjoyed a high reputation for the 
cure of many diseases, but it must be confessed that in reality it is a drug of no 
great value. It is the wood of a tree, some 
thirty or forty feet high, growing in Jamaica 
and the warmer parts of America. We 
usually see it in the chemists' shops in logs 
or billets, which are readily recognised from 
the central portion being almost black, and 
the surrounding wood of a much lighter 
colour. „It is generally known as lignum 
vita — wood of life. It is very hard and 
heavy, and is frequently used for making 
rulers, skittle-balls, and other similar 
articles. The black central portion con- 
tains a large quantity of resin, which is 
obtained by allowing it to exude from the 
living trunk of the tree. The best way in 

which to take this drug is as the ammoniated tincture of guaiacum, which is 8 
solution of the resin in sal volatile. It should be taken in tea-spoonful doses in 
about half a tumblerful of milk three or four times a day. It may be employed 







.— CniAIAOCM. 



GELSEMINUM. 791 



with advantage in many kinds of chronic rheumatism, particularly in that form 
in which the symptoms are relieved by warmth. Rheumatism is such an 
obstinate complaint that any drug which will afford us even a chance of doing 
good should be thankfully received. 

GELSEMINUM. 

This, the yellow jessamine, field jessamine, or woodbine (Gelseminum semper- 
virens), is a native of America, and is one of the most beautiful climbing plants of 
the Southern States. It ascends lofty trees, forming festoons from branch to branch, 
and in its flowering season, in the early spring, scents the atmosphere with its 
delicious odour. It belongs to the Loganiacese or mix vomica family, and is not in any 
way related to our common garden jessamine. It is extensively cultivated as a garden 
plant in many parts of America, not only for the beauty of its flowers and their rich 
perfume, but from the rapidity of its growth and the shade it affords. It begins to 
blossom early in March, and remains in flower until the end of May. It is not 
grown in England, and a specimen now at Kew is, we believe, the only one in that 
country. The portion of the plant used for medicinal purposes is the root, which is 
several feet in length and often an inch or more in diameter. It is doubtful whether 
the leaves possess any medicinal properties, and a tincture prepared from the flowers 
is comparatively inert. 

Gelseminum was first used as a remedy for fever. It was introduced into 
practice by a curious accident. A planter of Mississippi, whilst labouring under a 
severe attack of bilious fever, which resisted ' all the usual remedies, sent a servant 
into his garden to procure a certain medicinal root and prepare an infusion of it for 
him to drink. The servant by mistake collected the root of the yellow jessamine 
and gave an infusion of it to his master, who in a short time became so completely 
paralysed that he was unable to move a limb or even to raise his eyelids, although 
he could hear and was cognisant of circumstances passing around him. His friends, 
greatly alarmed, collected about his bed, waiting the result with much anxiety, and 
expecting every minute to see him breathe his last. After some hours he gradually 
recovered, and was astonished to find that his fever had left him. 

Curiously enough, cases of poisoning by gelseminum are in America by no means 
uncommon. A few years ago a medical man purchased five barrels of tincture of 
gelseminum, and was on his way home, when the vessel grounded on a sand bar on 
the Ohio river. In the process of shifting the freight the barrels were brought on 
deck, and in the hurry and confusion remained there unnoticed. During the night, 
however, the sailors, supposing it to be whisky, tapped a barrel and drew off a 
bucketful, which they commenced drinking out of tin mugs. In the morning they 
were all found lying perfectly helpless, and unable to move even a finger. It wa? 
for a time supposed that they were dead, but an appeal to the doctor decided the 
nature of the case, and by a judicious administration of stimulants they all ultimately 
recovered. The activity of the drug depends upon the presence of a body known as 
gelsemine. It is a powerful poison, and in one case it was estimated that the 
quantity which caused death did not exceed a sixth of a grain. It exerts its influence 
chiefly on the muscles of respiration, and it has been found by experiments on 



792 MATERIA MEDICA. 



animals that in cases of poisoning by this substance recovery will nearly always take 
place if artificial breathing be maintained until the drug is eliminated from the 
«ystem. 

The preparation of gelseminum most commonly used is a tincture composed of 
one part of the plant to four of rectified spirit. It may be obtained from anj 
chemist. The dose for an adult is from ten to twenty drops every three or four 
hours. If the medicine is continued several days, the smaller dose should be given ; 
Pr. 41 may be employed with advantage. In larger quantities it is apt to produce 
pain over the brows, dimness of vision, and giddiness. Gelseminum may sometimes 
be substituted for aconite with advantage in the treatment of fever. It is said to be 
best adapted to the simple fever of childhood. When quinine is not obtainable it 
has been sometimes used with success in the treatment of ague. 

It has obtained a great reputation in the treatment of neuralgia of the jaw. It 
is particularly useful in these cases when the complaint depends on the presence of a 
decayed tooth. In simple acute toothac/ie it may be both given internally and applied 
locally. 

In deep-seated rheumatism considerable success has attended its employment, but 
we are unable at present to say what are the indications for its use. 

It is often used to allay the hard dry cough of consumptives, where there is no 
expectoration It is almost a specific for dull headache and giddiness, and is very- 
useful for that drowsy stupid feeling of which many complain in hot weather. It is 
especially indicated when there is drooping of the upper eyelids, when objects appear 
double. It is a capital remedy for sick-Jieadache. It may be given with advantage 
in the nervous excitement of hysterical people. It appears to exert an action on the 
womb, and it is said to ease difficult and painful menstruation^ and also after-pains. 

Taking it all in all, it is a most valuable remedy. 



HAMAMELIS VIRGINICA. 

This is the witch-hazel, a plant some ten or twenty feet high, growing abundantly 
in nearly all parts of North America. It is usually met with in stony places on 
elevated ground, and frequently on the banks of streams and borders of swamps. 

In former times popular opinion attributed to it extraordinary powers of 
divination. In Michigan it is said to be still used for finding out hidden springs, 
and is likewise relied on for the discovery of treasures, mines, &c. 

It is well known that hamamelis was held in the very highest estimation by the 
Indians, and there can be no doubt that as a curative agent it is a drug of very 
considerable value. 

It is used largely for arresting bleeding, and proves equally efficacious, whether 
the blood comes from the nose, lungs, stomach, bowels, or other organ. It is 
especially indicated when the blood comes up easily, and the bleeding is not attended 
with any expulsive effort. 

It has been used with success in cases of dysentery when there is much blood in 
the motions. 

Hamamelis, in addition to its styptic properties, appears to exert a special 



HELLEBORE. 793 

influence on the veins ; when administered internally it eases the pain of varicose 
veins of the legs, and when the internal administration is supplemented by its 
external application as a lotion, the veins gradually become smaller and smaller, and 
after a time resume their natural size. This statement is startling, but it is true. 

In the treatment of bleeding piles hamamelis is one of our best remedies — it is 
Al. For haemorrhoids, or piles, it is almost a specific. A drop or two of the 
tincture should be administered in a little water every two or three hours, or 
a smaller dose may be given more frequently. This quantity should not be exceeded, 
for large doses often produce severe throbbing pains in the head ; Pr. 45 may be 
employed. For varicose veins and piles it is necessary to apply it externally as well, 
and for this purpose recourse may be had to the hamamelis lotion (Pr. 95). For 
varicose veins the lotion should be applied on a piece of lint covered with a larger 
piece of oil-silk to prevent evaporation, and the whole limb should then be care- 
fully bandaged. A hamamelis cerate, or ointment, is now made, which in the case of 
piles may be sometimes used as a substitute for the lotion. 



HELLEBORE. 

The black hellebore {Helleborus niger), so called from the dark colour of its root, 
is a smooth shining herbaceous plant, about a foot high, a native of the shady woods 
of the lower mountains of many parts of Europe. It is largely cultivated in our 
gardens as an ornamental plant, and from flowering in the winter months has 
obtained its name of " Christmas rose." This, or a closely-allied species, was used 
in medicine 1,400 years before Christ. By the ancients it was regarded as a specific 
for many diseases, and was commonly employed in the treatment of insanity. It 
was the favourite purgative of the Greek physicians, and was especially prized by 
them in the treatment of apoplexy, paralysis, and dropsy. In large doses it is a 
powerful acrid poison. A tincture is made by mixing 2^ ounces of the bruised root 
with a pint of proof spirit, allowing them to stand for a week with occasional agitation, 
and then pressing and straining. 

In modern medicine hellebore is but little used, but it may be given with 
advantage in the different forms of dropsy. In swellings of the legs, and fluid in the 
chest and belly, it proves useful, but it is especially indicated in the case of children 
suffering from water on the brain. The dose of the tincture is one or two drops in a 
little water every two hours. 

HEMLOCK. 

The common spotted hemlock (Conium mactdatum) is a tall umbelliferous plant, 
a native of Britain, and is found growing by the roadsides and hedges, and in waste 
places. It is distinguished from all other plants which it resembles by its tall, 
smooth, spotted stem, its smooth leaves, the rugged edge of the five ribs of its fruit, 
and its peculiar mousy odour. The only other native plant belonging to this natural 
order having a spotted stem is covered with hairs. Cases of *>oisoning with hemlock 
are not uncommon, particularly on the Continent, the root bi ; mistaken for fennel, 
asparagus, or parsnip. The leaves of hemlock have been occasionally substituted for 



794 



MATERIA MEDICA. 



parsley, although, considering their slight resemblance, it is difficult to see how the 
mistake could have arisen. Such mistakes are frequently attended with disastrous 
results. Not long ago several French soldiers, wishing to improve the flavour of 
their soup, threw into the pot a quantity of hemlock leaves chopped fine. One of 
them, who partook rather freely of the pot-au-feu he had helped to prepare, became 
senseless in less than two hours, and died an hour later, his face being so livid that 
he looked as if he had been strangled. His companions, who had been more abste- 
mious, or whose appetites had been less keen, ultimately recovered, although for 
many hours they all appeared to be intoxicated. 

Hemlock derives considerable histo- 
rical interest from having been the state 
poison of ancient Athens, and the in- 
strument of Socrates' death. The account, 
as narrated by his friend and disciple, 
Plato, of the last moments of the philo- 
sopher, and of the heroic calmness and 
resignation with which he met his fate, is 
of touching interest. 

" And Crito, hearing this, gave the 
sign to the boy who stood near. And 
the boy departing, after some time re- 
turned, bringing with him the man who 
was to administer the poison, who brought 
it ready bruised in a cup. And Socrates, 
beholding the man, said, 'Good friend, 
come hither; you are experienced in 
these affairs, what is to be done 1 ' 
' Nothing,' replied the man, ' only when 
you have drank the poison, you are to 
walk about until a heaviness takes place 
in your legs ; then lie down : this is all you have to do.' At the same time he 
presented him the cup. Socrates received it from him with great calmness, without 
fear or change of countenance, and regarding the man with his usual stern 
aspect, he asked, ' What say you of this potion ? Is it lawful to sprinkle any 
portion of it on the earth as a libation or not 1 ' ' "We only bruise/ said the man, 
as much as is barely sufficient for the purpose.' ' I understand you,' said Socrates, 
'but it is certainly lawful and proper to pray the gods that my departure from 
hence may be prosperous and happy, which I indeed beseech them to grant.' So 
saying, he carried the cup to his mouth, and drank it off with great promptness and 
facility. 

" Thus far most of us had been able to refrain from weeping ; but when we saw 
that he was drinking, and actually had drunk the poison, we could no longer restrain 
our tears. And from me they broke forth with such violence that I covered my 
face and deplored my wretchedness. I did not weep for his fate so much as for 
the loss of a friend and benefactor, which I was about to sustain. But Crito, 




Fig. 10.— HEMTOCK. 



HEMLOCK. 795 



nnable to restrain his tears, was compelled to rise. And Apollodorus, who had been 
incessantly weeping, now broke forth in loud lamentations, which infected all who 
were present except Socrates. But he, observing us, exclaimed, ' What is it you do, 
my excellent friends ? I have sent away the women, that they might not betray 
such weakness. I have heard that it is our duty to die cheerfully, and with 
expressions of joy and praise. Be silent therefore, and let your fortitude be seen !' 
At this address we blushed, and suppressed our tears. But Socrates, after walking 
about, now told us that his legs were beginning to grow heavy, and immediately lay 
down, for so he had been ordered. At the same time the man who had given him 
the poison examined his feet and legs, touching them at intervals. At length h« 
pressed violently upon his foot, and asked if he felt it, to which Socrates replied that 
he did not. The man then pressed his legs, and so on, showing us he was becoming 
cold and stiff. And Socrates, feeling it himself, assured us that when the effects had 
ascended to his heart he should then be gone. And now the middle of his body 
growing cold, he threw aside his clothes, and spoke for the last time, i Crito, we owe 
the sacrifice of a cock to ^Esculapius. Discharge this and neglect it not.' l It shall 
be done,' said Crito ; ' have you anything else to say 1 ' He made no reply, but a 
moment after moved, and his eyes became fixed. And Crito, seeing this, closed his 
eyelids and mouth." 

It will be noticed that the symptoms of poisoning do not quite correspond with 
those described in the French soldiers who put hemlock in their soup. It is probable 
that the activity of the plant depends greatly on the season in which it is gathered, 
and on the soil in which it is grown. We are informed, on the authority of a Russian 
botanist, that peasants of his country eat the plant with impunity after it has been 
boiled several times in water, although why they should eat it at all we are not told. 

The only reliable preparation of hemlock is the prepared juice, known technically 
as succus conii. Some years ago the hemlock was vaunted as an internal remedy 
for cancer and all kinds of tumours. The encomiums bestowed upon it led to its 
universal adoption, but time, the greater leveller, has proved that, however benignly 
it sometimes acts when first administered, we cannot attribute to it virtues of so 
conspicuous and valuable a nature. At the same time, the pain of cancerous ulcers 
in the neighbourhood of the womb is often relieved by the use of conium, although 
frequently these effects are temporary, and the drug must be viewed only in the light 
of a valuable palliative. 

In St. Vitus' s dance conium may be used when other means of treatment have 
proved unsuccessful. 

In the early stage of shaking palsy, when only one limb is affected, and the body 
is not weakened by disease and suffering, it may bring relief. 

The hemlock juice should be given in tea-spoonful doses three times a day, the 
dose being, if necessary, gradually increased to twice that quantity. The indications 
that the patient has had enough are drooping of the eyelids, sluggish movements of 
the eyeball, laziness of vision, with giddiness and weakness of the knees. Until these 
symptoms are produced the drug often fails to do any good, but their presence is to 
be regarded as an indication that it will not be necessary to repeat the dose for from 
twelve to twenty-four hours. Conium is in many respects allied to gelseminum. 



f96 



MATERIA MEDICA. 



HENBANE. 

Common henbane (Ilyoscyamus niger) grows wild in the Northern and Eastern 
States, from Nova Scotia to Rhode Island. The English name has obviously 
reference to the injurious effects of the seeds on fowls. The whole plant has a strong 
fetid narcotic smell, and abounds in a clammy juice of a similar odour. The root 
has a sweetish taste— ^-a circumstance which has caused it to be mistaken for parsnip. 
In its medicinal properties hyoscyamus corresponds in many respects to belladonna 

and stramonium. It is used chiefly as a 
substitute for opium, when the latter can- 
not be taken, or when its administration 
is undesirabla As a single dose for the 
relief of pain, from one to two tea-spoon- 
fuls of the tincture may be taken. Hen- 
bane is often added to purgative drugs to 
prevent them from griping. It enters 
into the composition of the calomel pill 
(Pr. 61). 

HYDRASTIS. 

The hydrastis canadensis, or golden 
■eal, is a drug of A merican origin. It is 
a herb about a foot high, usually bearing 
two large leaves and a solitary flower. 
The root is the part used medicinally, and 
of this a tincture is made by treating one 
part with four parts of rectified spirit 

It is a tonic, and is used in the treat- 
ment of indigestion. 

In simple constipation it may be given 
with advantage. 

Its internal administration and local application have been recommended in 
cancer of the breast, but respecting the benefits obtained from this method of treat- 
ment there is considerable diversity of opinion. It is said to relieve pain and 
improve the general health, and in some cases such beneficial effects have followed 
its use that a projected operation has been abandoned. In cancer of the womb it has 
proved useless. It should be borne in mind that even if no benefit is obtained 
from its use, it cannot possibly do any harm. The tincture should be given in drop 
doses every hour. It often does good in piles, and then the internal administration 
should be combined with the use of the lotion (Pr. 96), applied freely on lint, and 
renewed frequently. 

INDIAN HEMP. 

The Indian hemp (Cannabis indica) is essentially the same as that so largely cul- 
tivated for the sake of its" fibre. It was at one time supposed that there were two 




Fig. 11. — HENBAUB. 



INDIAN HEMP. 797 



different species, but 4 a careful examination and comparison have established the fact 
that our common hemp is identical with the plant which from the earliest times has 
been celebrated in the East for its intoxicating properties. The hemp came to us 
originally from Persia, although it is stated to be a native of India, but, like the 
tobacco and the potato, it has a wonderful power of adapting itself to exigencies of 
soil and climate, and is now widely distributed over the surface of the globe. The 
sap contains a peculiar resinous substance in which the esteemed narcotic virtue 
resides. In northern countries the proportion of this resin is so small as to have 
escaped general observation, but in the warmer regions of the East it exudes 
naturally and in considerable quantities from every part of the plant In Central 
India it is collected during the hot season by men clad in leathern dresses, who 
tun through the hemp fields brushing violently against the plants. The soft resin 
naturally adheres to the leather, and is subsequently scraped off and kneaded into 
balls. In other districts the dress is regarded as superfluous, and is dispensed 
with, the collectors appearing in the most primitive costume. The parts used in 
Asia for the purposes of intoxication, and in Europe as a medicine, are chiefly the 
leaves, the flowering top, and the resin. It forms the intoxicating " bang " or 
" hashish " of the Eastern nations, and is known in India as " the leaf of delu- 
sion," the " increaser of pleasure," the " cementer of friendship," the " cause of a 
reeling gait," and the "laughter-mover." It can boast of considerable antiquity, 
and is probably the " assuager of grief " of which Homer speaks as having been given 
to Helen by Telemachus in the house of Menelaus. It is said that during the 
wars of the Crusaders the soldiers of the Saracen army when intoxicated with this 
drug were in the habit of rushing into the camps of the Christians and committing 
great havoc, being themselves totally indifferent to death. These men were known 
as " hashasheens," from which is derived our familiar word "assassins." 

There are several ways in which the cannabis indica may be employed for the 
production of its intoxicating effects. Sometimes it is smoked, but the most com- 
mon form of haschish, and that which is the basis of most of the other prepara- 
tions, is made by boiling the leaves and flowers in water, to which a certain 
proportion of fresh butter has been added. The decoction is evaporated to the 
thickness of a syrup, and is then strained through cloth, the butter in the process 
becoming impregnated with the active resinous principle of the plant In this 
form it retains its active properties for many years, turning only slightly rancid 
with age. Its taste is very disagreeable, and it is consequently usually taken 
mixed with spices and other aromatic substances so as to form a confection or 
electuary. All preparations of Indian hemp are capable of producing intoxication, 
the most prominent effect of a large' dose being a pleasant delirium, followed by 
more or less exhaustion. With Orientals the inebriation resulting from its use 
is usually of an agreeable or cheerful character, exciting the individual to laugh, 
dance, and sing, and to commit various extravagances. The drug is credited with 
the power of producing true happiness, an enjoyment purely moral and etherial, a 
gratification uncontaminated with " things rank and gross in nature." The haschlsh- 
eater is happy, not like the gourmand, when he has satisfied his appetite, but rather 
like him who has just received tidings of great joy. 



798 MATERIA MEDICA. 



Bayard Taylor, in his " Pictures of Palestine," gives a most interesting account 
of the effects produced on himself by a dose of haschish taken experimentally. 
He was not an habitual haschish-eater, having used it only once before in Egypt, 
and then in a very mild form. The experiment was made in a caravansary in 
Damascus) and the drug was freshly procured by his dragoman. He was 
unacquainted with the strength of the mixture or the dose in which it should be 
taken, and he accordingly commenced with a tea-spoonful, allowing the paste to 
dissolve slowly in his mouth. He sat quietly for some time awaiting the result, 
but at the expiration of nearly an hour was unable to detect the least change in 
his feelings. He then took an additional half tea-spoonful, immediately followed 
by a cup of hot tea, to aid its absorption. This proved effectual, and a "fine 
nervous thrill," accompanied by a burning at the pit of the stomach, was suddenly 
experienced. The author in describing his sensations says : — 

" The sense of limitation — of the confinement of our senses within the bounds 
of our own flesh and blood — instantly fell away. The walls of my frame were 
burst outward and tumbled into ruin ; and without thinking what form I wore — 
losing sight even of all idea of form — I felt that I existed throughout a vast extent 
of space. The blood, pulsed from my heart, sped through uncounted leagues before 
it reached my extremities ; the air drawn into my lungs expanded into seas of 
limpid ether, and the arch of my skull was broader than the vault of heaven. 
Within the concave that held my brain were the fathomless deeps of blue , clouds 
floated there, and the winds of heaven rolled them together, and there shone the 
orb of the sun. It was — though I thought not of that at the time — like a revelation 
of the mystery of omnipresence. It is difficult to describe this sensation, or the 
rapidity with which it mastered me. In the state of mental exhalation in which I 
was then plunged, all sensations as they rose suggested more or less coherent images. 
They presented themselves to me in a double form ; one physical, and therefore to 
a certain extent, tangible ; the other spiritual, and revealing itself in a succession 
of brilliant metaphors. The physical feeling of extended being was accompanied by 
the image of an exploding meteor, not subsiding into darkness, but continuing to 
shoot from its centre or nucleus — which corresponded to the burning spot at the pit 
of my stomach — incessant adumbrations of light that finally lost themselves in the 
infinity of space. 

" My curiosity was now in a way of being satisfied ; the spirit (demon, shall 
I not rather say ?) of hasheesh had entire possession of me. I was cast upon the 
flood of his illusions, and drifted helplessly whithersoever they might choose to bear 
me. The thrills which ran through my nervous system became more rapid and 
fierce, accompanied with sensations that steeped my whole being in unutterable 
rapture. I was encompassed by a sea of light, through which played the pure 
harmonious colours that are born of light. While endeavouring, in broken exprea 
sions, to describe my feelings to my friends, who sat looking at me incredulously, I 
suddenly found myself at the foot of the great Pyramid of Cheops. The tapering 
courses of yellow limestone gleamed like gold in the sun, and the pile rose so high 
that it seemed to lean for support upon the blue arch of the sky. I wished to 
ascend it, and the wish alone placed me immediately upon its apex, lifted thousands 



INDIAN HEMP. 799 



of feet above the wheat fields and palm groves of Egypt. I cast my eyes downward, 
and to my astonishment saw that it was built, not of limestone, but of huge square 
plugs of cavendish tobacco ! Words cannot paint the overwhelming sense of the 
ludicrous which I then experienced. I writhed on my chair in an agony of laughter, 
which was only relieved by the vision melting away like a dissolving view ; till out 
of my confusion of indistinct images, and fragments of images, another and more 
wonderful vision arose. I was moving over the desert, not upon the roc king drome- 
dary, but seated in a barque, made of mother-of-pearl and studded with jewels of 
surpassing lustre. The sand was of grains of gold, and my keel slid through them 
without jar or sound. The air was radiant with excess of light, though no sun was 
to be seen. I enhaled the most delicious perfumes, and harmonies such as Beethoven 
may have heard in dreams, but never wrote, floated around me. The atmosphere 
itself was light, odour, and music ; and each and all sublunated beyond anything the 
sober senses are capable of receiving. Before me, for a thousand leagues, as it 
seemed, stretched a vista of rainbows, whose colours gleamed with the splendour of 
gems — arches of living amethyst, sapphire, emerald, topaz, and ruby. By thousands, 
and tens of thousands, they flew past me, as my dazzling barge sped down the 
magnificent arcade ; yet the vista still stretched as far as ever before me. I revelled 
in a sensuous elysium which was perfect, because no sense was left ungratified. But 
beyond all, my mind was filled with a boundless feeling of triumph. My journey 
was that of a conqueror — not of a conqueror who subdues his race either by love or 
by will, for I forgot that man existed — but one victorious over the grandest, as well 
as subtlest, forces of nature. The spirits of light, colour, odour, sound, and motion 
were my slaves, and having these I was master of the universe. The fulness of my 
rapture expanded the sense of time ; and though the whole vision was probably not 
more than five minutes in passing through my mind, years seemed to have elapsed 
while I shot under the dazzling myriads of rainbow arches." 

Sometimes the most ludicrous ideas are produced by the use of the hemp. One 
of Bayard Taylor's friends imagined, whilst under the influence of the drug, that 
he was a steam engine. He suddenly sprang from his seat to the floor exclaiming, 
with a shriek of the wildest laughter, " Oh, ye gods ! I 'm a locomotive !" This was 
his ruling hallucination, and for the space of two or three hours he continued to pace 
to and fro, with a measured stride, exhaling his breath in violent jets, and when he 
spoke dividing his words into syllables, each of which he brought out with a jerk, 
at the same time turning his hands at his sides as if they were the cranks of 
imaginary wheels. The delusion must, in this case, have been very perfect, for 
having raised a pitcher of water to his lips, to quench his thirst, he put it down 
again without drinking, exclaiming, in the greatest excitement, " How can I fill my 
boiler when I 'm letting off steam 1 " 

It is stated that all persons are not similarly affected by Indian hemp, and that 
race and climate exert a modifying influence on its action. It has been estimated 
that it is habitually used for its intoxicating effects by from two to three hundred 
millions of the human race, and there is evidence to show that, when indulged in 
for a length of time, it produces loss of appetite and strength, and considerable 
mental weakness. 



800 MATERIA MEDICA. 



The preparation of the drug most commonly used for medicinal purposes is the 
" Extract of Indian Hemp," made from the il&wering tops of the plant grown in 
India. It may be given in the form of pills (Pr. 67), one to be taken three times 
a day. 

It may be combined with iron when there is great pallor, or any other indication 
for the use of that drug. 

Cannabis indica is a most valuable remedy for megrim or gick-headac/ie. It acts like 
a charm, and is most serviceable in warding off attacks. It is useful in those severe 
forms in which the headache is continuous for weeks and weeks, but it is especially 
effective when from fatigue, anxiety, or change of life the attacks are increasing 
in frequency. In some cases of neuralgia benefit may be experienced from its use, 
but it is not one of our best remedies for this complaint. 



IODINE IODIDE OP POTASSIUM. 

Iodine is made from " kelp," or the ashes of sea-weed collected in the north of 
Scotland and Ireland. T ¥hen pure, iodine is a black crystalline substance somewhat 
resembling bJack-le^d. It stains the fingers, and, on being gently heated over * 
flame, is convert iiito violet vapour, having an extremely pungent and disagreeable 
odour. It is most commonly used dissolved in spirit, in the form of a liniment or 
lotion, when it is readily recognised by its peculiar colour and odour. 

Iodide of potassium is a combination of iodine with potash, and differs very 
markedly in its appearance from iodine itself. It is a white crystalline salt, not 
unlike ordinary sea-salt. It is odourless, has a saltish taste, and dissolves readily 
in water. 

Iodine is not suitable for internal administration, and its use is confined almost 
exclusively to its external application. There are several forms in which it may be 
used for this purpose, of which the " iodine liniment," the " tincture of iodine," and 
" iodine ointment," are the most useful. These differ from one another chiefly in 
their strength, and consequently in their activity. The iodine liniment is made by 
dissolving an ounce and a quarter of iodine, half an ounce of iodide of potassium, and 
a quarter cf an ounce of camphor, in half a pint of spirits of wine. The tincture is 
made by dissolving a quarter of an ounce of iodine, and half that quantity of iodide 
of potassium in the spirit ; whilst the ointment is made by mixing thirty-two grains 
each of iodine and iodide of potassium with a tea-spoonf id of spirit, and two ounces 
of lard. The liniment is not only the strongest, but the most useful preparation ; 
but many people have such a delicate skin that its application would cause too much 
irritation, and recourse must be had either to the ointment or tincture. For children 
the liniment is too strong, and the ointment should be used in preference. 

In consumption the iodine liniment may be applied to the front of the chest 
under each collar-bone, and will very often ease the cough and lessen the amount of 
expectoration when all the ordinary cough medicines have been tried in vain. The 
mode of application presents no difficulty. A little liniment is poured into a saucer 
and painted on the chest in a thin coat, with a good broad brush. As soon as this 
layer is dried a second may be applied, but two are generally sufficient. The smell 



IODINE — IODIDE OF POTASSIUM. 801 

of the iodine often causes smarting and watering of the eyes, and it is consequently 
advisable to keep them shut whilst it is being used, or to turn the head away. 

A layer of cotton wool should be at hand to throw over the chest, so that 
the iodine may be prevented from touching and staining the linen. The lini- 
ment causes considerable smarting for some minutes, and sometimes even for an 
hour or two. It is better on this account to apply it in the morning rather 
than at bed-time, so that the rest may not be disturbed by the irritation. 

Should the smarting really become unbearable the paint can readily be removed 
by washing the part with any kind of spirit that may be at hand, such as eau-de- 
cologne, spirits of wine, or even brandy or whiskey, and the pain will then be quickly 
relieved by the application of a poultice. A solution of iodide of potassium in water 
will also remove it. These preparations of iodine seldom or never blister, and may 
be used in moderation with perfect safety. The outer skin, however, occasionally 
after some days peels off in little flakes, but without leaving any sore. 

Many old-standing coughs not due to consumption may be relieved by a single 
coat of the liniment applied over the whole back. 

In many cases of stitch in the side the iodine liniment painted over the painful 
spot will quickly give relief. 

People who have long suffered from gout and rheumatism with swollen joints often 
apply the iodine liniment with advantage, the swelling in a few days gradually 
subsiding. 

In early and slight cases of ringworm a few drops of the tincture of iodine will 
often effect a cure, though frequently other measures have to be resorted to. 

Iodide of potassium has acquired a great reputation in the treatment of many 
old, long-standing diseases. It is the active ingredient in one or two patent medicines, 
and has made the reputation of several " world-renowned blood-purifiers," the other 
constituents being usually nothing more than a little burnt sugar and water. 

It may be advantageously given according to Pr. 32. This mixture often proves 
beneficial in rlieumatism, particularly in that form which begins in the evening and 
lasts nearly all night, but ceases in the day-time. The fact of the pain being worse 
at night is usually to be regarded a3 an indication that iodide of potassium will do 
good. 

Pains in the bones occurring in middle-aged people, particularly if troublesome 
at night, often yield to this remedy. Nodes or tender swellings, or lumps on the 
bones, such as are sometimes met with on the skin, frequently disappear after a short 
course of this medicine. Painter's colic, and the numerous complaints from which 
painters, compositors, and others who gain their bread by working in lead, frequently 
suffer, may be greatly benefited by this mixture, the iodide of potassium having the 
remarkable power of expelling the lead from the system. 

That troublesome complaint, a cold in the head, may often be cut short by taking 
a couple of doses of this mixture at bed-time. 

Most people can take iodide of potassium even in large quantities, and indefinitely, 
without suffering from it in any way. There are people, however, who are so sus- 
ceptible to its influence that even a single dose of it will bring on a condition which is 
known as "iodism." In "iodism" there is a constant watery discharge from the 
51 






802 MATERIA MEDICA. 



eyes and nose, accompanied by a tight, uncomfortable feeling across the forehead. 
The sufferer is unable to bear the light, and generally shuts himself up in his room 
with the blinds drawn down, his time being chiefly occupied in alternately sneezing 
and blowing his nose. He generally imagines that he has a bad cold in his head, 
and says he can't think where on earth he caught it. On discontinuing the medicine 
this condition disappears almost as rapidly as it came, and the patient is puzzled 
enough to know why his cold got well so quickly. The addition of ten or fifteen 
drops of sal volatile to each dose of the mixture will often prevent the occurrence of 
this condition, even in those who usually suffer from it. Should this addition fail 
to arrest the production of iodism, the patient may regard it as an indication that he 
is unfortunately unable to take the medicine, and must manage to get rid of his 
complaint by some other means. 

IPECACUANHA. 

Towards the end of the seventeenth century ipecacuanha obtained in Paris a 
great reputation for the cure of dysentery. There is a curious anecdote related 
respecting its first introduction to public notice, but as there are several different 
versions of it we take the liberty of telling the story in our own way. It appears 
that a merchant named Gamier, who had been attended by his physician through a 
long and dangerous illness, presented him, on his recovery, with a root which was 
said to be a positive cure for dysentery. The physician, however, being old, and 
having a good practice, was but little inclined to put faith in any new remedy. He 
postponed making a trial of the wonderful root from time to time, and finally gave 
it to his pupil, Helvetius, telling him to do what he liked with it. Helvetius, who 
was a very energetic young man, lost no time in administering it to several of his 
friends and patients who were suffering from dysentery, and the success of the treat- 
ment convinced him that he had indeed found a specific for that disease. He at 
once saw the value of his discovery, but instead of sharing it with the members of his 
profession, for the benefit of suffering humanity, determined to keep it a secret, and 
use it as a commercial speculation. He entered into a contract with the Willing of 
the period, and in a few days the whole city was placarded with bills, setting forth 
the manifold virtues of the new drug. The advertisement was in every paper, the 
hoardings were covered with gaily-coloured posters, sandwich-men promenaded up and 
down the boulevards, and you could not even go outside your door without being 
advised, in letters a foot long, to try " Helvetius's Anti-Dysenteric Pills." Time 
went on, dysentery was unusually prevalent, and at last it was known that the 
Dauphin, the son of Louis XI V., had contracted it. There were frequent consulta- 
tions of the court physicians and surgeons, but still their royal patient got no better. 
At last, having exhausted every means at their disposal, they resolved to send foi 
Helvetius. They could not meet him in consultation after his unprofessional conduct, 
but they told him they were willing to purchase his secret at his own price. He 
agreed to sell it for £1,000, a sum at that time worth very much more than now. 
The money having been handed over to Helvetius, he told them that his remedy was 
ipecacuanha. The truth of his statement was confirmed by the merchant Gamier, 
who opportunely put in an appearance and claimed a share of the profits* 



IPECACUANHA, 



803 



Subsequently Helvetius repented of his evil ways, tore down the objectionable 
placards, was restored to professional favour, and finally ended by writing a learned 
and elaborate treatise on the uses and properties of his favourite drug. 

Ipecacuanha is the root of a plant growing in moist woods near Pernambuco 
and Rio de Janeiro. As met with in the shops it is in irregular contorted pieces 
some three or four inches long, and of about the thickness of a small quill. It 
consists of two parts, an outer brittle portion, which is active, and of an almost 
inert, slender, tough, woody, central cord. The powder is of a pale brown colour, 
and has a nauseous and somewhat bitter taste. 

Some people are extremely susceptible to the action of ipecacuanha, even the 
minutest quantity inducing in them symp- 
toms somewhat resembling those of hay 
fever. This idiosyncrasy is a consider- 
able inconvenience to those who, from the 
nature of their employment, are brought 
much in contact with the drug. A lady, 
the wife of a surgeon, could always tell 
when he was dispensing a prescription 
containing ipecacuanha, from the distres- 
sing tightness in the chest which she 
experienced. If by any mishap she hap- 
pened to enter the surgery, even for a 
moment, whilst the drug was being pow- 
dered, she was almost immediately affected 
with violent and protracted sneezing. 
Sometimes this was followed by difficulty 
of breathing, cough, and spitting of blood. 

In some cases the paroxysms have lasted for days, and the subsequent exhaustion 
has been so great as to threaten the life of the unfortunate sufferer. 

In larger doses ipecacuanha produces nausea and vomiting, accompanied by 
perspiration and a feeling of weakness. The quantity required to excite vomiting 
varies greatly in different people ; with some the smallest dose is sufficient, whilst 
with others large doses are imperative. As a rule, fifteen grains of the powdered 
root, or a table-spoonful of the wine, will suffice to produce the desired result. It 
is often an advantage where time is not an object to administer an emetic in 
divided doses — a sixth part, for example, every three or four minutes. Children 
require almost as much as adults. Ipecacuanha may be described as an emetic 
which is mild, somewhat tardy, but certain in its action. It produces very little 
prostration; but the fact of its not acting instantly renders it a less valuable medicine 
than sulphate of zinc in cases of poisoning. 

In the emetic draught (Pr. 27) the ipecacuanha and sulphate of zinc are 
combined. It is certain and prompt in its action. Vomiting may be promoted by 
draughts of hot water. 

The most commonly employed preparation of ipecacuanha is the wine, which is 
made as follows : — Macerate one ounce of ipecacuanha in coarse powder in one pint 




Fig. 12.— IPECACUANHA. 



804 MATERIA MEDICA. 



of sherry for seven days, with occasional agitation; strain, press, and filter, then add 
sufficient sherry to make it up to a pint. 

"We will now consider the therapeutical applications of ipecacuanha — the diseases 
in which it proves most beneficial, and its mode of administration. 

In the first place, as regards dysentery, the disease in which it won its laurels. 
It is necessary in these cases to administer the drug in large doses, or but little 
benefit will be obtained from its employment. From sixty to ninety grains of the 
powder should be given as a dose, and repeated in from ten to twelve hours if 
necessary. This large dose does not as a rule produce nausea or sickness, but 
should these symptoms arise they may be obviated by making the patient lie down 
immediately after taking the medicine. In old, long-standing cases not requiring 
prompt treatment it is a good practice to administer the first dose at night when 
the patient is in bed. Should the first few doses excite sickness the medicine 
need not be discontinued, as this symptom passes off in a few days. Frequently 
the beneficial effects of the treatment is almost instantaneous, the motions even in 
the very worst cases becoming natural in frequency and character, and relief being 
obtained from the straining and griping. 

Some forms of diarrhoea in children may be admirably treated with ipecacuanha. 
The indications for its employment are vomiting, purging, and the stools being tinged 
with blood. If given hourly, in half tea-spoonful doses of the mixture (Pr. 50), it 
will often succeed in removing the sliminess of the stools, even when the other 
symptoms are absent. The vomiting, when present, is usually arrested before the 
diarrhoea. 

Few remedies are more efficacious in checking some kinds of vomiting than 
ipecacuanha, given according to Pr. 50. It is the best remedy for the vomiting of 
pregnancy. This distressing complaint usually occurs only in the morning, frequently 
on getting out of bed, or whilst in the act of dressing. If relief be not speedily 
obtained from the mixture taken in the ordinary way, a dose should be given on 
awakening, and before any attempt is made to move. Sometimes the nausea and 
vomiting come on before or immediately after every meal, so that the unfortunate 
patient is in danger of dying of starvation in the midst of plenty. Ipecacuanha is 
the remedy in these cases. Sometimes, though rarely, the vomiting of pregnancy 
fails to yield not only to this but to every other medicine. It is probable that in 
many of these cases it is dependent on a displacement or alteration in the shape of 
the womb, which would require treatment by an obstetric physician, or one who has 
devoted especial attention to this branch of medicina Many women who, during 
their pregnancy, have been free from nausea and vomiting, suffer from both these 
symptoms when they are suckling. They may be so constant and severe as to greatly 
exhaust the strength of the mother, and to compel her to wean the child pre- 
maturely. This condition is admirably treated by tea-spoonful doses of the 
ipecacuanha mixture three or four times a day. 

Ipecacuanha undoubtedly exerts a powerful influence on the bronchial tubes, and 
is one of the chief ingredients in nearly all our cough medicines and lozenges. The 
wine, used as an inhalation, in the form of spray, is undoubtedly the best treatment 
for chronic bronchitis (see Bronchitis). 



. 



iron. 805 

In many cases of whooping-cough, Pr. 50 does good; the indications for its adminis- 
tration are the occurrence of retching and vomiting. 

Ipecacuanha has been employed with success in all forms of bleeding, but 
especially in bleeding from the bowels. In some very severe forms of flooding a tea- 
spoonful dose of ipecacuanha wine has arrested the now, and rescued the patient 
from a most critical condition. 

IRON. 

For more than 3,000 years iron has been used in medicine. It was known 
to the antediluvian patriarchs, and it is probable that it was the first mineral 
used internally. By the alchemists it was called mars, and was represented by the 
symbol 6. 

It is a constant and necessary constituent of the body, and enters largely into 
the composition of the colouring matter of the blood. Iron is essentially a blood 
tonic, or "blood maker." It possesses the power of improving the quality of 
the blood, by restoring to it those principles in which it is deficient. In 
the condition known as " anaemia," or " poorness of the blood," there is a deficiency 
of iron in the system, and the administration of this element will effect a cure, 
almost as certainly, though not so quickly, as food will cure hunger or water 
thirst. 

The preparations of iron are numerous, but it is used in the treatment of so 
many diseases that this is a great advantage. We cannot do better than review in 
detail some of the most useful of these preparations. 

Steel Wine is a favourite form in which to administer iron to children. It is 
made by suspending for a month an ounce of iron wire in a pint bottle of sherry in 
such a manner that it is very nearly, but not quite, immersed. The bottle should 
be frequently shaken, and the stopper removed. When the process is complete the 
wine should be strained, and is then ready for use. The best wire to use for this 
purpose is what is known in the trade as No. 35. Some people substitute malaga 
for sherry, and the iron wine so made, if not better, has certainly the advantage ol 
being sweeter. A mixture of sherry and malaga is very palatable. The dose for 
a child is one or two tea-spoonfuls. For an adult a small wine-glassful may be taken 
with a biscuit for lunch. It is a mistake to regard such an agreeable preparation 
as a medicine. The only disadvantage of taking a large dose is that it is apt to 
confine the bowels. 

In Devonshire and some other parts of the country cider is used instead of the 
wine. A handful of iron nails or thin wire is thrown into a bottle of cider, and 
allowed to digest for a week. A wine-glassful is taken three times a day. This 
form is not officinal in England, but is recognised in Germany. 

Reduced Iron, so called from being reduced in its preparation from an oxide 
of iron, is a fine greyish-black powder which is strongly attracted by the magnet, 
and exhibits metallic streaks when rubbed with firm pressure in a mortar. It is 
insoluble in water, but being in a finely divided state is readily dissolved by the acid 
juices of the stomach. It is a most powerful remedy for restoring the condition of 
the blood, and it can be conveniently administered to children, as it is almost 



806 MATERIA MEDIOA. 



destitute of taste, and but a very small dose is required. The iron powders 
(Pr. 76) will be found useful, and may be placed on the tongue or mixed in food 
three times a day. 

Reduced iron can also be obtained as reduced iron lozenges, each containing on© 
grain. From one to six may be taken as a dose. 

The Moist Peroxide of Iron is made by precipitating a solution of persulphate of iron 
with soda, collecting the precipitate on a calico filter, and preserving without drying in a 
well covered vessel. It is a pasty mass of reddish-brown colour. It is not much 
used in the treatment of disease, but is a valuable antidote in case of arsenic poisoning, 
in which it is given in table-spoonful doses as fast as the patient can swallow it. When 
dried and powdered this preparation is used for making chalybeate plaster, which is 
used for lumbago and other complaints, when warmth and rest are desirable. 

Griffith's Mixture, or compound iron mixture, is made as follows : — Hub together 
in a mortar a drachm each of myrrh and sugar and half a drachm of carbonate of 
potash, make them into a thin paste with a little rose water, then add gradually 
more rose water and four drachms of spirit of nutmeg until nearly half a pint of 
milky fluid is formed. Then add twenty-five grains of blue vitriol dissolved in about 
four table-spoonfuls of rose water, and stir it all thoroughly together, when there will 
be about half a pint of mixture. The bottle in which it is kept should be quite full 
and tightly stoppered, so as to exclude the air. In a few days the mixture decom- 
poses, losing its grass-green colour and becoming yellowish-brown, when it is no 
longer fit for use. This mixture has obtained a great reputation for restoring the 
periods in young pallid women in whom they have temporarily ceased. It should 
be taken in doses of two table-spoonfuls or more three times a day, the treatment 
being commenced a week or ten days before the expected time. 

Griffith's Pills, or carbonate of iron pills, are sometimes used for a similar 
purpose, but are far less successful ; one or two may be taken three times a day. 

These preparations were first used by Dr, Moses Griffiths, a physician of the 
last century. 

Tincture of Steel, or tincture of perchloride of iron, is one of our most valuable 
preparations of iron. It is decidedly astringent in its action, and some people 
have a difficulty in taking it. For those who like iron, and with whom it agrees, 
twenty drops of tincture of steel may be taken in a glass of water three times a day. 
For those who are not accustomed to its use Prs. 1 and 2 are to be preferred. The 
chloric ether and glycerine disguise the taste and lessen the roughness of the iron, 
whilst the quassia as a stomachic bitter improves the appetite. 

Blue Vitriol, or Sulphate of Iron, is another very valuable preparation of iron. 
It is an old, old drug, which was used by the Romans in the time of Pliny for making 
ink, It is prepared by dissolving iron wire in oil of vitriol and crystallising the 
solution. It is met with in beautiful light bluish-green crystals, which when dis- 
solved in water form a solution having a very astringent taste. The crystals and 
solution on exposure to air gradually assume a dirty brown colour, an indication 
that they are decomposing and have deteriorated in character. By strongly heating 
the crystals, the water which they always contain is driven off, leaving the dried 
sulphate of iron. 



IRON. 807 

This is, weight for weight, nearly twice as strong as the crystals. It is used in 
the preparation of sulphate of iron pills (Pr. 63). These pills contain nothing but 
dried sulphate of iron and one drop of syrup to make them coherent. A little care 
and knack are requisite to make them, but there is no real difficulty. When 
made they should be as hard as a marble, and should they not exhibit this cha- 
racter it is to be taken as an indication that there has been some error in their 
preparation. 

Syrup of Iodide of Iron. — This is made by the direct combination of iron with 
iodine. The only objection to its use is that it is apt to decompose when exposed 
to the light or air. The decomposition may be to some extent obviated by suspend- 
ing in the fluid a coil of iron wire. It is administered when we wish to give iodine, 
and at the same time desire the tonic and blood-making power of the iron. The 
dose is from twenty drops to a tea-spoonful, which may be given in water. It is 
one of the ingredients of Pr. 4. 

Phosphate of Iron is a slate-blue amorphous powder, insoluble in water. It is 
often used in cases of rickets and other affections of the bones, in which the use of 
iron is indicated. It may be given, freely diluted with water, in the form of syrup 
of phosphate of iron, each spoonful of which contains one grain of the phosphate. 
The dose of the phosphate of iron is from five to ten grains. Pr. 4 contains both 
the phosphate and iodide of iron. 

Parrislis Chemical Food, an American preparation, contains in each tea-spoonful 
one grain of phosphate of iron, two grains and a half of phosphate of lime, with 
potash and soda. The dose is one or two tea-spoonfuls in a little water, three times a 
day. It is undoubtedly a useful preparation. 

Eastoris Syrup is said to contain in each tea-spoonful one grain each of phosphate 
of iron and phosphate of quinine, and one thirty-second of a grain of strychnia, 
besides syrup and water. The dose is a tea-spoonful in water three times a day. 
The presence of strychnia, in this preparation should be borne in mind, as an over- 
dose would undoubtedly be attended with unpleasant consequences. 

Citrate of Iron and Ammonia. — This is a mild preparation of iron, which, from 
its freedom, astringency, and agreeable taste, is readily taken by children and delicate 
people. It is made in thin, shiny scales of a beautiful hyacinth-red colour. It is 
soluble in water and in most infusions, and should be given in doses of from five to 
fifteen grains. Pr. 3 is an agreeable form in which to take it. 

Citrate of iron wine is made by dissolving 160 grains of citrate of iron 
and ammonia in a pint of orange wine, shaking it occasionally, and at the end of 
the third day filtering it, when it is ready for use. The dose is from a tea-spoonful 
to a table-spoonful. 

Tartarated Iron, like the citrate, is a " scaly " preparation. It occurs in thin, 
transparent flakes of a deep garnet colour. It is slightly sweetish and astringent 
in taste. A solution in water is sometimes, on account of its cheapness, used as a 
substitute for steel wine. Such economy in the treatment of the sick is undesirable, 
and is in reality but another name for reckless extravagance. 

Citrate of Iron and Quinine is an elegant preparation combining the properties 
of iron and quinine. Its thin, golden yellow scales have a chalybeate and bitter 



808 MATERIA MEDICA. 



taste, and may be taken in ten-grain doses in any aromatic water. It may be given 
too, in an effervescing form, as in Pr. 7. 

In speaking of the different preparations of iron it will have been noticed that 
some, such as the tincture of steel, are described as being astringent, whilst others 
are said to be destitute of astringent properties. The astringent preparations are 
undoubtedly the most valuable, ]?ut as they sometimes upset the stomach, recourse 
must be had occasionally to those which are milder and less active. Iron salts have 
this disadvantage, that they frequently temporarily discolour the teeth, and stain the 
tongue black. Some people on this account take all mixtures containing iron through 
a quill or straw, sucking them up with as much gusto as if they were drinking 
sherry cobbler. Such a precaution is almost superfluous, for just brushing over the 
teeth with a tooth-brush and rinsing out the mouth with a little tepid water will 
generally suffice to ease the minds of even those who are most particular respecting 
their personal appearance. 

The long-continued use of iron has a tendency to confine the bowels, a point to 
which attention should be directed. The difficulty may be overcome by the occasional 
use of a saline purgative. Many medical men consider that the addition of a laxative 
to an iron preparation increases the activity of the latter. Should the perchloride of 
iron mixture prove too binding, half a tea-spoonful of Epsom salts or five drops of 
tincture of belladonna may be advantageously added to each dose. 

Iron salts colour the stools black, a condition which need excite no alarm, as it 
is a natural consequence of the administration of the medicine. 

There are individual peculiarities with respect to iron, just as there are in regard 
to iodine and many other medicines. Many people tell you that it is no use recom- 
mending them iron, because they cannot take it. They " never could take it," it always 
" upsets the stomach," and brings on " a nasty fulness about the head." They will take 
anything but iron, but iron they cannot and will not take. This, as a rule, means 
nothing more than they have not yet found a preparation of iron that will suit them, 
and when iron is the only remedy that will prove of benefit, our chances of curing 
them depend solely upon our ability to find some form of iron which will not incon- 
venience them. The sulphate of iron pill (Pr. 63), a strong and valuable preparation, 
may often be administered under these circumstances, when everything else has failed. 
In all cases it is advisable to occasionally humour the stomach by changing the form 
in which the iron is given. The continuous use of the same mixture for any length 
of time is apt to become distasteful, merely from its constant repetition, if from 
nothing else. It is almost as bad as being confined to one article of diet. 

It has been said that people of a sanguine temperament owe their disposition to 
an excess of iron in the blood, and that the phlegmatic temperament is caused by a 
deficiency of that constituent. We fear that it can hardly be claimed for iron that 
its administration has the power of improving the disposition If this fact were 
established there are a good many people who might be benefited by a course of this 
tonic. 

Let us now turn our attention to the consideration of those diseases in which 
iron is likely to prove of service. 

In the first place, it is to be regarded almost as a specific for cmcemia, oi 



isoh. 809 

bloodlessness. One so frequently sees people, both men and -women, suffering from 
this condition, that its indications are hardly likely to have escaped our attention. 
The sufferer is pale, languid, listless, and generally out of sorts. The colour has 
flown from his cheeks, and the ruddy hue of health has given place to that pale 
flabbiness which is a sure indication of ill-health. His work is a trouble instead of 
a pleasure, he no longer takes any interest in it, and probably says, or at all events 
feels, that everything is a bore and a nuisance. His appetite is poor, he generally 
suffers from indigestion, and very frequently from some disturbance of the bowels. 
If you examine his nails, or turn down his eyelids, or look at the inside of his lips, 
you will find that they are white and pale instead of presenting their natural florid 
red colour. This is a formidable list of symptoms, but the condition is fortunately 
one which can be readily and quickly remedied by full doses of the perchloride of 
iron mixtures (Prs. 1 and 2), or by taking the sulphate of iron pills (Pr. 63.) The 
patient should of course live as well as possible, and, above all, take plenty of 
out-door exercise. 

Many young and delicate women who suffer from irregularity of the periods 
become anaemic to such an extent that their complexion assumes almost a greenish 
hue. This condition, known as cldorosis or green sickness, is readily controlled by 
the use of iron. As an old writer says : "It is good to cure maidens of the greene 
sicknesse, and sends againe the lively colour into their faces." The systematic use of 
the iron pills is almost invariably attended with the most satisfactory results. A 
pill three or four times a day will in a week produce a very marked improvement. 
The patient's natural colour quickly returns, and the rosy hue of health once more 
mantles the cheeks which it seemed to have forsaken for ever. Iron is equally 
beneficial in cases in which the paleness is the result of some sudden loss of blood, or 
of a long continued and exhausting discharge. It supplies the pabulum of which 
the system has been drained. , 

Bleeding from the lungs, kidneys, or stomach, is often controlled by tincture of 
steel taken in a little water. The less astringent preparations are of comparatively 
little service in these cases. 

Many complaints, such as epilepsy, hysteria, and neuralgia, are greatly aggravated 
by the co-existence of anaemia. Iron, by removing this condition, will often lessen 
the severity of the attacks, Nature, with a new means at her disposal, making a 
fresh effort to restore the balance of health. The effervescing iron mixture (Pr. 7) 
may be taken at intervals with advantage. 

Many children suffering from St. Vitus* s dance will be found on examination to 
be paler than natural, and the administration of some mild form of iron such 
as the citrate of iron mixture (Pr. 3), or the iron powders (Pr. 76), will often, 
by the removal of the impoverished condition of the blood, cure the complaint. 

It may be laid down as a rule that when a patient is markedly pale, iron 
in some form or other will prove beneficial. Even in BrigMs disease, and in 
disease of the heart, iron, although it may be useless as a curative agent, will 
often mitigate the intensity of some of the most distressing symptoms, and at 
all events give temporary relief. 

In diphtheria and in erysipelas large doses of iron should be administered 



810 MATERIA MEDIOA. 



Fifteen to twenty drops of the tincture of steel, given every hour in water for 
several consecutive hours, will do much to lighten the severity of the attack. 
The frequent repetition of the medicine is the essential condition for the attain- 
ment of success. 

JFor the removal of those abominable little thread-worms which so frequently 
infest the lower bowel, an injection containing tincture of steel is very efficacious. 
The injection is made by adding half a tea-spoonful of tincture of steel to a 
pint of water, and throwing this, by means of a syringe, well up into the bowel. 
The iron coming into contact with the parasites quickly destroys them, and 
they are then expelled without difficulty. The use of the iron in the form of 
an injection is necessary, it is almost useless to take it in the usual way — by 
the mouth. 

JALAP AND SCAMMONT. 

These drugs are both yielded by plants belonging to the natural order of 
which our common convolvulus is a member. By jalap we mean the dried roots 
of the jalap plant, a native of Mexico, imported from Xalapa, or Jalapa, the 
city from which the name of the plant is derived. Scammony is a resin obtained 
from the dried root of a species of convolvulus, growing in Syria and Asia 
Minor. It occurs in irregular masses, of a blackish-green colour and musty 
odour. It is most extensively adulterated, the best scammony often containing 
less than one-third of the real drug, the rest being a compound of starch, woody 
fibre, gum, and earthy matter, including chalk. 

Both jalap and scammony are purgatives, and are employed in cases of 
obstinate constipation. The former is best administered in the form of the com- 
pound jalap powder, which consists of jalap, acid tartrate of potash, and ginger. The 
dose of this is for an adult from ten to thirty grains. In dropsies a fifteen-grain 
dose may be given every morning or on alternate mornings with advantage, for a 
brisk watery purge serves to carry off the excess of fluid from the body and 
limbs. There is a similar preparation of scammony known as compound scam- 
mony powder, containing scammony, jalap, and ginger. It is used as a purgative in 
from ten to twenty-grain doses. To children it is given in doses of from three to five 
grains, chiefly for the expulsion and destruction of the little thread-worms which infest 
the lower bowel. The compound jalap and bitartrate of potash powders (Pr. 98) 
will be found useful 

LEAD. 

Lead, the saturn of the alchemists, is not used in the metallic state in 
medicine. 

The oxide of lead is known as " litharge," and is largely employed in making 
plasters. It is formed when melted lead is exposed to a current of heated air, and 
is usually procured during the process of extracting silver from lead ore. It occurs 
in pretty scales of a pale brick-red colour. 

The "lead or diachylon plaster" is made by boiling together four pounds of 
powdered litharge, one gallon of olive oil, and three and a half pints of water, keep- 



LEAD. 81 1 

ing them simmering for four or five hours, and stirring constantly until the mass has 
acquired a proper consistence to be spread on calico. The ordinary "sticking 
plaster " is made by adding to every two pounds of the melted diachylon plaster 
four ounces of resin and two ounces of hard soap. " Soap plaster " differs from the 
latter in the proportions of lead and resin, there being added to every two and a 
quarter pounds of melted diachylon plaster six ounces of hard soap and one ounce of 
resin. We need hardly say that only under very exceptional circumstances would 
it be necessary to make these plasters oneself, for unless a large quantity were 
required those obtained from the chemist would be in all probability equally good, 
and undoubtedly cheaper. At the same time it is desirable to be acquainted with 
the composition of these different plasters, as they differ somewhat in their uses 
and properties. The diachylon plaster is much valued for its adhesiveness, smooth- 
ness, and complete freedom from irritating properties. It forms an excellent strap- 
ping for parts requiring support, and is employed for keeping the surfaces of wounds 
in contact. The ordinary sticking-plaster is still more adhesive, but its use is 
occasionally objectionable on account of its irritating properties. The soap plaster 
is frequently used as an application to tender or abraded surfaces. 

A stout lead plaster will often relieve pain in the loins dependent on general 
•weakness. Pains in the back due to piles or some derangement of the womb are 
often cured by the same means. Plasters occasionally cause intolerable itching from 
the retention of the sweat, but this difficulty is readily obviated by punching them 
at regular intervals with a number of little holes somewhat larger than a pin's 
head. 

Acetate of lead, or sugar of lead, is made on a large scale from litharge. It is a 
white, spongy-looking mass, composed of brilliant, but minute needle-shaped crystals, 
having a sweetish taste. It dissolves in water, forming a clear or slightly milky 
fluid. Sugar of lead is undoubtedly a poison ; but it is much less energetic in its 
action than is generally supposed. Upon one occasion, by some accident, about 
thirty pounds of this substance were mixed at a miller's with eighty sacks of flour, 
and the whole was made into bread by the bakers, and supplied as usual to 
their customers. No fewer than five hundred people were attacked with 
symptoms of poisoning after partaking of this bread, but not one of the cases 
proved fatal. The symptoms produced by an over-dose are a dry, burning 
sensation in the throat, thirst, vomiting, colic, great prostration, and cramps in 
the limbs. 

What to do in Poisoning by Sugar of Lead. — 1. Send for the doctor. 2. Promote 
vomiting by a tea-spoonful of sulphate of zinc and frequent draughts of warm 
water, or any other means. 3. Give a table-spoonful of Epsom salts or Glaubers 



Slow poisoning from the continuous and prolonged introduction of lead into the 
system is by no means uncommon. There are many ways in which this may arise, 
and it is not always easy to detect the source of the mischief. It is frequently met 
with among workmen whose occupations bring them habitually into contact with 
preparations of lead. Painters, who use white-lead in the preparation of their 
colours, so frequently suffer from one of its most prominent symptoms that the 



812 MATERIA MEDIOA. 



complaint is often known as "painters' colic." Card-glazers and paint-grinders are 
subject to the disease, whilst compositors, from handling leaden type, are sometimes 
disabled by it. Lead miners, and more especially those who are engaged in smelting 
the metal, become early acquainted with the disease and its attendant dangers. The 
workmen who are employed to whiten Brussels lace by beating white-lead into the 
fibre, constantly breathe an atmosphere of this poisonous salt, and frequently suffer 
from lead poisoning. It is not, however, by any means confined to those who earn 
their bread by the sweat of the brow, for it is introduced into the system in so 
many different ways, that every one, the richest and poorest, may suffer from its 
effects. Drinking-water which has been kept in leaden tanks or has been conveyed 
for any distance through leaden pipes is a fruitful source of mischief Some years 
ago a contractor undertook to supply a town in the west of England with water 
from a spring some quarter of a mile distant. Leaden pipes were laid down for the 
purpose, and in a few weeks after the opening of the new supply there were a large 
number of cases of lead-poisoning, the teetotalers more especially being sufferers. 
The inhabitants became alarmed, the matter was investigated, and the water supplied 
in the town — although at the spring perfectly pure — was found to be largely con- 
taminated with lead. The leaden pipes were replaced by iron pipes, and the epidemic 
of lead-poisoning, which had so quickly arisen, soon disappeared. 

Home-made wines are often contaminated with lead from being carelessly allowed 
to ferment in jars glazed with a composition containing lead. Shot used for clean- 
ing bottles is accredited with the power of causing lead-poisoning if not removed 
before bottling the wine. Formerly, chronic lead-poisoning was so prevalent in 
Devonshire, that an inquiry was instituted into the origin of what was called the 
Devonshire colic. In the first plaoe it was found that it occurred chiefly in persona 
who drank the cider there manufactured, and by degrees the malady was traced to 
the admixture of lead with the cider, either designedly for the purpose of sweeten- 
ing it, or by the inadvertent employment of lead in the construction of the cider 
mills and vats. Under somewhat similar circumstances arose the colic of Poictou. 
Preparations of lead were largely used to prevent the wines of the country from 
turning sour, the injurious effect of the metal upon the human body not being at 
that time recognised. 

It has been found that in public-houses the beer first drawn in the morning is 
largely impregnated with lead derived from standing during the night in the pipes 
used to convey it from the barrels to the bar. The early tippler has to encounter 
more dangers than is generally supposed. Several curious cases of slow poisoning 
have occurred from the habitual use of snuff coloured with red lead. It occasionally 
happens that even when the snuff has not been intentionally adulterated, enough 
lead has been absorbed from the leaden packing to cause well-marked symptoms, 
Children's farinaceous foods, which have been packed in lead, should be carefully 
avoided. Wafers are sometimes coloured red with lead, a circumstance which has been 
ingeniously employed by a sensational novelist in the elaboration of a plot in which 
slow poisoning was the chief incident. Many ladies will hear with surprise, 
not altogether unmixed with alarm, that lead is one of the commonest ingredients 
of hair dyes, and that it enters largely into the composition of some of the most 



LEAD. 813 

popular cosmetics. Many cases of lead poisoning have arisen from the too frequent 
and liberal application of preparations rejoicing in the name of " Bloom of Youth," 
or some equally attractive title. 

Occasionally, sugar of lead, takenfor medicinal purposes, has excited symptoms of 
poisoning ; but such cases are rare, and afford no ground for abandoning the use 
of a most valuable remedy. A very small quantity of lead, if frequently repeated, 
is adequate to produce all or some of the symptoms of lead poisoning — a quantity, 
for instance, not greater than from one-fortieth to one-fiftieth of a grain in the 
gallon. There is no doubt that some people are much more readily affected by lead 
than others ; in fact, the susceptibility to its action runs in families just as much as 
gout does. An instance is related of a lady who presented all the symptoms of lead 
poisoning, from sleeping for a single night in a room which had been recently painted. 
Another lady suffered from lead colic and paralysis, which are supposed to have been 
caused by the emanations arising from some lead works situated nearly three-quarters 
of a mile from the house in which she resided. Of course, such cases as the last 
are quite exceptional, and can be regarded only in the light of curiosities. The 
possibility of the use of the preparations of lead for criminal purposes should 
not be overlooked. 

The symptoms caused by slow lead poisoning are so characteristic that the 
nature of the complaint cannot, in well marked cases, remain long unrecognised. 

In the first place there is " colic," pain of a most distressing character in the 
walls of the abdomen, chiefly in the region of the navel. At one time it raged like 
an epidemic in a portion of tne fleet, from the accidental impregnation of the rum 
with lead, and was then known as the " West Indian dry belly-ache." The pain is 
usually eased, but occasionally aggravated, by firm continuous pressure. Very 
frequently the colic is one of the first symptoms of lead poisoning, but occasionally 
its appearance is delayed until long after the nature of the complaint has been 
determined by other signs. The colic is usually associated with, and possibly 
dependent on, a confined state of the bowels. The constipation caused by lead is 
most obstinate, even powerful purgatives producing very little effect Frequently 
the patient suffers from cramps in the calves of the legs, and other parts of the body, 
He is harassed by pains in the joints, which are generally of a rheumatic character, 
and are increased by movement of any kind, but more especially by cold, damp, or 
wet weather. 

In addition to these symptoms there are complete loss of appetite and intense 
thirst, the mouth is dry, and the breath usually offensive. The general nutrition of 
the body is impaired, the skin becomes pale and sallow, and soon the patient is but 
a shadow of his former self. Sometimes there is paralysis, which frequently 
assumes the form of " wrist drop." The muscles of the arm are wasted, the wrist 
can be no longer straightened, and the hand hangs down powerless and useless. 

A very curious symptom, and one which is always associated with chronic lead 
poisoning, is the occurrence of a blue or purplish line running along the edges of the 
gums, just where they meet the teeth. It is seen on the gums only where they 
come in contact with the teeth, and where there are no teeth the line is absent. It 
is observed first, and is always most marked on the gums in the neighbourhood of 



814 MATERIA MEDIOA. 



the front or incisor teeth. It is one of the earliest indications of the effect of lead 
on the system, and is one of the last to disappear. It is never absent in slow 
poisoning by lead if there are any teeth, and its presence has served to elucidate the 
nature of many a previously obscure case of disease. When colic or " wrist drop " 
is present this blue line should always be looked for. 

We must now consider the treatment to be adopted in cases of lead poisoning. 
Obviously the first thing to do is to detect the origin of the mischief, and to make 
sure that no more lead is introduced into the system. In the case of contaminated 
water, some other source of supply must be found, or the patient must confine his 
attention to other beverages. It is always desirable to start with a good purge, and 
two table-spoonfuls of Pr. 34 should be taken every four hours, until the bowels are 
well opened. The iodide of potassium mixture (Pr. 32) should then be taken in two 
table-spoonful doses three times a day. In cases of " wrist drop " galvanism will 
probably have to be resorted to under medical advice and superintendence. 

When a person has once suffered from lead poisoning he will in all probability, 
unless extremely careful, be attacked again. If a worker in lead, he should make 
an endeavour to find some occupation in which he is not brought in contact with 
the metaL Except in the case of young men, it must be acknowledged that it is no 
easy matter to change one's employment. If unfortunately obliged to return to his 
old work, he should pay the utmost attention to cleanliness — a point too frequently 
neglected by artisans who work in metals. The face and hands should, if possible, 
be always washed before meals, the mouth should also be rinsed out, and the hair 
combed. The working clothes should be washed once or twice a week, and should 
be used as little as possible out of the workshop. The meals must never be taken 
in a room in which the manipulation of lead is in any form in progress. Many 
workers in this metal find it advantageous to take three or four times a day, in a 
little water, fifteen drops of aromatic sulphuric acid. The acid combines with the 
lead to form an insoluble compound, which is not absorbed into the system. In 
many large lead works the men are given treacle-beer acidulated with sulphuric 
acid. It is made as follows : — 

Treacle, 151b.; bruised ginger, Jib.; water, 12 gallons; yeast, 1 quart; bicar- 
bonate of soda, ljoz.; oil of vitriol (sulphuric acid), 1J oz. by weight. Boil the 
ginger in two gallons of water, add the treacle and the remainder of the water (hot), 
put the whole in a barrel, and add the yeast. When the fermentation is nearly 
over add the oil of vitriol, previously mixed with eight times its weight of water ; 
lastly the soda, dissolved in a quart of water. It is fit for use in three or four 
days. 

Goulard water is a dilute solution of subacetate of lead. It is a cooling, 
sedative, and astringent lotion, and is frequently used externally as an application to 
bruises, burns, scalds, and wounds of all kinds. In some forms of skin disease, 
when there is much inflammation, and when the surface is raw and weeps copiously, 
the lotion applied on linen not only checks the discharge, but allays the accompany- 
ing itching, burning, and tingling. The application should be renewed frequently. 
It is a poison when taken internally. A drummer in a French regiment, who was 
much addicted to drinking, stole a bottle of Goulard water and drank it for the sake 



LOBELIA. 815 

of the spirit which it contained. How much he actually drank was not ascertained, 
but the quantity was sufficient to cause death on the evening of the third day. 

Sugar of lead is, from its astringent properties, largely used internally for check* 
ing bleeding from all parts of the body, but more especially from the lungs and 
stomach. It is best administered according to Pr. 30, two table-spoonfuls being taken 
every four hours until the bleeding ceases. This mixture is useful in all forms of 
diarrhoea. It is frequently successful in arresting the purging of dysentery and 
typhoid fever. It is also used for arresting the morbid changes in the kidney in 
Bright 's disease. 

LOBELIA. 

Indian tobacco (Lobelia inflata) is a native of North America, and was used by 
the aborigines long before its introduction into European practice. For many years 
it was employed almost exclusively by the so-called medical herbalists, who stoutly 
maintained that it was incapable, even in large doses, of producing any ill effects. 
Many deaths have occurred from its injudicious use, and although it is a valuable 
remedy for many diseases it is not a drug which can be given in unlimited quantities. 
The symptoms produced by lobelia poisoning are very similar to those resulting from 
tobacco. Some people are very susceptible to the action of the drug, and even a 
small medical dose may cause a good deal of depression, and perhaps vomiting. 
These effects, although disagreeable, are transitory, soon passing off. The prepara- 
tion of lobelia most commonly employed is a tincture of the strength of two and a 
half ounces of the dried plant to a pint of spirit. 

Lobelia has obtained its reputation chiefly in the treatment of asthma. On any 
indication of the onset of an attack, the use of the medicine should be at once com- 
menced. Ten drops should be given every ten minutes in a little water for an hour, 
or until relief is obtained. By this method of using divided doses the risk of 
depression is almost completely obviated, for the patient can discontinue the use of 
the drug as soon as there is any nausea or sickness. 

Sometimes lobelia proves very useful in whooping cough, in a few days reducing 
the frequency of the spasmodic attacks by one-half. For children of ten years of 
age, fifteen drops of the tincture should be given every hour, with an additional 
dose before each paroxysm, if its advent can be predicted. For very young children 
five drops of the tincture may be given every hour. Curiously enough children are 
infinitely more tolerant of lobelia than are adults, it seldom causing in them any 
depression or nausea. 

LETTUCE AND HOPS. 

The common lettuce possesses distinct narcotic properties. Its sedative powers 
have been long and familiarly known, and we are told in the fables of antiquity that 
after the death of Adonis, Yenus threw herself on a bed of lettuces to lull her grief 
and sooth her anguish. It is related moreover of Galen, the celebrated physician of 
the first century, that he was in the habit of eating a lettuce at bed-time, for the 
relief of sleeplessness, a practice still resorted to with success by many who 
experience a difficulty in obtaining their fair share of rest 



816 MATERIA MEDICA. 



The leaves of our common garden lettuce are universally esteemed as a cooling 
and agreeable salad, but when the plant is allowed to flower it develops a bitter 
milky juice, leaving an odour allied to that of opium. "When the stem is cut off 
about a foot from the top this juice freely exudes, and by exposure to the air dries 
and forms a brown solid called lactucariwm or lettuce opiivm. This substance 
is yielded in still greater abundance by the strong-scented lettuce (Lactuca virosa), 
a plant growing wild in the neighbourhood of hedges and old walls. It is readily 
distinguished from the cultivated variety by the shape of its leaves and the purple- 
red colour of the stem. 

The lettuce is at present but little used in medicine, although by some it is 
regarded as one of the most valuable of our native plants, the dried juice constituting 
an excellent substitute for opium. Lactucarium, like many sleep -producing agents, 
is somewhat uncertain in its action, but it may, nevertheless, be used with advantage 
in cases in which the use of opium is inadmissible. The ordinary dose for an adult 
is from two to ten grains dissolved in spirit. 

The 7iop is not much used in medicine, although it is reputed to possess sedative 
properties. In hot countries a hop pillow is often recommended for sleeplessness. 
It is occasionally used with advantage in cases of restlessness, when for any reason 
the use of opium is considered objectionable. The benefit said to have been obtained 
from it by George III. brought it for a time into more general notice. 

In the form of bitter-beer the hop is an excellent remedy for dyspepsia and 
debility of the digestive organs. 

LIME WATER AND CHALK. 

As both these substances contain lime, and are used in medicine for very similar 
purposes, they may be conveniently considered together. 

Lime, or quick lime, is usually made from chalk by strongly heating it to drive 
off the carbonic acid. The best lime, however, is made from white Carrara marble. 
Slaked lime is prepared by adding water to quick lime. Place two pounds of lime 
in a metal pot, pour over it a pint of water, and when vapour is no longer given 
off set it aside to cool. When it is cool it may be taken out, sifted through an 
iron-wire sieve, and kept in a closely-stoppered bottle. Slaked lime should be 
freshly prepared ; it loses much of its activity if allowed to lie about exposed to 
the air. Lime water is readily prepared : — Put two ounces of slaked lime into a 
stoppered bottle containing a gallon of water. Shake it for a few minutes, and 
then place it on one side to settle. In a few hours the undissolved lime will have 
fallen to the bottom, and the upper clear fluid may be decanted off and used as 
required. It is important to keep the bottle well stoppered. 

Lime is much more readily soluble in sugar-and-water than in pure water, and 
advantage is taken of this fact to make a saccharated solution of lime, which is 
twelve times as strong as the ordinary lime water. It is made as follows : — Hub 
up together one ounce of slaked lime and two ounces of white sugar. Transfer the 
powder to a bottle containing a pint of water, and shake it occasionally for a few 
hours. Finally draw off the clear solution and keep it in a stoppered bottle. 

We need, we presume, say nothing concerning the origin of chalk. Before 



LIME WATER AND CHALK. 817 



being used in medicine it has, however, to undergo a little preparatory treatment, 
which is similar to that used in making whiting. It is reduced to a very fine 
powder, being ground in a mill, and it is then stirred round and round in water, 
so as to separate the grosser impurities by allowing them to sink to the bottom. 
The pure chalk which is held in suspension is subsequently allowed to subside, and 
is made into little cakes and dried. 

Chalk mixture is made by rubbing up together a quarter of an ounce of prepared 
chalk and gum acacia with seven and a half ounces of cinnamon water, and then 
adding half an ounce of syrup. 

The aromatic powder of chalk contains a large number of ingredients. It is 
made by mixing thoroughly eleven ounces of prepared chalk, four ounces of cinnamon 
bark in powder, three ounces each of nutmeg and saffron, one and a half ounces of 
powdered cloves, one ounce of cardamom seeds, and twenty-five ounces of refined 
sugar. Believers in a combined effect should have great faith in this preparation. 

Lime is a constituent of both the hard and soft tissues of the body. It forms 
more than two-thirds the weight of bones, which, on being deprived chemically of 
their salts, are converted into mere flexible gelatinous masses. 

A knowledge of this fact leads to the administration of lime in cases of rickets, 
in which disease there is a deficiency of earthy matter in the bones. 

Lime water is a useful remedy for vomiting, and also for diarrhoea. It often 
proves useful in vomiting resulting from ulceration of the , stomach. It should be 
mixed with milk, either in equal parts or in the proportion of one of lime water to 
four of milk. When the vomiting is incessant it may be necessary to feed the 
patient on this alone, until the stomach has recovered itself sufficiently to bear solid 
food. Small quantities of the milk and lime water are often retained when every- 
thing else is at once rejected. It is as well to begin with a tea-spoonful, or at most 
a table-spoonful, administering it frequently, and very gradually and cautiously 
increasing the dose. 

Babies very often throw up their milk ; in fact, they generally do so. Some- 
times the milk is curdled, and comes up in lumps; sometimes it passes in this 
curdled condition from the stomach into the intestines, and is a fruitful source of 
colic, wind, diarrhoea, and consequent wasting. Children often suffer greatly from 
this cause. Of course in these cases attention must be paid to the dieting, and more 
particularly to the quality of the milk; but if no error can be detected in this 
direction, lime water will generally overcome the difficulty. It prevents the lumpy 
coagulation, and cures the vomiting, diarrhoea, and their attendant evils. One-eighth 
part of lime water added to the milk usually suffices, but in case of failure, larger 
quantities of each, even equal parts, should be tried. 

In all cases in which ordinary lime water is used, one-twelfth the quantity of 
the saccharated solution of lime may be substituted. Under many circumstances, 
in travelling, for example, it is a great advantage to be able to use a concentrated 
solution. In many cases of simple diarrhoea occurring in adults, a couple of table- 
spoonfuls or more of the chalk mixture will restrain the over-action of the bowels ; 
whilst for children, from five to twenty grains, according to the age, of aromatio 
chalk powder will have the desired effect. 
52 



818 MATERIA MEDICA. 



MAGNESIA. 

There are four different kinds of magnesia in common use, calcined magnesia, 
heavy calcined magnesia, carbonate of magnesia, and heavy carbonate of magnesia, 
irrespective of several patent preparations. 

Carbonate of magnesia is made by dissolving ten ounces of Epsom salts and 
twelve ounces of carbonate of soda, each in a pint of water. The two solutions are 
then mixed and the whole evaporated to dryness on a sand bath. The residue is 
digested for half an hour with two pints of water, the insoluble carbonate of 
magnesia is collected in a calico filter, and after repeated washing by allowing water 
to run over it, it is dried at a temperature not exceeding boiling point. 

In the preparation of the light carbonate of magnesia the same ingredients are 
used and in the same proportions, but the solutions employed are four times as 
weak. 

Calcined magnesia is made by exposing the carbonate of magnesia to a red heat 
in a crucible until all the gas is driven off. Light calcined magnesia is obtained by 
a similar process from the light carbonate of magnesia. 

The characters and properties of magnesia are so well known, that it would be 
superfluous to enter into a detailed description of them. The two carbonates of 
magnesia effervesce on the addition of an acid, and are thus distinguished from 
calcined magnesia. 

Magnesia and carbonate of magnesia are very similar in their action on the 
system, and are universally used as mild and agreeable aperients. They have an 
alkaline reaction, and might have been ranked with alkalies, but their effects are in 
other respects so widely different that they merit a separate consideration. 

Magnesia is especially indicated in acidity of the stomach and heartburn with a 
tendency to constipation. It is of value in disorder of tlte bowels occurring in children, 
its mild action, freedom from taste, and anti-acid properties proving of great advan- 
tage. It is usually combined with a little rhubarb, and may be given in the form of 
Gregory's powder, of which the dose is for children from five to ten grains, and for 
an adult half a tea-spoonful. As an anti-acid, magnesia is preferable to the 
carbonate, as the latter, by giving off a quantity of gas, distends the stomach. The 
dose of either form of magnesia or the carbonate is, as an anti-acid, from ten to 
twenty grains, and as a purgative twenty to sixty grains. It must be remembered 
that the bulk of the light preparations is much greater than of the others. The 
medicine may be conveniently taken in water or milk and water. 

Magnesia is an extremely insoluble salt, and when used as a purgative, either in 
excessive doses or too frequently, is apt to accumulate in the intestines and give rise 
to very unpleasant symptoms. A lady, subject to attacks of gravel, took every 
night for a period of two years and a half from one to two tea-spoonfuls of calcined 
magnesia. At the expiration of that time she began to suffer from pain and tender- 
ness in the left groin, which was found to be associated with a deep-seated tumour, 
which could be indistinctly felt on pressure. This was followed by constipation, 
alternating with spasmodic action of the bowels, incessant straining, and a highly 
irritable state of the stomach. In one of these attacks she evacuated a number of 



MARSH MALLOW — HOREHOUND — ELECAMPAGNE — COLTSFOOT — LIQUORICE. 819 

soft brown lumps, which on examination were found to consist entirely of magnesia 
she had swallowed, bound together by the secretion of the intestine. The tumour 
was found to have disappeared, and the lady rapidly recovered. Another patient, 
however, was less fortunate, for a post-mortem examination made six months after 
she had abandoned the use of the drug disclosed in her abdomen the presence of a 
mass of magnesia weighing nearly five pound*. 

The solution of citrate of magnesia forms an agreeable and mild aperient draught 
suitable for children and delicate persons, especially where there is irritability of the 
stomach. The following is its mode of preparation : — Dissolve 200 grains of citric 
acid in a pint of water, and having added 100 grains of carbonate of magnesia, stir 
until it is dissolved. Filter the solution into a soda-water bottle, add a table- 
spoonful of syrup of lemons, then introduce forty grains of bicarbonate of potash in 
crystals, and immediately close the bottle with a cork, which should be secured with 
wire or string. The dose is half a tumblerful or more. 



MARSH MALLOW — HOREHOUND — ELECAMPAGNE — COLTSFOOT — LIQUORICE. 

There are several medicines which, though seldom prescribed by doctors, are yet 
not unfrequently employed in the treatment of coughs and colds. Some of the 
commonest of these we have enumerated above. 

The Marsh Mallow (Althcea officinalis) is common in many parts of England, 
growing chiefly in marshes near the sea. In general appearance it closely resembles 
the common mallow or " bread and cheese." The flowers are of a pale rose colour, 
and appear in short clusters from the bosom of the leaves. The root is the part 
usually employed for medicinal purposes. It is 
long, round, branched, and of about the thick- 
ness of the finger. It is naturally of a dirty 
white colour externally, but is sometimes peeled, 
so as to expose the pure white interior. It has 
no odour, but a bland mucilaginous taste. It 
is greatly esteemed by the French, who use it 
in the form of the pdte de guimauve. In this 
country it is commonly taken as a syrup, which 
is prepared as follows : — Macerate one and a 
half ounces of marsh mallow root, dried and 
sliced, in one pint of cold water for twelve 
hours. Press out the liquor, and strain through 
linen. Then add three pounds of sugar, or twice 
the strained liquor, and dissolve with a gentle 
heat. Lastly, when cold, add half a fluid drachm 
of rectified spirit to each ounce. The dose is 
from a tea-spoonful to a table-spoonfuL 

The Common Mallow possesses properties similar to those of the marsh mallow. 
An infusion of the root sweetened with sugar forms a useful drink when the throat 
is dry and sore 




Fig. 13.— ALTHJEA OJTICIWAISB. 



820 



MATERIA MEDICA. 




The Horehound (Marrubium vulgare) is not a common plant in England or 
Ireland, and is still more rare in Scotland, although in a few particular localities it 
is found in great abundance. It enjoyed a great reputation with our ancestors for 

the cure of coughs and colds of all kinds. 
Their favourite preparation was "horehound 
tea," which was made by covering an ounce of 
the plant with a pint of boiling water. It was 
taken in wine-glassful doses. The syrup of 
horehound is prepared by adding sugar to the 
infusion, and the candied horehound of the 
shops is supposed to be made by evaporating 
this down until it becomes solid, 

Coltsfoot (Tussilago farfara) is one of the 
commonest of our native plants, being found 
in profusion in most parts of the country 
From the earliest times it has had a reputa- 
tion for the cure of coughs. Its name is said 
to be derived from the resemblance borne by 
the heart-shaped, small toothed leaves, to a 
colt's hoof. A decoction is commonly made 
by throwing a handful of the leaves into two 
pints of water, and boiling them down to one pint. The dose is a tea-cupful. The 
ancients preferred smoking it, and even in some parts of England this method is still 
adopted ; for the so-called " British herb tobacco " consists chiefly of coltsfoot. A 
nostrum which for many years was sold as " essence of coltsfoot " contained not a 
particle of the substance from which its name was derived. 

Elecampagne {Inula helenium) is a large herbaceous plant having coarse yellow 
composite flowers. In properties it is allied to senega. The root is used in the form 
of decoction, prepared by boiling half an ounce in a pint of water. The dose is 
from two to four table-spoonfuls. The article which for the last five-and-forty years 
has been sold in the shops in London as elecampagne is not a fluid but a solid, 
composed principally of sugar, coloured with cochineaL This having been melted by 
heat is poured into shallow tin dishes, and allowed to cool so as to form a hard 
brittle cake of about an eighth of an inch in thickness. 

Liquorice is an extract prepared from the root of the common liquorice. The 
black cylindrical or flattened rolls, in which we usually buy it, are well known. 
The greater part is imported from Spain, and is well known as " Spanish liquorice." 
When allowed to dissolve slowly in the mouth it may serve to ease a tickling cough. 



Fig. 14— MASBTJBIUM T^LaARE. 



MERCURY, OR QUICKSILVER, 

No mention is made of mercury in the Old Testament, but we are told on the 
authority of an Oriental writer that the Egyptian magicians, in their attempts to 
perform the miracles of Moses, employed wands and cords containing mercury, which 
when warmed by the sun imitated the movements of serpents. It is said, too, that 



MERCURY, OR QUICKSILVER. 821 



the priests of Memphis were acquainted with its physical properties, and employed 
it as a means of conveying motion to the images of the gods in then temples. 

The metal has, in its time, received many names. " Hydrargyrum," " argentum 
vivum," and " quicksilver," are terms by which it has at different periods of its 
history been known, whilst the name mercury was applied to it on account of its 
volatility, and in reference to him who was at once the messenger of the gods and 
the patron of thieves, pickpockets, and all dishonest persons. In alchemy it was 
known by the symbol $, a sign which is still occasionally seen on the large red and 
blue show bottles in the chemists' windows. 

Mercury itself is occasionally found in the metallic state in the form of globules, 
but occurs more frequently as sulphide of mercury or native cinnabar. It is found 
in China, but the principal mines are those of Idria in Carolina, and Almaden in 
Spain. Large quantities have of late years been obtained from California. 

Quicksilver, unlike other metals, is a liquid at ordinary temperature, and is 
remarkable for its weight and beautiful silver colour and lustre. At very low 
temperatures it freezes, and may be obtained in the solid form, whilst, when very 
strongly heated, it is converted into a colourless gas. It readily combines with 
metals to form what is known as an amalgam, a property of which advantage is 
taken in the extraction of the precious metals. Its purity is shown by its brilliancy 
and great mobility, the slightest speck of adhering dirt or dust being readily 
detected. It is usually purified from mechanical admixtures by squeezing it through 
a pocket-handkerchief or piece of wash-leather, or by filtering it through a pin-hple 
in a sheet of paper. Quicksilver when contaminated by metallic impurities rapidly 
tarnishes on exposure to the air, and the presence of lead, tin, or zinc may be 
suspected if a little globule rolled along a smooth dry sheet of paper, instead of 
preserving its spherical form, becomes partly adherent, and leaves behind it a "tail" 
or smudge. 

The injurious effects resulting from prolonged exposure to the vapour of mercury 
are well known. They are observed in water-gilders (who plate with gold 
dissolved in mercury), looking-glass silverers, barometer makers, workmen employed 
in quicksilver mines, and others exposed to the emanations of mercury. In most 
cases it induces a remarkable affection of the nervous system, manifested by the 
production of " shaking palsy " or the " trembles." The first symptom is usually 
unsteadiness of the arm, succeeded by quivering of the muscles, and this at last 
becomes almost convulsive in its character. The tremulous hand can be no longer 
directed with precision, and after a time can scarcely convey food to the mouth. An 
old writer, describing the case of one of his patients, says, " he could not, with both 
his hands, carry a glass half full of wine to his mouth without spilling it, though he 
loved it too well to throw it away." Soon the legs are affected and begin to shake, 
especially at the knees, so that in walking they tremble and dance about almost as 
if they were hung on wires. The speech is hurried, staccato, and stammering, and 
in extreme cases there is disturbance of the intellect. In addition to the excessive 
debility there is complete loss of appetite, with obstinate constipation. When the 
disease attains its greatest intensity the unfortunate sufferer presents a most pitiable 
aspect. In constant tremulous commotion, tottering, trembling, shaking, and 



822 MATERIA MEDICA. 



stuttering, he is almost helpless. He can hardly walk or talk, he dare not touch 
any object for fear of breaking it or letting it fall, and on raising his agitated hand 
with food to his mouth he misses his aim and inflicts involuntary blows on his 
face. He must be fed and clothed like a child. Some unfortunates deprived 
of assistance have been known to crawl on all fours, and seize their food with the 
lips, like the lower animals. 

Many years ago an English man-of-war received on board several tons of quick^ 
silver saved from the wreck of a vessel near Cadiz. In consequence of the rotting 
of the bags, the mercury escaped, and the whole of the crew became more or less 
affected. In the space of three weeks 200 men were struck down by it, two died, 
and all the animals — cats, dogs, sheep, fowls, a canary bird, nay, even the very rats, 
mice, and cockroaches — were destroyed. Early in this century there occurred 
another instance of poisoning by mercury vapour on a still larger scale. A fire 
broke out in the quicksilver mines at Idria, near Trieste, and above nine hundred 
persons in the neighbourhood were attacked with the " trembles." Of late years 
the disease has in this country greatly diminished in frequency — water gilding, the 
most dangerous trade in which mercury is employed, having been in a great measure 
superseded by electro-plating, which is comparatively innocuous. Looking-glass 
silvering may be conducted in large, well- ventilated apartments, furnished with 
special means for preventing the diffusion of the metallic particles, with comparative 
safety, provided always that the workmen are employed only at intervals, and are 
temperate and careful. But when these conditions are disregarded — especially if 
the men are kept continuously at the work — the symptoms already described make 
their appearance in all their horrible intensity. 

For the cure of this complaint the complete removal of the sufferer from his 
noxious employment is absolutely necessary. He should resort to frequent ablu- 
tions, and should, if possible, obtain a change of air. Sulphur taken both internally 
and in the form of sulphur baths, should be used to free the system from the 
mercury, and electricity and galvanism should be judiciously employed under 
medical supervision. 

Mercury is seldom given internally in the metallic state. It has been proposed 
as a solvent for silver coins, accidentally swallowed ; but this mode of treatment, we 
should imagine, would receive neither the approbation of the medical attendant, nor 
the consent of the patient. Formerly pounds and pounds of quicksilver were given 
in obstruction of the bowels, it being supposed that by its mechanical action it would 
succeed in breaking through the impediment. It almost uniformly proved useless, 
and there are now fortunately at our disposal other means which have entirely 
superseded this crude and unscientific mode of treatment. In the reign of 
Charles II. quicksilver was much used by ladies, in doses of a small tea-spoonful 
night and morning, to remove freckles and beautify the complexion. Water 
which had been boiled with mercury was at one time given for the expulsion of 
worms. It was not successful, probably for two reasons — in the first place, mercury 
is perfectly insoluble in water; and secondly, it exerts no influence at all on 
worms. This last statement is proved by the fact that people who are salivated 
with mercury are not cured of their worms; and, moreover, these parasite* 



MERCURY, OR QUICKSILVER, 823 



have been often found in the bodies of those who have spent their whole lives 
working in the quicksilver mines. 

It will be seen that mercury taken into the stomach in the metallic state produces 
no noxious effects, although a small dose of one of its salts might readily affect the 
system. Sometimes, however, the metal when long retained in the bowels undergoes 
some chemical change, and then suddenly produces its full effects on the system. 

The different preparations of mercury are usually employed either as purgatives 
or with the view of bringing the system under the action of the drug. To obtain 
the purgative action one large dose is, as a rule, administered, whilst to ensure the 
constitutional effects small doses are given frequently. The prolonged use of 
mercury is attended with the production of a condition known as " mercurialism." 
This is characterised by a metallic brassy taste in the mouth, slight redness and 
swelling of the gums, and tenderness of the teeth, a foetid breath, and an increased 
flow of saliva. If the use of the drug is still continued a condition known as 
"salivation" or "ptyalism" rapidly succeeds. The mouth becomes violently 
affected, the gums are inflamed and ulcerated, the teeth are loosened, the tongue is 
swollen to such an extent that it hangs out of the mouth, incapacitating the patient 
from either eating or speaking ; the salivary glands are enlarged, very painful, and 
inflamed, whilst the saliva is secreted so freely that it flows most copiously from 
the mouth. In cases of profuse salivation the amount of saliva secreted is very 
great, the fluid pouring from the mouth almost continuously. In one case as much 
as sixteen pints are said to have been collected in twenty-four hours. In addition 
to these by no means trifling symptoms, the patient often suffers from severe 
neuralgic pains in the jaws, a general feverish condition, and a profuse diarrhoea. 

It must be clearly understood that these symptoms are caused only by the abuse 
of mercury, and that all the beneficial effects of the drug may be obtained without 
the production of salivation. Salivation is a distinct evil, and its occurrence can 
always be guarded against by immediately discontinuing the medicine on the 
occurrence of the slightest tenderness of the gums. In years gone by it was thought 
that no beneficial action could be derived from mercury unless the patient were 
thoroughly salivated, and the quantity of saliva to be excreted before the use of 
the drug was discontinued was often fixed by the physician. 

There are many circumstances which influence the production of salivation. 
Some people are extremely susceptible to the action of mercury, a dose which on 
the majority of people would have no effect producing in them profuse salivation. 
There are people who are at once salivated by a three-grain calomel pill, just as 
there are people who can never eat a mutton chop without suffering from symptoms 
which rival in intensity those of Asiatic cholera. Truly what is one man's meat 
is another man's poison. As might be supposed, weak feeble individuals are more 
easily affected than the strong and hearty. Children, however, usually resist in a 
very remarkable manner the action of mercurials, and are rarely salivated. Illness, 
too, influences the operation of mercury, for in inflammation it is well borne, 
whilst Bright's disease and affections of the kidney generally render the system very 
sensitive to the action of the drug, which in these cases should be given, if at all, 
with the utmost caution, 



824 MATERIA MEDICA. 



Salivation is usually caused by the prolonged and injudicious use of mercury, 
but not always, for there are several other drugs which exert a similar influence on 
the salivary secretion. Foremost among them is a South American plant known as 
jaborandi, whilst preparations of arsenic, of antimony, and of copper occasionally 
exhibit this property. There is, too, a condition known as " spontaneous," or " idio- 
pathic " salivation, salivation, that is, occurring without any obvious cause. A French 
physician relates the case of a patient who had been under observation for nine years, 
and had during the whole of that time spat from eight to nine pints of saliva daily. 

As we have described with some minuteness the symptoms of salivation, and 
pointed out the evil effects resulting from the abuse of mercury, it is only fair that 
we should speak of the means at our disposal for the alleviation or cure of this 
condition should it unfortunately occur. 

In the first place a man who is salivated is in no fit condition to go out. During 
the whole time that his mouth is sore he must confine himself to the house, take 
light but nourishing food, regulate the state of the stomach and bowels 4 , and above 
all avoid taking cold. Occasionally he should suck a chlorate of potash lozenge, 
and gargle his mouth and throat with the alum gargle (Pr. 81). Iodide of potassium 
possesses the power of eliminating mercury from the system, and the mixture (Pr. 
32) should be taken three times a day. When the secretion of saliva is very copious, 
tincture of belladonna often proves useful. The patient's strength must be supported, 
and a change of air is usually advisable. 

"We must now consider in detail the different preparations of mercury, and the 
combinations which it forms with other elements. No one desirous of bringing the 
system under the influence of mercury would think of taking a spoonful of quicksilver, 
any more than he would undergo a course of iron by swallowing nails, or taking a 
bite out of the poker. The metal must be given in some form in which it can be 
assimilated and absorbed into the system. 

Grey Powder. — In this the mercury is intimately mixed with chalk, and exists in 
a state of fine subdivision. It is made by rubbing up in a mortar one ounce, by 
weight, of mercury, with two ounces of prepared chalk, until the metallic globules 
can be no longer seen, and the mixture has acquired a uniform grey colour. When 
the drug is made on a large scale labour is economised by placing the ingredients 
in a cask which is rapidly rotated on an axis. It is probable that the chalk and 
mercury are not chemically combined, but are merely in a state of intimate 
mechanical admixture. Grey powder is insoluble in water, but any acid, such as a 
little vinegar, will soon dissolve up the chalk with effervescence, leaving behind a 
residue which, on examination with a lens, is found to be composed of minute 
globules of quicksilver. The ordinary dose of grey powder is, for adults, from three 
to eight grains, but for children much smaller doses are often given. It should 
never be made up into pills, for the contraction of the substance which must be 
added to it to make it consistent frequently squeezes out the mercury, which then 
collects in large globules in the interior of the bolus. It should always be given in 
powder either alone or, if necessary, mixed with a little rhubarb. Prs. 71 and 
72 are useful combinations for children. It will be noticed that the dose contained 
in the first powder is very much smaller than in the second. As already explained, 



MERCURY, OR QUICKSILVER. 825 



we give a large dose when we require the purgative action, but we obtain the 
constitutional effects by the frequent administration of small doses. The powder 
containing rhubarb is a purgative — the other is not. 

Blue Pill or Mercurial Pill, like the last preparation, contains mercury in a 
state of minute subdivision. This is, undoubtedly, the oldest, as well as the most 
popular form of mercurial pill, and is said to have been first introduced by Francis 
the First, King of France. 

It is made by rubbing together mercury, confection of roses, and powdered 
liquorice root. Steam power is now employed for this purpose, a considerable 
advantage, as the efficacy of the pill depends on the extent to which the mercury is 
subdivided. A blue pill may be given either for its purgative properties, or for its 
effects on the general system. The practice of taking a blue pill at night, followed 
by a black draught in the morning, is a very popular form of obtaining a purge. It 
must never be forgotten that " blue pill " is a mercurial preparation, and that 
its constant use may possibly cause salivation, and the other symptoms which arise 
from the over-action of mercury. 

The constitutional symptoms of mercury may be induced by taking blue pill 
with opium (Pr. 62); the opium neutralises the purgative properties of the 
mercury. 

Mercurial Ointment, or blue ointment, as it is often called, has been in use 
for over 1,000 years. It is made by rubbing up mercury with lard and suet, until 
the globules are no longer visible even under a lens. The preparation is effected by 
machinery, in consequence of the difficulty experienced in sufficiently subdividing, 
or, as it is technically termed, " killing " the mercury. Unfortunately this prepara- 
tion is often, to say the least of it, carelessly made. A portion of the mercury is 
omitted, and the requisite depth of colour is obtained by the addition of Prussian 
blue. The ointment is of course for external application only. It is used not only 
locally to tumours of various kinds, but also as a means of affecting the constitution. 
When the latter object is desired a piece of ointment about the size of a walnut 
should be rubbed into the skin night and morning. It matters little to what part 
of the surface the^ ointment is applied, supposing the skin to be moderately thin ; 
but the regions most generally selected are the arm-pits and the inside of the thigh. 
It is better for the patient to rub in the mercury himself, as by that means none 
of the ointment is lost, but should another person be the operator he should protect 
his hand with a leather glove. Moderate warmth and the occasional use of the hot 
bath render the skin supple, and promote the absorption of the drug. 

Quite recently a preparation known as " oleate of mercury " has been introduced, 
which threatens to prove a formidable rival to our old friend the "blue ointment." 
Oleic acid is one of the constituents of common fat, and the oleate of mercury 
consists of the recently precipitated oxide of the metal dissolved in this acid. The 
solutions of oleate of mercury are made of three different strengths. The 5 per 
cent, solution is a perfectly clear, pale yellow liquid, resembling olive oil, but thinner; 
the 10 per cent, solution is also fluid and perfectly clear, but as dark as linseed oil; 
whilst the 20 per cent, preparation is an opaque yellowish unctuous substance, which 
readily melts with the heat of the body and forms a kind of transparent colourless 



826 MATERIA MEDICA. 



varnish when applied to the skin. These preparations are cleanly and economical, 
and have a much greater diffusibility or penetrating power than the old mercury 
ointment, for they are absorbed by the skin with great promptitude, and rapidly 
manifest their remedial powers. They are used in all cases in which the blue 
ointment proves beneficial. They are not rubbed in like ordinary liniments, but 
should be painted on the part with a brush, or lightly spread over with tLe 
finger. They are extremely useful for inducing the action of mercury on the 
system. A piece of the 20 per cent, ointment about the size of a large bean placed 
in the patient's arm-pit night and morning, for five or six consecutive days, 
rapidly and easily, and without any sign of uncleanliness, produces in a mild form 
the constitutional effects of mercury. 

Mercury Plaster contains one-third of its weight of mercury, and is employed 
chiefly as a stimulant in old standing swollen joints and other similar cases. 

Calomel is a subchloride of mercury, and differs chemically from corrosive subli- 
mate only in containing an atom less of chlorine. It was used at a very early period 
by the Hindoos, and was largely prescribed by them internally. It occurs native in 
Spain, and is there known as native calomel, or horn mercury. 

It is usually prepared artificially from sulphate of mercury and common salt. 
A little corrosive sublimate is always formed in the process, and is removed by 
frequent washing with water. The importance of freeing the drug from this impurity 
is very great, as the corrosive sublimate is an active poison when administered in 
doses in which calomel is usually given. 

Calomel is a dull white, heavy powder, almost tasteless, ^,nd perfectly insoluble 
in water, which last property is, as we have seeji, turned to account in its purification, 

Calomel may be ranked among the milder preparations of mercury, and is most 
frequently employed for its purgative properties. It often produces in children the 
so-called " calomel stools," or green motions. It is frequently given in combination 
with other purgatives, particularly as the compound calomel or " Plummer's pill," 
which contains, in addition to the calomel, antimony, guaiac resin, and castor oil. 
When a simple purgative calomel pill is required, Pr. 61 may be used, the henbane 
preventing griping or any unpleasant consequences. When it is desired to employ 
calomel for purposes apart from its purgative action, the calomel and sugar powders 
(Pr. 73) may be employed. 

Calomel is undoubtedly poisonous in large doses, but considerable quantities 
have nevertheless been taken on several occasions without unpleasant symptoms. In 
one case an ounce of calomel was swallowed by mistake, and was retained on the 
stomach for two hours before the error was discovered. The only effects noticed 
were slight nausea and faintness. Subsequently an emetic was administered, the 
calomel was vomited up, and the patient was quite well on the day but one following. 
In this case the drug appears, by some fortunate combination of circumstances, to 
have remained in the stomach unabsorbed. 

When mixed with lime-water, calomel forms the well known " black wash," 
which is frequently used as a local application to sores of a specific nature. 

Black Wash. — Calomel, thirty grains ; lime water, half a pint. Mix to form % 
lotion. The bottle must be well shaken before each application. Label it " poison. • 



MERCURY, OR QUICKSILVER. 827 



Corrosive Sublimate is known chemically as perchloride of mercury. As usually 
sold it is a heavy, semi-transparent, crystalline mass, freely soluble in water, and 
having a strong metallic taste. It is a powerful irritant poison, although in extremely 
small doses it is a most valuable medicine. From three to five grains will kill an 
ai 1 ult. The symptoms produced by large doses come on almost immediately, some- 
Limes even in the very act of drinking the poison. A strong metallic taste is per- 
ceived in the mouth, and is followed by a feeling of constriction and burning heat, 
extending from the throat to the stomach. In a few minutes excruciating pain is 
felt over the abdomen, accompanied by profuse purging, and incessant vomiting of 
mutters tinged with blood. The pulse gradually fails, and in a few hours death is 
ushered in by fainting, convulsions, or general insensibility. The symptoms of 
poisoning by corrosive sublimate at first closely resemble those of Asiatic cholera, 
but should life be prolonged for some days the resemblance to dysentery is more 
striking. 

We shall have frequently to refer to the administration of this salt when speaking 
of the medicinal uses of mercury. The ordinary dose is from y^ to J of a grain. 
The corrosive sublimate mixture (Pr. 48) may be employed. The dose for a child 
is a tea-spoonful given frequently. 

The best antidote in cases of poisoning by corrosive sublimate is white of egg, 
the contents of one egg being sufficient to neutralise about four grains of the poison. 
A few years ago, a celebrated chemist, whilst lecturing, inadvertently swallowed, 
instead of water, a mouthful of a concentrated solution of corrosive sublimate. 
Immediately perceiving the error, he sent for some eggs, which were fortunately 
procured in a few minutes. The whites were at once taken, and the sufferer, 
although the poison was retained, ultimately recovered without any material harm. 
Had it not been for the prompt use of the albumen, he would almost infallibly 
have perished. 

What to do in Poisoning by Corrosive Sublimate. — 1. Send for the doctor. 
2. Swallow the contents of several eggs. 3. If eggs are not procurable take milk 
or flour and water. 4. Take as an emetic in hot water, either (1) a table-spoonful 
of ipecacuanha wine, (2) half a drachm of sulphate of zinc, or (3) a table-spoonful of 
mustard, or (4) the emetic draught (Pr. 27) may be used. 

White Precipitate or Ammoniated Mercury is made by adding ammonia to corrosive 
sublimate. It is an opaque white powder, quite insoluble in water. It is not used 
internally in medicine, but is, unfortunately, too frequently employed by those who, 
weary of life, forget the canon fixed against self-slaughter. The dilute white 
precipitate ointment (Pr. 89) is frequently used as an application in skin diseases, 
and more particularly for the destruction of lice and other parasites. 

Red Iodide of Mercury is a crystalline powder of a beautiful bright vermilion 
colour. It is not soluble in water, but dissolves freely in the iodide of potassium 
mixture (Pr. 32). Respecting its action on the system we have little to say, as it 
so closely resembles in this respect corrosive sublimate. 

The applications of the different preparations of mercury to the treatment of 
disease are very numerous — in fact, mercury is one of the most valuable drugs at 
our disposal. 



828 MATERIA MEDICA. 



The calomel ointment proves very efficacious in the treatment of many forms of 
itching. The annoying itching which accompanies many skin diseases may often be 
allayed by this preparation. In the itching from nettle-rash, however, it is usually 
useless. The ointment is of great service in allaying itching in ilie region of the 
back passage. This affection is often troublesome to cure, and its existence not only 
most effectually prevents the sufferer from going into society, but really renders life 
miserable. A remedy such as this is a boon. 

The different preparations of mercury are of great service in the treatment of 
disorders of the stomach occurring in children. In these cases considerable care is 
required in the selection of the appropriate remedy, and we shall therefore describe 
the indications for each preparation somewhat fully, 

Sometimes a particular form of vomiting is met with in very young children, 
generally in those only a few weeks old, the characteristic feature of which is its 
suddenness. Immediately the milk is swallowed it is forcibly shot out from both 
nose and mouth, either curdled or uncurdled, and apparently without any retching 
or effort on the part of the child. Diarrhoea may co-exist, but there is usually 
constipation. This affection often proves both obstinate and dangerous, for all the 
food being rejected the child is reduced almost to a skeleton, and dies actually of 
starvation. This condition, after resisting all other remedies, can frequently be cured 
by giving one of the "sugar and grey " powders (Pr. 71) every two hours. 

In the diarrhoea of children mercury is extremely useful Cases of the following 
kind are often met with; every mother knows them. The baby is poorly, his 
digestion is bad, and he suffers all day long with the wind, and very often passes 
three or four nasty, pale, pasty, stinking motions, which look just like a piece of 
clay. One of the " sugar and grey " powders given every hour for a day or two 
will restore the motions to their natural colour, and cut short this condition, even 
should it have existed for weeks. 

Then, again, there is another kind of diarrhoea to which children are subject. 
The stools are slimy, mixed with blood, and often passed with a good deal of pain 
and straining. Sometimes the slime is very tenacious, and being covered with 
blood looks like a piece of flesh. It is best treated by tea-spoonful doses of the 
corrosive sublimate mixture (Pr. 48) given hourly or oftener. This method will 
cure the complaint even after several months' duration. 

Infants not unfrequently suffer from chronic diarrhoea, in which the stools — ten 
or a dozen of which may be passed in the day — are watery, muddy-looking, or 
green-coloured, and extremely offensive. This condition may be restrained by the 
" sugar and grey " powders, given at first every hour, and then every two or three 
hours, according to the frequency of the stools. The occurrence of vomiting is au 
additional indication for this mode of treatment. Although the diarrhoea can be 
arrested, yet the disease may have persisted for so long a time that a serious injury 
may have been inflicted on the stomach, so that food can be neither digested nor 
absorbed, and the child, in spite of every effort, gradually wastes away. 

Infantile Cholera is an extremely fatal disease, running so rapid a course that 
the child soon assumes a death-like aspect, and is in a very critical condition. It 
is characterised by incessant sickness, and by almost continuous diarrhoea, the 



MERCURY, OR QUICKSILVER. 829 



motions being copious and offensive, and either watery and almost colourless, or of 
a dirty muddy aspect. It is essential to check this condition as speedily as possible, 
and this can be usually accomplished by giving one of the "sugar and grey" powders 
every half hour, until relief is obtained. 

In that form of diarrhoea in which the child passes large offensive stools, 
evidently composed of decomposed milk, mercury proves of little use. 

Chronic Diarrhoea occurring in adults will, if the stools are pale and watery, 
yield to tea-spoonful doses of the corrosive sublimate mixture taken every two or 
three hours. 

Similar treatment proves beneficial in dysentery, when the stools are slimy and 
contain blood. The corrosive sublimate mixture taken as directed, in tea-spoonful 
doses, will usually remove the blood and slime, although the use of some other 
diarrhoea medicine may have to be resorted to before the disease is entirely cured. 

In typhoid or gastric fever the sugar and calomel powders may be given every 
two hours with advantage. The earlier this mode of treatment is commenced 
the more likely is it to prove beneficial. It usually lessens the height of the 
fever, shortens its duration, and checks the diarrhoea. Care should be taken not 
to salivate the patient, and on the slightest indication of tenderness of the gums 
the medicine should be at once stopped. 

Occasionally children are met with some three months old, or it may be younger, 
who have become emaciated, pale, fretful, and shrivelled in the face till they look 
like little old men. They suffer from "snuffles," or obstruction of the nose, so 
that they are obliged to keep the mouth open, and sucking is with them almost an 
impossibility. They have generally an eruption on the skin, particularly about 
the soles of the feet and on the buttocks. There is often inflammation at the 
corners of the mouth, and very frequently the eyes are also affected. They will 
rapidly improve if a grain of grey powder be given three times a day with a 
little sugar. It never in this dose purges, but, on the contrary, if diarrhoea be 
present, it frequently checks it. A little piece of the calomel ointment passed 
into each nostril will usually cure the "snuffles," and remove the difficulty in 
breathing. In these cases, however, it is, as a rule, advisable to obtain the advice 
of a medical man. 

People who sutler from biliousness often obtain relief by taking calomel. When 
the bowels are at the same time confined, it is a good plan to take one of the calomel 
pills at bed-time ; but when there is no attendant constipation, it is better to take 
one of the calomel powders, or one of the "sugar and grey" powders three or 
four times a day. These powders are especially adapted for those who frequently 
suffer from this condition, and in whom the constant employment of the pills 
would produce depression and possibly salivation. 

The white-furred tongue, often seen in people who suffer from indigestion, may 
be readily cleaned by one of the sugar and grey powders taken three or four 
times a day. The nasty taste in the mouth, which is so frequently an accompaniment 
of this condition, may be removed by the same means. 

The sugar and grey powders taken hourly are extremely useful both in 
scarlatina and quinsy, when the tonsils are so large as almost to meet, and when the 



830 MATERIA MEDIOA. 



patient is unable to swallow, and is in great distress from the difficulty in breathing. 
The swelling is reduced in a few hours, and all danger is over. 

These powders act with almost equal promptness in mumps, speedily relieving 
the swelling and pain of this affection. 

We must now speak of a complaint in which mercury is pre-eminently useful, 
and for the cure of which its administration, in some form or other, is, as a rule, 
absolutely necessary. We cannot do better than describe a typical case. A young 
man of some seventeen or eighteen years of age comes up to town on a visit, or 
possibly to pass an examination. He, naturally enough, takes the opportunity of 
freedom from parental care and home influences to acquire a knowledge, or what he 
considers to be a knowledge of New York life, its sights, follies, and mysteries. He 
keeps late hours, frequents places of so-called amusement, which were better left 
unvisited, acquires habits and tastes of which he had better have remained ignorant. 
In due time his visit comes to an end, he returns home, and after a while settles 
down to his old quiet pursuits and amusements. Some six weeks or so pass by, and 
the city visit with its attendant dissipation has become a thing of the past, a 
well-nigh forgotten subject, when our friend becomes little by little sensible of 
a feeling of malaise and discomfort. He loses flesh, becomes restless and slightly 
feverish. His appetite is poor, his bones and joints ache, and his hair becomes dry 
and thin. He attaches but little importance to it, and yet it worries him, he is dull 
and moody, and cannot shake it off. A week or two later he is somewhat alarmed 
by a rash breaking out on his skin, an eruption of a peculiar copper colour, which 
seems to prefer the fronts of the arms and legs to their back. Simultaneously with 
the appearance of this eruption he suffers from a bad sore throat, and on examining 
his tonsils in the glass he notices that they are ulcerated. His voice is at times quite 
hoarse, and people are always asking him how his cold is. The rash takes about a 
fortnight coming out, and lasts close upon two months before he can get rid of it. 
When it is at its height, he notices a breaking out about the comers of the mouth, 
and in some other situations. 

If you are suffering from these symptoms the best thing you can do is to go to 
the doctor at once. He will listen to your story as he has listened to many a similar 
story before, and, by a little judicious treatment, will do his best to restore you once 
more to a condition of health. We do not believe in self-treatment in these cases, 
L as you may be possibly so situated that you cannot obtain personal medical 
advice, we will indicate the line of treatment which must be adopted. In the first 
place, you must do your utmost by temperate and abstemious living, and by taking 
plenty of exercise, to support your general health. Then you must take mercury — - 
this is indispensable. It matters little in what form you take it, but take it you 
must. You may take a couple of table-spoonfuls of the corrosive sublimate mixture 
(Pr. 48) three times a day, or one of the opium or blue pills (Pr. 62) twice a day, or 
if you do not like medicine you may rub in the blue ointment. You will have to take 
mercury for a long time — even after your symptoms have entirely disappeared, or 
they will inevitably return in some form or other. You may change your 
preparation of mercury occasionally, but you must take especial care not to salivate 
yourself. Directly you perceive any tenderness about your gums, suspend the 



MUSTARD. 831 



medicine for a day or two, and then begin again, taking it less frequently, or in smaller 
doses. When possible we should advise you to seek medical advice, and not attempt 
to treat yourself. 

MUSTARD. 

There are two different species of mustard used for medicinal purposes, one 
having white and the other black seeds. Both varieties grow wild in the fields, and 
have been cultivated in most parts of Europe from time immemorial. Both kinds 
have yellow flowers, those of the white mustard being larger than those of the 
black. When crushed and sifted both seeds yield the flour of mustard, the best being 
obtained from a mixture of the two seeds. Mustard is commonly adulterated with 
flour, turmeric and capsicum powder being added to imitate the natural colour and 
pungency. When dry it has but little smell, but when moistened it evolves a 
pungent, penetrating odour, which proves very irritating to the eyes and nostrils. 
It is extensively used as a condiment, and probably assists the assimilation of many 
foods which are digested with difficulty. In larger quantities it acts as an emetic, 
and from being always at hand is frequently used for evacuating the stomach in 
cases of poisoning. From a tea-spoonful to a table-spoonful of mustard flour should 
be added to a tumbler of tepid water, and taken without delay. Cases of obstinate, 
and even dangerous, hiccup have been promptly cured by drinking an infusion of 
mustard, made by steeping a tea-spoonful of mustard flour in a tea-cupful of boiling 
water for twenty minutes, and then straining. 

In the form of a poultice, mustard applied to the skin acts as a valuable counter - 
irritant. A mustard poultice is made by mixing equal quantities of linseed meal 
and mustard flour with a little hot water, and stirring them well together. The 
linseed and mustard should be thoroughly mixed before being added to the water. 
Some people add vinegar, but this is a mistake, as it retards the production of the 
essential oil, on which the irritating properties depend. Care should be taken that 
the water employed in making the poultice is not too hot. 

A mustard poultice can seldom be borne longer than twenty minutes, and people 
with delicate skins are often unable to endure it even for this time. It should never 
be allowed to produce a blister, as they are usually very troublesome to heal Not 
unfrequently, strong mustard poultices are applied to the calves of the legs in cases 
of concussion of the brain, apoplexy, <fcc. It must be remembered that the patient 
being insensible is incapable of expressing pain, and that unless we are careful to 
remove it in time, the mustard may form a large blister, which in a person debilitated 
by disease may be followed by the most serious consequences. 

Mustard may be used externally in all cases in which cantharides proves useful, 
and the formation of a blister is not necessary. Thus it is useful in bronchitis, 
pleurisy, and inflammation of the lungs. In these cases the whole chest or back 
should be covered with the poultice, as the larger the tract of skin irritated, the 
greater is the influence exerted on the organs beneath. The mustard paper or 
mustard leaves now so much in vogue may be used as an elegant substitute for the 
mustard poultice. 

Added to a hot foot-bath, mustard is often used to cut short a cold, to 



832 MATERIA MEDICA. 



relieve headache^ and to arrest the progress of inflammation in any of the internal 
organs. 

In women in whom the periods have been suddenly arrested, a mustard hip-bath 
used for a few days before the next expected time will often suffice to restore the 
function. 

NITRO-GLYCERINE OR GLONOINE. 

The somewhat fanciful appellation of glonoine has been applied to the substance 
usually known as nitro-glycerine. It is a heavy, oily-looking liquid, almost 
insoluble in water, but dissolving in alcohol or ether. It is made by the action of 
nitric and sulphuric acids on glycerine. Its preparation is attended with considerable 
danger, as a slight blow or concussion would cause it to explode with destructive 
violenca 

Nitro-glycerine exerts a powerful influence over the animal economy. Thus, if 
a single drop be added to 99 drops of rectified spirit, and two drops of the mixture 
be placed upon the tongue, it may produce very startling symptoms. A gentleman 
who had expressed his utter unbelief in the possibility of so small a quantity of any 
medicine producing any appreciable result, was given, at his own request, a dose of 
this mixture. He says : — " After swallowing this small quantity of fluid — it could 
not have exceeded two drops — I asked what effects I was to expect, but was told to 
wait and observe for myself. I then purposely conversed on other subjects. In 
about three minutes I experienced a sensation of fulness in both sides of the neck, 
and to this succeeded nausea, and I said, ' I shall be sick.' The next sensation of which 
I was conscious was as if some of the same fluid was being poured down my throat, 
and then succeeded a few minutes of uncertainty as to where I was, during which 
there was a loud rushing noise in my ears like steam passing out of a tea-kettle, and 
a feeling of constriction around the lower part of my neck, as if my coat were 
buttoned too tightly ; my forehead was wet with perspiration, and I yawned fre- 
quently. When these sensations had passed off, which they did in a minute or so, 
they were succeeded by a slight headache, and a dull heavy pain in the stomach, 
with a decided feeling of sickness, though without any apprehension that it would 
amount to vomiting. I lay on a sofa feeling rather languid, but talking cheerfully, 
conscious at the same time that I could very well exert myself both mentally and 
physically if I liked, but that it was more pleasant to be idle. This condition lasted 
about half an hour, at the end of which I was quite well, and walked home a distance 
of half a mile with perfect confidence." This gentleman appears to have been some- 
what susceptible to the action of the drug, for although these symptoms usually 
follow its administration, yet in the majority of people a larger dose is necessary to 
produce them. 

In Sweden nitro-glycerine is largely used in mining, under the title of " blasting 
oil," and during the last four years no less than ten cases of poisoning by it have 
occurred in that country. It has been found that the vapour of the liquid acta 
powerfully as a narcotic poison, and even when much diluted with air it produces 
intense headache. 

Although nitro-glycerine is so powerful a poison, there is not the slightest reason 



KITRITE Of AVTL. 833 



why we should not use it in appropriate doses as a medicinal agent. It affords 
another example of a drug which is at once a powerful poison and a valuable 
medicine. 

Next, as to the manner in which it should be administered. The mixture to 
which we have already referred does admirably for all ordinary purposes. One drop 
of glonoine is thoroughly shaken up with 99 drops of rectified spirit, and of this the 
dose is one or two drops taken on sugar. It is not usually advisable to use a larger 
dose, and people who are very susceptible to the action of the drug may have to 
use only one drop, or even to dilute the mixture with an equal quantity of spirit 
before using it. The production of any of the symptoms mentioned in the case we 
have quoted is an indication that too large a dose is being taken. 

Glonoine is a most admirable remedy for congestive headaches, characterised by a 
feeling of pulsation and throbbing. When the head feels as if it were so full that it 
must burst, the drug is especially indicated. A single dose usually effects a cure, 
but it may, if necessary, be repeated in three hours. It has been found of service in 
sunstroke, and is occasionally used for nervous palpitation. 



NITRITE OF AMYL. 

Nitrite of amyl is a yellowish fluid, having a powerful and peculiar odour, 
somewhat resembling that of pine-apples. When inhaled, even in very small 
quantities, it produces almost immediately flushing of the face, and a sensation of 
pulsation all over the body. It may be convenient to have an agent which will 
enable one to blush at pleasure, but it must be admitted that the accompanying 
sensation is far from pleasant. From certain experiments made on animals with 
this drug it was concluded that it would exert a beneficial effect on that awful disease 
known as angina pectoris, or the suffocative breast pang. The supposition was 
correct, and we have now the means of curing, or at all events alleviating, a disease 
in the presence of which we were formerly helpless. This is undoubtedly one of the 
greatest triumphs of modern medicine. 

The amyl is, in these cases, used in the form of inhalation, for it fails to act 
with anything like the same certainty when taken internally in the ordinary way. 
A bottle containing two or three drachms is procured, and of this two or three drops 
are poured on a pocket-handkerchief, and gently inhaled until the effects of the drug 
are experienced. It is advisable for the first inhalation to be performed in the 
presence of the medical attendant, but subsequently the patient should learn to 
administer it for himself. After a time people become habituated to its use, and from 
five to ten drops may be poured on the pocket-handkerchief, or the bottle may be 
held quite close to the nose, without the production of any unpleasant symptoms. 
The nitrite of amyl should be kept in a stoppered bottle, but even in spite of this it 
after a time becomes stale and flat, and the supply must be renewed. Nitrite of 
amyl is an excellent remedy for those " heats and flushes " to which many women 
are subject. In these attacks not only does the patient feel hot, but she turns red 
all over. They usually last only a few minutes, but sometimes an hour or more, 
and they may be repeated several times a day. They are usually attended with 
53 



834 MATERIA MEDICA. 



perspiration, which may be very profuse. In these cases the nitrite of amyl should 
be given according to Pr. 52. A dose should be taken every three hours, and an 
additional dose on the first appearance of the flush. Relief is often obtained at 
once, but sometimes not until the medicine has been taken for a week or more. 
As the patient grows accustomed to the remedy, it is often necessary to increase the 



NITRE OR SALTPETRE AND CHLORATE OF POTASH. 

These salts are familiar enough to those of us who in our youthful days devoted 
our energies to the study of the now somewhat abstruse science of pyrotechnicology. 
Both are used largely in the manufacture of fireworks. 

It is to be presumed that nitre, being a natural production, was known to the 
Chinese and Indians, more particularly as both these intelligent races at an early 
period of their respective careers exhibited a remarkable aptitude for manufacturing 
explosive agents. Nitre is found as an exudation or efflorescence on the soil in many 
parts of India. It is washed out, and sent to this country in a rough state, and is 
here purified for use. In Europe it is prepared artificially, in what are known as 
nitre-beds or plantations. Refuse animal and vegetable matters are mixed with 
ashes and lime rubbish to form heaps, which are protected from the wet, but are 
exposed freely to the air. They are watered occasionally with liquid nitrogenised 
matter, and at intervals of about three years are washed out to obtain the nitre. 
The whole process, viewed chemically, is extremely interesting, but as the salt is 
given internally we must be pardoned for not entering more fully into detail. 

Nitre crystallises in beautiful colourless striated six-sided prisms, which are 
readily formed by dissolving a quantity of saltpetre in boiling water and then leav- 
ing the solution to cool. These crystals have a pleasant saline taste, and when 
thrown in the fire, or placed on a piece of red-hot chanoal, deflagrate with an 
energy which acts as a reminder that they form 75 per cent, of gunpowder. 

Let us nc^7 pass on to a consideration of its therapeutical applications. Of what 
use is it to us in the treatment of suffering humanity ? It has been loudly lauded, 
like many another drug, in the treatment of rheumatic fever. It has been claimed 
for it that it not only shortens and mitigates an attack of acute rheumatism, but 
protects the heart from the baneful effects of the disease. We are sorry we cannot 
endorse these statements, but mast confess that there are drugs of which we shall 
speak presently on which we should place greater reliance in the treatment of this 
disease (see Salicine). 

In case of inability to hold the water occurring in children, nitre often proves 
successful, provided always that that condition is not dependent on worms or some 
similar exciting cause. 

In sore throat, saltpetre is often taken in the form of nitre balls. These are 
simply made by fusing the nitre and then casting it in bullet-moulds. 

In cases of r/ieumatism and lumbago accompanied by scanty high-coloured water 
saltpetre should be used. In a few hours under its influence the water becomes 
clear and bright, and the pains then gradually subside. 

If used in rheumatic fever, nitre must be employed in large doses, as much as 



NITRE OR SALTPETRE AND CHLORATE OF POTASH. 835 

from half an ounce to an ounce being given in the course of the day in lemonade or 
barley water, sweetened to taste. In other diseases, such as rheumatism, from five 
to ten grains may be taken in water every hour until relief is obtained. For children 
the dose is from one to three grains. 

Chlorate of potash is made on a larger scale for the preparation of lucifer- 
matches and detonating powders by a process which practically is equivalent to 
passing chlorine gas through potash. When powdered up in a mortar with sulphur 
it detonates violently, a fact to be remembered in dispensing. 

This drug finds its chief application in the treatment of diseases of the mouth. 
It proves of signal service in ulceration of the edges of the gums and the sides of the 
mouth and tongue. This condition, though seldom dangerous, is, to say the least of 
it, extremely unpleasant, and in children often proves very difficult to cure. Im- 
plicit trust may be placed in chlorate of potash in the treatment of this condition 
In another troublesome complaint it often proves useful, for if taken early and 
frequently it will often cut short a cold. It usually quickly relieves the hoarseness, 
and stiffness in the nose, and above all the raw feeling in the throat. 

The dose is from ten to twenty grains or more, and it may be conveniently taken 
in the form of chlorate of potash lozenges, each of which contains five grains. 

We have already seen the action of nitre and chlorate of potash on the system 
when used separately ; let us now consider an extremely useful application when 
used in combination As every one knows, blotting-paper, dipped in a solution of 
nitre, and dried, forms "touch -pa per," which, when ignited and allowed to smoulder 
away, sometimes serves to cut short an attack of asthma. Too frequently, however, 
these papers prove useless, and the unfortunate sufferer continues to wheeze away, 
and gasp and fight for his breath, until the attack has worn itself out and reduced 
him to a condition of utter prostration By the addition of chlorate of potash to 
the solution used in making these papers, their utility is greatly increased. As this 
as a point of considerable practical importance, we must enter somewhat fully into 
their mode of preparation. It would be well if the papers were prepared by the 
asthmatic himself, or under his immediate superintendence, or, if this is impossible, 
they should be made by some one on whom he can place implicit reliance. The 
materials requisite are three in number — some large sheets of blotting-paper, and 
some nitre, and chlorate of potash. In the first place, some water should be put to 
boil in a large shallow saucepan, or other similar utensil. The porcelain dishes used 
by chemists are extremely useful for this purpose, particularly as they can be 
placed on a tripod or retort-stand, and kept hot by means of a lamp. Into the 
water should be thrown equal quantities of the two salts which are to be dissolved 
in it. There is no occasion to weigh them, but a handful of each may be thrown in 
as frequently as may be necessary. Whilst the water is getting hot, and the salts, 
aided by a little occasional stirring, are being dissolved, the paper may be cut up. 
The best blotting-paper to use for this purpose is the white, because it is usually 
thicker, and absorbs more. It should be cut or torn into pieces of about' six inches 
square, which should be piled one on the top of the other, each mound consisting of 
six pieces. Whilst this process is in progress the water will have been boiling, and 
will have taken up as much of the salts as it can dissolve. It is essentia? to supply 



836 MATERIA MEDXCA. 



the salts freely, so that a perfectly saturated solution may be obtained. All being 
in readiness, a pile of paper should be plunged in the boiling solution, and kept 
under the surface till it is thoroughly wet through. It is then to be taken out, and 
placed on a board, or better still, on a grating and allowed to drain. The solution 
is to be kept boiling over the lamp or fire, and as fast as one pile of paper is 
finished another is to be plunged into the solution. If the operator is not very 
expert in the matter, he had better use an old knife for fishing the paper out 
of the water, or he will assuredly scald his fingers. When the solution is exhausted, 
the process may be stopped, and attention given to the piles which have been 
already prepared. The different layers of paper will be found to be adherent, and 
the whole mass will resemble a piece of damp cardboard. The papers should then be 
placed in the warm — preferably in the sunshine — and* allowed to dry at their leisure. 
If dried before the fire care must be taken that they are not ignited by an accidental 
spark. When dry they may be sprinkled over with a few drops of tincture of 
sumbul, spirits of camphor, or any other agreeably smelling substance. 

When finished, they will be hard and stiff, and both surfaces will be studded 
with small acicular crystals. 

The mode of using these " nitre tablets," as they may be conveniently called, is 
sufficiently simple. One of them is doubled across the middle, and placed, tent-wise, 
on some non-inflammable substance, and then ignited at each extremity of the fold. 
The tablet will burn vigorously, with the production of considerable heat, and 
a large volume of dense smoke. Especial care must be taken not to put the 
tablet near the bed. It should not be lighted on a plate, as there is a risk of 
breaking it, but the coal-scuttle, or an old sheet of tin, may be utilised for 
this purpose. 

Many an attack of asthma has been cut short by the employment of these 
papers, and their use has proved a boon to many a sufferer. The nitre papers sold 
in the shops are usually too weak to prove of much service in bad cases. 



NUX VOMICA AND STRYCHNIA. 

The nux vomica tree is a native of the East Indies, and grows abundantly on 
the coast of Coromandel, flowering during the cold season. It is a member of the 
venomous strychnia family, which, curiously enough, is botanically so closely allied 
to the natural orders yielding gentian and the common bark, that it has been found 
impossible to define any strict line of demarcation. It is a middle-sized tree, with a 
short, crooked, thickish trunk, irregularly branched, and covered with a smooth ash- 
coloured bark. The leaves are ovate in shape, shining, smooth on both sides, and 
marked with five distinct nerves ; the flowers are small, greenish- white in colour, 
and exhale a strong, disagreeable odour. The fruit is round, about the size of a 
large apple, of a rich orange colour, filled with a soft jelly-like pulp, containing the 
seeds, generally five in number. These seeds are about the size of a quarter, and 
are covered with a soft woolly substance of a pretty grey colour. They are hollow 
on one side, whilst the other is convex and furnished with a boss or top-knot, so that 
they remind one irresistibly of a very little Chinaman's hat. They have an intensely 



VtrX VOMICA AKD STRYCHNIA. 837 

bitter taste, and are extremely hard — so hard, indeed, that they are powdered with 
the greatest difficulty, and have often to be filed down. The whole plant is pervaded 
with that deadly poison, strychnia, the greater portion residing in the seeds and bark. 
The nuts prove fatal to dogs, horses, hares, wolves, foxes, cats, rabbits, rats, birds, and 
in fact, so far as we know, to every living creature. It is very generally believed in 
many parts of the country that nux vomica — commonly called "rat's-bane" — 
although poisonous in the case of all the lower animals, may be taken with impunity 
by human beings, an opinion which we need hardly say is utterly without founda- 
tion. Another and, if possible, still more absurd superstition, is that all animals 
born blind are protected from its influenca Powdered nux vomica is largely used 
for the purpose of destroying vermin, it, or the alkaloid strychnia, being the active 
ingredient in nearly all the vermin and insect-killers. It has occasioned many 
deaths, chiefly as the result of suicide, for, owing to its bitter taste, its presence in 
an article of food would be at once detected in any attempt to murder. Strychnia, 
though equally bitter, might possibly be given in a pill without the peculiarity of 
its taste being noticed. 

The symptoms produced by large doses of strychnia or nux vomica resemble those 
occurring in the course of the disease known as tetanus or lockjaw. Soon after the fatal 
dose has been taken the patient is suddenly seized with a feeling of suffocation, and 
complains of great difficulty in breathing. He is restless and uneasy, and there 
are twitchings and jerkings of the head and limbs — a shuddering or trembling of 
the whole frame. Convulsions then commence suddenly — the limbs are stretched 1 
out, and the hands clenched, the head is jerked violently backwards, and the whota 
body becomes as stiff as a board, and is arched in the form of a bow, the patient 
being supported only on his head and heels. The chest is fixed by the spasm, so 
that breathing is for the time arrested, and the face assumes a dusky, congested 
appearance, with a wild, drawn, anxious aspect, the eyeballs being prominent and 
staring, and the lips livid. Sometimes the muscles of the face are contracted in 
such a manner as to make it assume a most ghastly grin. Shooting pains like 
electric shocks are experienced in various parts of the body, often first in the back, 
and then down the legs and arms. Each spasmodic attack lasts for a minute or 
more, and then ceases altogether for a time. Throughout the paroxysms the mind 
remains perfectly clear, and the patient's sufferings are agonising. The slightest 
touch, a breath of air, the movement of the bed-clothes, the most trivial cause will 
at once excite the spasm. The consciousness of the accession of the fit is very 
remarkable. The patient calls out loudly, "It is coming !" and screams and shrieks, 
"Hold me 1 hold me !" In vain he seeks for relief in gasping for air and in 
requiring to be turned over, moved, or held. Sometimes there is frothing at the 
mouth, and this froth is generally mixed with blood from injury to the tongua 
The muscles which move the jaw, although the first to be affected in the lockjaw 
of disease, usually escape till near the end in this form of poisoning. In a fatal 
ease death is rapid ; and if the patient survive two or three hours, sanguine hopes 
may be entertained of his recovery. The fatal termination may be due either to 
exhaustion from the repeated convulsions, or to suffocation from paralysis of the 
muscles of the chest Death under these circumstances is indeed horrihJ% and 



838 MATERIA MEDICA. 



after witnessing a scene such as we have described, one naturally exclaims with 

the poet, 

** By many a death-bed I have been, 
And many a sinner's parting seen, 
But never aught like this." 
It is, in fact, unique. 

What to do in Poisoning by Strychnia or Nux Vomica. — I. Send for the doctor, 
and say it is strychnia poisoning. 2. Make the patient lie down, and keep the 
room absolutely quiet. 3. Give him twenty-five grains of chloral in a little water. 

It is very essential to keep the room quiet. All officious friends and relatives 
should be requested to withdraw, for nine times out of ten they are infinitely more 
trouble than they are worth. 

For medicinal purposes, we use three preparations containing strychnia — viz., 
an extract of nux vomica, a tincture of nux vomica, and a solution of strychnia. 
These are all " officinal " articles — that is, they find a place in the " U.S. Dispensa- 
tory " — and may, of course, be used in appropriate cases with perfect safety. 

Nux vomica has attained a great and widespread reputation in the treatment of 
indigestion and disorders of the alimentary canal. It is especially valuable in the 
case of people who become nervous and dyspeptic as the result of over-work, and much 
mental worry. Many business people — city men, for example — who suffer from 
headache, sleeplessness, weight after food, and constipation, experience much benefit 
from a course of this medicine. It should be given when the food lies like a load at 
the stomach, and especially when there is heartburn accompanied by flatulence. The 
sensation of heat and weight at the top of the head, which is often an accompaniment 
of these symptoms, may also be removed by the same means. The best and most 
useful preparation for all these cases is the tincture of nux vomica. It may be 
given according to Pr. 44. This mixture will be found of considerable value in 
the treatment of habitual constipation. It is not meant that because the bowels 
are upon any one particular occasion confined that nux vomica is to be taken, 
but that when constipation is a constant source of trouble it will afford relief. 
It does not act as ordinary purgatives do, but gives tone to the walls of the 
alimentary canal, and in this way stimulates them to action. Should the 
inefiicient action of the bowels be due to a defective secretion of bile, the motions 
being pale in colour, nux vomica will probably prove of little benefit. In other 
cases, a tea-spoonful of the mixture taken three or four times a day will prove amply 
sufficient to insure daily one comfortable motion. Five drops of tincture of nux 
vomica in a tumbler of cold water, drank slowly a little at a time whilst dressing in 
the morning, usually acts speedily on the bowels. 

Nux vomica is one of our pleasantest bitters, and six or eight drops of the 
tincture taken in water or in a wine-glassful of infusion of gentian, about half an 
hour before meals, will improve the appetite and digestion. 

In many affections of the nervous system this mixture may be employed with 
advantage. It often proves of benefit in paralysis, and even in cases in which it 
fails to effect a cure it may prevent the further wasting of the limbs. In these 
cases, two table-spoonfuls of the mixture (Pr. 44) should be taken three times 
a day. 



OAK-BARK — GALL-NUTS — TANNIC ACID — GALLIC ACID. 



S39 



Its action is very conspicuous in sick-headache, particularly when this common 
and troublesome complaint can be traced to some error in diet, or to a confined state 
of the bowels. It is advantageous in these cases to take a tea-spoonful dose every 
five or ten minutes to the extent of eight or ten doses, and then to continue the 
medicine at longer intervals. 

It is useful, too, in Iwadaches occurring in strong, robust adults, who also suffer 
from giddiness, flushed face, and constipation. In these cases tea-spoonful doses of 
mix vomica mixture taken frequently will prove most effectual. 

The morning vomiting and trembling of the hands of those who over-night have 
dined not wisely but too well, may be controlled by the same means. 

There are two other drugs derived from the same family as strychnia which 
merit at least a passing notice. These are St. Ignatius's beans, and the woorara 
poison. 

The tree producing ignatia, or the seeds of St Ignatius, is indigenous to and 
abounds in the Philippine Islands. The fruit is pear-shaped, and each contains 
about twenty seeds. Their properties were first discovered by the Jesuits, and 
named after their patron. These, like nux vomica, contain a considerable amount 
of strychnia, and it is doubtless to this substance that they owe much of their energy, 
although they have properties which are peculiarly their own. A tincture is usually 
made containing the drug in the proportion of one to ten. This should be mixed with 
ten times its volume of water, and of this drop-doses may be taken hourly. It is 
recommended in the treatment of hysteria, and may be given with advantage to 
either men or women who are hysterical. In some forms of neuralgia it has proved 
of considerable value. 

The curari or woorari, although of no practical use in medicine, has recently 
attracted considerable attention from its employment by physiologists in the per- 
formance of experiments on animals. It was at one time said simply to paralyse the 
animal, and not in the slightest degree to deaden its sufferings, but there are reasons 
for supposing that an animal under its influence is quite insensible to pain. It is the 
arrow poison which is used by the Indians for the destruction of game. It is prepared 
by them with a great deal of mystery, and is mixed with other herbs, with red and 
black ants, and with the pounded fengr? of a venomous snake. It, like the serpent 
poison, is almost inert when swallowed, but is a deadly poison when introduced into 
the system through a wound. 



OAK-BARK GALL-NUTS TANNIC ACID GALLIC ACID. 

The British oak, as is well known, is a majestic forest tree distinguished above all 
others by the slowness of its growth, its great size and longevity, and the value of 
its wood. There are two distinct species of oak in England, which are known as 
the " pedunculate," and the "sessile." They are readily distinguished, for in the 
former the acorn is provided with a stalk or peduncle, whilst on the latter it is 
sessile or stalkless. As we have already said, the oak is a tree which attains a great 
age, and its wood is almost useless for the purposes of art until hs^i a century lias 



840 MATERIA MEDICA. 



The only part of the tree which is used for medicinal purposes is the bark, which 
is usually separated in the spring or early summer. We obtain it in pieces of one 
to two feet in length, which vary a little in their appearance according to the age of 
the stem, or branch, from which they have been taken. The bark of young stems is 
thin, moderately smooth, covered externally with a silvery or ash-grey cuticle, and is 
frequently beset with lichens ; internally it is, in the fresh state, whitish, but when 
dried brownish-red and fibrous. The bark of old stems is thick, very rough 
externally, cracked and wrinkled, and it is usually of inferior quality. 

The oak-bark is made into a decoction in the following manner : — Boil 1 J ounces 
of bruised oak-bark in one pint of water for ten minutes in a covered vessel, then 
strain, and wash the bark with enough water to make one pint of the decoction. Its 
principal value in medicine arises from its astringent properties. It forms a per- 
fectly safe, useful, and economical lotion, gargle, or injection. As a gargle it is use- 
ful in that common and disagreeable complaint, a relaxed sore throat As an 
injection it is employed with advantage for all kinds of discharges, and its efficacy 
may be greatly increased by the addition of a couple of tea-spoonfuls of alum to 
every pint. Internally it may be given in all kinds of bleeding from tlie lungs , 
8to7nach, &-c., in doses of two to three table-spoonfuls, or more. 

There is another species of oak growing in England known as the gall or Dyer's 
oak. It is a native of Asia Minor, but is now commonly met "with throughout 'the 
country. It seldom exceeds the height of six feet, and the stem is crooked, so that 
it has rather the features of a shrub than of a tree. The acorn is nearly sessile, 
smooth, cylindrical, and is two or three times as long as its cup, which is slightly 
downy, and is covered with indistinct scales. This is the species which yields the 
nut-galls of commerce. These excrescences are produced on the young branches by 
a small insect which punctures the tender shoot with a curious spiral sting, and 
deposits its eggs in the aperture so made. In a few hours the surrounding tissues 
swell, a tumour is produced, and the eggs become enclosed in a fleshy chamber, 
which serves not only for shelter and defence but also for food, for the larvae feeding 
upon the interior there undergo their metamorphosis. In fact, it is a comfort- 
able situation with "all found." No production of nature seems to have puzzled 
the ancient philosophers more than galls. . An old writer of repute ascribed their 
origin to spontaneous generation, and gravely states that weighty prognostications 
as to the events of the ensuing year may be deduced by ascertaining whether they 
contain spiders, worms, or flies. Other philosophers who knew that, excepting by 
rare accidents, nothing is found in galls besides different kinds of grubs, which they 
rationally conceived to spring from eggs, were very much at a loss to account for 
the conveyance of these eggs into the middle of a substance provided with no 
apertura Finally they settled the question, very much to their own satisfaction, 
by deciding that they were insects' eggs deposited in the earth which had been 
drawn up into the tree along with the sap, and after passing through different 
vessels had stopped in the twigs, and had there hatched and produced the galls. 
The theory was undoubtedly ingenious, the only objection to it being that, like 
many a modern theory, it had no foundation in fact. 

Gall-nuts are more or less globular in form, hard, about the size of a marble, 



OAK-BARK — GALL-NUTS — TANNIC ACID GALLIC ACID. 841 

and covered externally with a number of little knobs or tubercles. There are two 
varieties, the blue and white galls : ' the former, the produce of the first gathering, 
before the fly has escaped from its prison, is of a blackish-blue or deep olive colour; 
the latter, which is of superior quality, is of a greyish colour, and is provided with 
a small hole by which its late tenant departed. 

Both varieties of gall-nuts contain two very useful substances known as " tannic 
acid" and "gallic acid." Tannic acid is obtained in the form of a light glistening 
spongy mass or powder, having a very astringent taste, and dissolving freely in 
water. Gallic acid occurs in white or pale fawn-coloured silky crystals, which 
are also freely soluble in water. As the gall-nuts owe their astringency to the 
presence of these two acids, the medicinal uses of the three bodies are almost 
identical. 

There are few more useful household medicines than "glycerine of tannin." It 
may be obtained at any chemist's, or made as follows : — Rub together one ounce 
of tannic acid and four fluid ounces of glycerine in a mortar, then transfer the 
mixture to a porcelain dish, and apply a gentle heat until a complete solution 
is effected. It should be kept in a wide-mouthed bottle with a long-handled 
camel's-hair brush for convenience of application 

It is very useful in many affections of the nose. Thus, after measles, scarlet 
fever, and some other diseases, the nostrils often become sore and red and dis- 
charge freely, the secretion not only blocking up the nose and causing a 
disagreeable feeling of stuffiness, but also running down on the upper lip and 
scalding it. A single application of the glycerine of tannin with the brush will 
often effect a cure, although the nose should be previously thoroughly cleansed, 
so that the astringent may come in actual contact with the sore surface. The 
application should be made freely and without hesitation. 

Sometimes the discharge from the nose is in young adults thick, lumpy, of a 
greenish colour, and very offensive in odour. The scabs may be half an inch 
long, and are expelled with difficulty, the unfortunate sufferer having to blow 
his nose ove^ and over again before he can get rid of them. Thoroughly brush- 
ing out the inside of the nostrils with the glycerine of tannin will usually give relief, 
and does much towards removing the disagreeable smell. When the seat of the 
disease is apparently too far back for the brush to reach it, the glycerine of tannin 
may be poured into a wash-hand basin with a little water, and then snuffed up 
the nostrils. The condition to which we have referred is generally known as 
ozcena. 

Glycerine of tannin forms a very valuable application in discharges from the 
ear, a common complaint in weak, unhealthy children after long illnesses. A few 
drops should be poured into the ear, and retained there by a little cotton-wooL 
A single application often effects a cure, but should it not do so it must be 
repeated. 

Glycerine of tannin is wonderfully useful in affections of the throat In many 
cases it acts like a charm. In a relaoced sore throat there is nothing better than 
swabbing out the throat with this substance. The patient should sit in a chair with 
his head slightly thrown back and his mouth wide open. The operator who is about 



842 MATERIA MEDICA. 



to perform the friendly office for him now dips the brush in the glycerine of tannin, 
and when it is thoroughly covered thrusts it into the open mouth, taking good care 
to go right to the back of the throat. The patient generally expectorates freely and 
forcibly, and it is a good plan to get behind him as soon as the application is finished. 
A basin or other utensil should be provided for the patient to spit into. If he does 
not at once express his relief it is because the astringency of the preparation prevents 
him from uttering the words of gratitude. The tannic acid gargle (Pr. 82) may in 
addition be used three or four times a day. Enlargement of the tonsils may often be 
treated with advantage in the same way. 

Many long-standing cougJis which are supposed to indicate that the sufferer is 
" going into a decline " are entirely dependent on a relaxed condition of the throat, 
and may be cured in a few days by the use of glycerine of tannin. 

Deafness is often due to the throat, and when such is the case it often yields to 
this method of treatment. 

Tannic acid lozenges are sometimes used in the cases in which we have recom- 
mended the application of the glycerine of tannin, but they are far less efficacious, 
and not so likely to afford relief. 

Gallic acid given internally is a very valuable remedy for bleeding from the lungs 7 
stomach, womb, kidneys, and in fact from any internal organ. It should be kept in 
powders, each containing fifteen grains, one of which may in any of these cases be at 
once dissolved in a little water and tossed off. When the glycerine of tannin only is at 
hand this may be employed mixed with water in two tea-spoonful doses. The 
medicine should be repeated at intervals of four hours. The astringent mixture (Pr. 
29) contains gallic acid, and is useful in all these cases. In many cases of Bright '* 
disease benefit may be obtained by the use of gallic acid in fifteen-grain doses every 
four hours. Two table-spoonfuls of the mixture contain this dose. 

We have already had occasion to refer to the use of an ointment of galls and 
opium for the relief of piles. 

OPIUM. 

We must now consider the characters and properties of that subtle and mighty 
drug opium, the gift of God to suffering humanity, the dread agent of unimaginable 
pleasure and pain. 

It is obtained chiefly from the white poppy (Papaver somniferum), which is 
cultivated for the purpose in Egypt, Persia, Asia Minor, India, and other warm 
countries. It is probable that this, our common garden poppy, is a native of the 
East, which has become naturalised in the South of Europe. It is raised in large 
quantities at Mitcham, in Surrey, chiefly for the sake of the heads, and it grows wild 
on the sandy banks of the fen ditches in some parts of Norfolk and Cambridgeshire. 
It is a hardy annual, flowering in July, and varying somewhat in the form and 
colour of its rich, beautiful double petals. 

The process of obtaining the drug consists essentially in making cuts into the 
unripe capsule, and collecting the juice which exudes. In Asia Minor they carry the 
incision in a line round the circumference, or in a spiral from apex to base, whilst in 
India it is customary to scarify the capsule from top to bottom. The white milky 



OPIUM. 



843 



juice is allowed to dry into tears, and is then scraped off and pressed together so as 
to form a homogeneous mass, after which it is dried in a Warm, airy room. The 
opium manufacturers suffer no inconvenience from the nature of their employment, 
contact with crude opium 
and breathing air impreg- 
nated with the emanations 
from the drug apparently 
exerting no injurious in- 
fluence on the system. 
During the operations of 
drying, packing, and exa- 
mining opium immense 
quantities necessarily pass 
through the hands of those 
engaged in the process, but 
no complaints are made 
of any ill effects resulting 
from contact with the 
drug. The native opium 
examiners often sit for 
hours together in the midst 
of tons of opium, samples 
of which they are con- 
stantly manipulating and 
smelling, and yet they, as 
a rule, enjoy the most per- 
fect health. This immu- 
nity contrasts strongly 
with the suffering of 
workers in lead and mer- 
cury, to which we have 
already alluded. These 
facts, however, are not to 
be regarded as an indica- 
tion that opium used ex- 
ternally is under all cir- 
cumstances inert. Thus 
laudanum applied to an 
ulcerated or abrased sur- 
face will produce poisonous 

effects — not so quickly, it is true, as when administered internally, but with equal 
certainty. A few years ago a child was accidentally killed by the application 
of opium and water to the surface of an extensive scald. 

There are several varieties of opium, of which the most valuable and best known 
are the Smyrna, Constantinople, Egyptian, and Indian. In this country the poppy 




15. — THE OPIUM POPPT. 



844 MATERIA MEDICA. 



has been occasionally cultivated for the purpose of obtaining opium, and specimens 
have been produced which were ascertained to be in no way inferior to the Oriental. 
Opium is a solid, compact substance, of a dark reddish-brown colour, opaque, soft 
and tenacious when fresh, but when long kept, hard and readily powdered. It has 
a strong, heavy, peculiar, and somewhat disagreeable smell, and a nauseous taste. 
It is inflammable, and burns with a bright flame. It is partly soluble in water, 
forming a solution of a dark brown colour. The Smyrna opium is imported in 
rounded or flattened masses, which are enveloped in leaves ; whilst the Egyptian is 
made into cakes of about three inches in diameter. The Bengal opium is peculiar, 
it being sent over in hard, round balls, nearly as large as a child's head, and looking 
very much like a 24-pound shot. The smell of opium is so essentially sui generis 
that no difliculty is experienced in recognising the drug in whatever form it may 
occur. 

Opium is not a simple substance, but consists of a number of principles, of which 
morphia is at once the most powerful, and, to us, the most familiar example. 
Opium, like most other expensive drugs, is not uncommonly adulterated, and fre- 
quently contains mechanical impurities, such as stones, sand, clay, bullets, and even 
cow-dung, all of which are readily detected by breaking up the mass in cold water, 
and allowing the heavy particles to subside. Other substances, such as sugar, 
treacle, and flour, are used for a similar purpose, but the fraud seldom succeeds 
with those who are practically acquainted with the colour, aroma, and texture of 
the drug. The value of any individual specimen depends chiefly on the percentage 
of morphia w^hich it contains. 

There are several forms in which opium may be given, and there are many pre- 
parations into the composition of which it enters. For external application we have 
the plaster and liniment, and an ointment of galls and opium, which is a favourite 
application for piles. Then we have an electuary or confection of opium, which is 
seldom used ; and the opium lozenge. It is an essential constituent in the compound 
soap pill, of Dover's powder, and of the aromatic powder of chalk and opium. 
Laudanum is a tincture of opium ; whilst a weaker preparation, combined with cer- 
tain aromatic substances, is known as paregoric or paregoric elixir. The liquid 
extract of opium and opium wine are of nearly the same strength as the tincture, 
for they contain a grain of opium in about twenty -five drops. " Black drop," a 
strong preparation of opium, the exact composition of which was kept secret, has 
now almost entirely fallen out of use, having been replaced by the more certain and 
trustworthy substitutes which we have just indicated 

We must now consider the effects produced by the internal administration of 
opium. A small dose, such as half a grain of solid opium, or from ten to twelve 
drops of laudanum, usually acts as a stimulant to those who are not habituated to 
its use. The pulse soon becomes stronger and quicker, the mind is exhilarated, the 
ideas flow more rapidly, a pleasurable, or even luxurious, sensation is experienced 
and for a tinre there is an increased capacity for bodily and mental exertion. These 
symptoms are followed by a diminution of muscular power, by drowsiness, a desire 
for repose, and a tendency to sleep. The mouth and tongue become dry, and 
hunger is diminished, though thirst is often increased. When a larger dose is 



opium. 845 



given the mind is apparently elevated to such an extent as to produce intoxication* 
or even delirium, and the various functions, both mental and corporeal, are 
invigorated. These effects, however, are of short duration, and are soon followed 
by languor and drowsiness ; the sensibility to external impressions is impaired, so 
as to induce sleep, which is attended by dreams, sometimes pleasant, but frequently 
of a most painful character. In many instances this stage is accompanied by 
languor, nausea, vomiting, thirst, and headache. The stimulating operation of 
opium generally continues about an hour, but the sedative effects usually last from 
six to eight hours. It is now recognised that opium may be given so as to obtain 
from it stimulating and also depressing effects, and that the former are primary, 
and are obtained from it in a moderate dose, while the latter are secondary, and are 
produced only by a larger dose. 

There is no form of poisoning so common as that by opium and its various 
preparations. In two years there were 196 people lilled by the intentional or 
accidental administration of opium, and this, in all probability, forms but a small 
proportion of the actual number of cases, as recoveries where medical aid is at 
hand are by no means unfrequent. When a poisonous dose has been taken the 
primary stage of excitement is of very brief duration, and great giddiness, with 
an irresistible craving for sleep, soon supervene. The sleep rapidly passes into 
profound insensibility, from which the patient can be roused only with the greatest 
difficulty, and even then he almost immediately relapses into a state of stupor. 
The face is usually pale, whilst the pulse, which was at first strong, becomes so 
weak that it can hardly be distinguished. If the pupils of the eyes be examined, 
by raising the upper eyelids, they will be found very small, a condition which is 
characteristic of opium poisoning. The power of swallowing is gradually lost, 
so that phlegm and saliva collect in the throat, and after a time breathing 



Sometimes it is not easy *o tell whether a person who is found insensible has 
taken opium or has had a fit. When the case is one of poisoning, the bottle, 
labelled laudanum, or smelling of that substance, will usually be found in the pocket 
or close at hand, whilst the account given by the friends, or the circumstances under 
which the occurrence took place, will aid one in arriving at a correct conclusion. 
The odour of opium is frequently detected in the breath or vomited matters, but 
when the drug has been taken in beer this may not be perceptible. 

The condition of the eyes is also a guide, for in opium poisoning the pupils are 
very small, whilst in an apoplectic fit they are usually large and frequently unequal 
in size. 

What to do in Poisoning by Laudanum or any other Preparation of Opium. — 
1. Send for the doctor. 2. Make the patient sick. The emetic draught (Pr. 27), a 
tea-spoonful of sulphate of zinc, dissolved in hot water, and given a half at a time, 
or large draughts of hot water, hot mustard-and-water, or salt-and-water, will have 
the desired effect. 3. Rouse the patient by every means in your power, keep him 
constantly walking about, shout at him, pinch him, strike him, stick pins into him, 
but do not let him go to sleep. 4. If he can swallow, give him hot strong coffee. 
5. Dash cold water suddenly into his face. Should he become perfectly insensible, 



846 MATERIA MEDICA. 



you must have recourse to the cold douche. Get a large can of cold water, stand 
upon the table, and pour it forcibly over his head and face ; take care that it does 
not get into his mouth, as he may be too feeble to expel it, and you may choke him. 
If it rouses him, repeat it on any signs of a relapse. 

These measures may, at first sight, appear to be rather energetic, but a desperate 
disease requires disagreeable treatment. The unfortunate victim has an irresistible 
desire to sleep, and it would be a cruel kindness to let him have his own way in 
the matter. The endeavours to keep him awake may have to be continued without 
a minute's intermission for hours and hours, and it may be necessary to send to the 
station for three or four policemen to relieve one another in the very tiring process 
of keeping the patient constantly on his legs. Even when he has been restored to 
consciousness, and is apparently perfectly sensible, he must be carefully watched, for 
at any moment he may have a relapse, and become once more comatose. It is not 
advisable in cases of opium poisoning to administer wine or brandy. 

The influence of habit in diminishing the powers of opium on the system are 
very remarkable. In Turkey and other Eastern nations, where the use of wine is 
prohibited by the established religion, it is consumed in immense quantities. It is 
taken with rich syrups and the juice of fruits, to make it more palatable, or it 
is made up into small lozenges with spices, and stamped with the words Masch 
Allah, " the gift of God." 

Much of our knowledge of the effects of opium on the system is derived from 
the confessions of De Quincey, the English opium-eater. It will be remembered 
that he commenced the practice of taking opium at the recommendation of a college 
acquaintance for the relief of an excruciating pain in the head and face from which 
he had suffered for some weeks. The graphic description of his initiation into the 
mysteries of the drug we cannot refrain from quoting : — " I was necessarily 
ignorant," he says, " of the whole art and mystery of opium-taking ; and what I 
took I took under every disadvantage. But I took it; and in an hour — oh, 
heavens ! what a revulsion ! what an upheaving, from its lowest depths, of the 
inner spirit ! what an apocalypse of the world within me ! That my pains had 
vanished was now a trifle in my eyes ; this negative effect was swallowed up in the 
immensity of those positive effects which had opened before me, in the abyss of 
divine enjoyment thus suddenly revealed. Here was a panacea, a QappaKov v-nirevQh, 
for all human woes ; here was the secret of happiness, about which philosophers 
had disputed for so many ages, at once discovered ; happiness might now be bought 
for a penny, and carried in the waistcoat pocket ; portable ecstacies might be had 
corked up in a pint bottle, and peace of mind could be sent in gallons by the mail- 
coach." Opium, moreover, possesses a wonderful power of sustaining the strength 
and of enabling men to undergo fatigue and continued exertion under which they 
would otherwise inevitably sink. The Tartar couriers who travel for many days 
and nights use it constantly, and with a few elates or a lump of coarse bread they 
traverse the trackless desert amidst privations and hardships which could be 
supported only under the influence of the drug. Even the horses are sustained 
by its influence, the traveller often sharing his store of opium with his flaggio 
steed. It is often supposed that the excitement produced by opium is similar to 



opium. 847 



resulting from indulgence in alcoholic liquors. Such, however, is not the case. De 
Quincey is so explicit upon this point that we need offer no apology for quoting his 
remarks on the subject : — 

" Opium, I affirm peremptorily, is incapable of producing any state of body at all 
resembling that which is produced by alcohol, and not in degree only incapable, but 
even in kind ; it is not in the quantity of its effects merely, but in the quality, that 
it differs altogether. The pleasure given by wine is always mounting and tending 
to a crisis, after which it declines ; that from opium when once generated is sta- 
tionary for eight or ten hours : the first, to borrow a technical distinction from 
medicine, is a case of acute, the second of chronic pleasure ; the one is a flame, , the 
other a steady and equable glow. But the main distinction lies in this, that whereas 
wine disorders the mental faculties, opium, on the contrary (if taken in a proper 
manner), introduces among them exquisite order, legislation, and harmony. Wine 
robs a man of his self-possession, opium greatly invigorates it. Wine unsettles 
and clouds the judgment, and gives a preternatural brightness, and a vivid exaltation, 
to the contempts and the admirations, to the loves ana the hatreds of the drinker ; 
opium, on the contrary, communicates serenity and equipoise to all the faculties 
active and passive, and with respect to the temper and moral feelings in general, it 
gives simply that sort of vital warmth which is approved by the judgment, and 
which would probably always accompany a bodily constitution of primeval or ante- 
diluvian health. Thus, for instance, opium, like wine, gives an expansion to the 
heart and the benevolent affections, but then with this remarkable difference, that 
in the sudden development of kind-heartedness which accompanies inebriation, there 
is always more or less of a maudlin character which exposes it to the contempt of 
the bystander. Men shake hands, swear eternal friendship, and shed tears, no 
mortal knows why, and the sensual creature is clearly uppermost. But the expansion 
of the benigner feelings incident to opium is no febrile access, but a healthy restora- 
tion to that which the mind would naturally recover upon the removal of any 
deep-seated irritation of pain that has disturbed and quarrelled with the impulses of 
a heart originally just and good." Our author subsequently says : — *'* Wine 
constantly leads a man to the brink of absurdity and extravagance, and beyond 
a certain point it is sure to volatilise and to disperse the intellectual energies, whereas 
opium always seems to compose what had been agitated, and to concentrate what 
had been distracted. In short, to sum up in one word, a man who is inebriated, or tend- 
ing to inebriation, is, and feels that he is, in a condition which calls up into supremacy 
the merely human, too often the brutal, part of his nature ; but the opium-eater (I 
speak of him who is not suffering from disease or other remote effects of opium) feels 
that the diviner part of his nature is paramount — that is, the moral affections are in a 
state of cloudless serenity, and over all is the great light of the majestic intellect." 

If we contrast the furious madman, the subject of delirium tremens, with the 
prostrate debauchee, the victim of opium, or the violent drunkard with the dreamy 
sensualist, intoxicated with his favourite drug, it must be admitted that the com- 
parison is not in favour of the former. The opium-eater is, at least, harmless to 
every one except himself, whilst the drunkard is not only a dangerous nuisance, 
but an enemy to the community at large. 



848 MATERIA MEDICA. 



It is usually stated that the elevation of spirits produced by opium is necessarily 
followed by a proportionate depression, and that the natural and even immediate 
consequence of opium is stagnation both of body and mind. This is positively 
denied by De Quincey, who affirms that for the ten years during which he took 
opium at intervals and in moderation, the day succeeding that on which he had 
recourse to the drug was always one of unusually good spirits. He states, too, that 
the primary exciting and stimulating effects always lasted with him during his 
noviciate for upwards of eight hours, and he was thui enabled to time the exhibition 
df his dose, so that its narcotic influence corresponded with the natural hours of rest. 
In his earlier experiences, when he resorted to the use of opium not oftener than 
once in three weeks, it never induced a desire for silence or solitude, for he owns 
that he frequently indulged in a debauch preparatory to a visit to the opera. This 
statement, however, is subsequently somewhat modified when he says : — " Yet in 
candour I will admit that markets and theatre^ are not the appropriate haunts of 
the opium-eater when in the divinest state ir^dent to his enjoyment. In that state 
crowds become an oppre_ Jon to him ; music even too sensual and gross. He 
naturally seeks solitude and silence, as indispensable conditions of those trances or 
profoundest reveries which are the crown and consummation of what opium can do 
for human nature. . . . The remedies I sought were to force myself into society, 
and to keep my understanding ki continual activity on matters of science. But for 
these remedies, I should certainly have become hypochondriacally melancholy. In 
after-years, however, when my cheerfulness was more fully re-established, I yielded 
to my natural inclination for a solitary life. And at that time I often fell into those 
ieveries upon taking opium, and more than once it has happened to me when I have 
been at an open window, in a room from which I could overlook the sea at a mile 

below me, and could command a view of the great town of L , at about the same 

distance, that I have sat from sunrise to sunset motionless, and without wishing to 
move." 

By degrees, as the habit of opium-eating becomes more and more confirmed, the 
drug loses its stimulating effects on the system, and the beatific intoxication so 
eagerly yearned for by its devotees is no longer produced. The dose is gradually 
increased, but even this, the last resource of the unfortunate victim of a baneful 
habit, in time proves unavailing, and an indescribable agony, both mental and cor- 
poreal, is the penalty paid for former indulgence. This is accompanied by a state 
of incapacity and feebleness, and of intellectual torpor in which the most ordinary 
mental exertion is performed with the greatest difficulty. De Quincey, speaking of 
his condition during the four years that he was under the Circean spells of opium, 
says : — " But for misery and suffering, I might indeed be said to have existed in a 
dormant state. I seldom could prevail on myself to write a letter — an answer of a 
few words to any that I received was the utmost that I could accomplish; and often 
that not until the letter had lain weeks, or even months, on my writing-table. 
Without extraneous aid, all records of bills paid or to be paid must have perished, 
and my whole domestic economy must have gone into irretrievable confusion." We 
are told in the biographies of Coleridge, another great opium-eater, that a prominent 
feature of his character was procrastination, and that he was strikingly deficient in 



opium. 849 

that steady persevering determination which is alone the precursor of success, and 
the parent of all gre'at actions. It is to this condition that De Quincey refers when 
he says : — " The opium-eater loses none of his moral sensibilities or aspirations ; he 
wishes and longs as earnestly as ever to realise what he believes possible, and feels 
to be exacted by duty ; but his intellectual apprehension of what is possible infinitely 
outruns his power, not of execution only, but even of power to attempt. He lies 
under the weight of incubus and night-mare ; he lies in sight of all that he would 
fain perform, just as a man forcibly confined to his bed by the mortal languor of a 
relaxing disease, who is compelled to witness injury or outrage offered to some 
object of his tenderest love; he curses the spells which chain him down from 
motion, and he would lay down his life if he might but get up and walk ; but he is 
powerless as an infant, and cannot even attempt to rise." 

The dreams, both waking and sleeping, which emanate from habitual indulgence 
in opium are of a maddening, frenzied character, and are to the unfortunate 
sufferer simply overwhelming in the reality of their unreality. De Quincey says : — 
u I was stared at, hooted at, grinned at, chattered at by monkeys, parroquets, by 
cockatoos. I ran into pagodas, and was fixed for centuries at the summit, or in 
secret rooms : I was the idol ; I was the priest ; I was worshipped ; I was sacrificed. 
I fled from the wrath of Brama through all the forests of Asia ; Vishnu hated me ; 
Siva laid wait for me. I came suddenly upon Isis and Osiris ; I had done a deed, 
they said, which the ibis and crocodile trembled at. I was buried for a thousand 
years in stone coffins with mummies and sphinxes, in narrow chambers at the heart 
of eternal pyramids. I was kissed with cancerous kisses by crocodiles, and laid 
confounded with all unutterable slimy things amongst reeds and Nilotic mud." 

Let us turn now for a moment to the consideration of a question which is 
frequently asked, but is by no means easily answered. Is opium-eating common in 
this country ? We believe that in some parts of England the custom is extremely 
prevalent, but this opinion, as may be imagined, rests solely on circumstantial 
evidence. It is well known that the quantity of opium imported into this country 
is much greater than is needed for strictly legitimate medical purposes. Many 
chemists have regular customers who come for their opium with as much regularity, 
and quite as much as a matter of course, as other people go to the public-house for 
their beer. It is not, it is true, usually drunk on the premises, but there are 
exceptions even to this rule, and people are known who would toss off their glass 
of laudanum with as much gusto as we dispose of our glass of bitter. The 
proceedings of the law courts occasionally disclose the fact that whole families 
have for years been opium-eaters without the circumstances attracting any attention 
on the part of their friends and neighbours. Students of biography know that some 
of our most eminent modern poets and philosophers have derived inspiration from 
this mighty drug. Medical men are often, in the course of their professional 
avocations, brought in contact with people who for years have constantly taken 
opium, and such cases are by no means uncommon amongst the inmates of ou 
hospitals and workhouses. It is to be feared that opium-eating pervades all classes 
of society, from De Quincey to John Jasper, from Coleridge to Miss Gwilt. Iff 
there any mark by which an opium-eater can be recognised ] We believe no* 
54 



850 MATERIA MEDICA. 

although it is said by some writers that an opium eater can be instantly recognised 
by his appearance. We are told that a total attenuation of the body, a withered 
yellow countenance, a lame gait, a bending of the spine, and glossy, deep sunken 
eyes, betray him at the first glance. These symptoms may perhaps be observed in 
those who are habituated to the use of inordinate quantities of opium, but they 
are certainly not characteristic of those who take tbe drug occasionally and in 
moderation. The opium-eaters whom we have seen have been in appearance very 
much like ordinary mortals, and it may be fairly assumed that it is only when the 
drug is used in large quantities that it sets its distinctive mark on the victim. The 
habitual drunkard is at once recognised, even the little boys in the street indicating 
the facility with which the diagnosis is made, but there is nothing characteristic 
of a teetotaller, nothing by which we can distinguish him from his fellow-creatures 
who take their glass of bitter or pint of claret at lunch or dinner every day of their 
lives. And so it is with the opium-eater, if he can only keep his vice within 
bounds he runs very little risk of detection. 

Is opium-eating injurious to the system 1 "When taken strictly in moderation 
we believe that it is not to any appreciable extent. It has been too much the 
practice of writers on the subject to content themselves with drawing the sad 
picture of the confirmed opium debauchee, plunged in the lowest depths of moral 
and physical exhaustion, and having formed the premises of their argument from 
this exception, to proceed at once to involve the whole practice in one sweeping 
condemnation. It would be almost as rational to paint the horrors of delirium 
tremens, and upon that evidence to condemn at once the entire use of alcoholic 
liquors. The question now under consideration is not what are the effects of opium 
used to excess, but what are its effects, mental and physical, when taken in 
moderation, either as a stimulant during excessive fatigue, or a restorative and 
sedative after bodily or mental labour. We have the evidence of De Quincey that 
from 1804 to 1812, a period of eight years, during which he was a dilettante 
eater of opium, he enjoyed perfect health, and was, in fact, never better in his life. 
It was only later, when he took the drug constantly and in large quantities, that 
his health suffered. It is well known that the Chinese are a nation of opium- 
eaters, and yet they are a muscular and well-formed race, the labouring classes 
being capable of great and prolonged exertion under a fierce sun and in an 
unhealthy climate. Their disposition is cheerful and peaceable, and in general 
intelligence they rank deservedly high among Orientals. In China and the islands 
of the Indian Archipelago, immense quantities of opium are consumed by smoking. 
The smokable extract called chandoo is made into pills about the size of a pea. 
One of these is placed in a small tube and lighted at a lamp, the smoke being 
retained in the mouth as long as possible, and then expelled through the nostrils. 
It does not appear that the practice, when pursued in moderation, is detrimental to 
health. Many people have attained the age of sixty or seventy who have been 
well known as habitual opium-smokers for thirty years or more. As 'Er Royal 
"Ighness the Princess Hopium Puffer says in " Edwin Drood," " It's opium, deary, 
and it's like a human creeter so far, that you always hear what can be said against 
it, but seldom what can be said in its praise." In spite of this evidence, however, 



opium. 851 



it should be distinctly understood that we do not advocate the use of opium, and 
have no hesitation in saying that no one has a right knowingly to enroll himself 
in the category of opium-eaters. Our advice to those who may be tempted to 
commence the practice is most emphatically, " Don't." 

When the baneful habit of opium-eating has been confirmed, it is with 
extreme difficulty that it is shaken of£ The agony of the opium-eater when 
deprived of his drug is as horrible as his happiness is complete when he has taken 
his accustomed stimulant. On the one hand, he suffers the torments of hell ; on the 
other, the bliss of paradise. Some idea of the powerful influence which opium exerts 
on its victims, and of the difficulty of casting off its yoke, may be formed from 
the following extract from a letter written by Coleridge to his friend and biographer 
Cottle :— 

" For ten years the anguish of my spirit has been indescribable, the sense of my 
danger staring, but the consciousness of my guilt worse, far worse, than all ! I have 
prayed with drops of agony on my brow ; trembling, not only before the justice of 
my Maker, but even before the mercy of my Redeemer. I gave thee so many 
talents — what hast thou done with them 1 

" Overwhelmed as I am with a sense of my direful calamity, I have never 
attempted to disguise or conceal the cause. On the contrary, not only to friends 
have I stated the whole case, with tears, and the very bitterness of shame, but in 
two instances I have warned young men, mere acquaintances, who have spoken of 
having taken laudanum, of the dire consequences, by an awful exposition of its 
tremendous effects on myself. Though before God, I cannot lift up my eyes, and 
only do not despair of His mercy because to despair would be adding crime to 
crime, yet to my fellow-men I may say that I was seduced into the accursed habit 
ignorantly. I had been almost bed-ridden for many months, with swellings in my 
knees ; in a medical journal I, unhappily, met with an account of a cure performed 
in a similar case (or what appeared to me to be so), by rubbing in of laudanum, 
at the same time taking a given dose internally. It acted like a charm, like a 
miracle ! I recovered the use of my limbs, of my appetite, of my spirits, and this 
continued for near a fortnight. At length, the unusual stimulus subsided, the com- 
plaint returned, the supposed remedy was recurred to — but I cannot go on through 
the dreary history. Suffice it to say that effects were produced which acted on me 
by terror, cowardice, fear of pain and sudden death, not (so help me God!) by any 
temptation of pleasure or expectation, or desire of exciting pleasurable sensations. 
On the very contrary ; Mrs. Morgan and her sister will bear witness so far as to 
say that the longer I abstained, the higher my spirits were, the keener my enjoy- 
ments — till the moment, the direful moment, arrived, when my pulse began to 
fluctuate, my heart to palpitate, and such a dreadful falling abroad, as it were, of 
my whole frame, such intolerable restlessness and incipient bewilderment, that in 
the last of my several attempts to abandon the dire poison, I exclaimed in agony, 
which I now repeat in seriousness and solemnity, ' I am too poor to hazard this.' 

"Had I but a few hundred pounds (but £200), half to send co Mrs. Coleridge, and 
half to place myself in a private mad-house, where I could procure nothing but 
what a physician thought proper, and where a medical attendant could be constantly 



852 MATERIA MEDICA. 



with me for two or three months (in less than that time life or death would be 
determined), then there might be hope. Now there is none ! O God, how willingly 
would I place myself under Dr. Fox, in his establishment I for my case is a species 
of madness, only that it is a derangement, an utter impotence of the volition and 
not of the intellectual faculties. You bid me rouse myself! Go, bid a man 
paralytic in both arms to rub them briskly together, and that will cure him. 
'Alas I' he would reply, 'that I cannot move my arms is my complaint, and my 
misery.' " 

Coleridge, we are told, was at this time in a pitiable condition. His passion for 
opium had so completely subdued his will that he seemed carried away without 
resistance by an overwhelming force. The impression was fixed on his mind that 
he would inevitably die unless placed under constraint, and that constraint he felt 
could be alone afforded in an asylum. 

That emancipation from the spells of opium may be obtained is shown by the 
case of De Quincey, who, after a seventeen years' use, and an eight years' abuse of 
the drug, finally succeeded in renouncing its powers. The struggle must of necessity 
be severe, but by steady perseverance success may be assuredly attained. De 
Quincey's description of his efforts to renounce the use of his old friend and enemy 
illustrates the difficulties which beset the path of those who determine to shake off 
the influence of the pernicious and enervating habit. 

" Opium," he says, "I resolved wholly to abjure, as soon as I should find myself 
at liberty to bend my undivided attention and energy to this purpose. It was not, 
however, until the 24th of June last that any tolerable concurrence of facilities for 
such an attempt arrived. On that day I began my experiment, having previously 
settled in my own mind that I would not flinch, but would 'stand up to the 
scratch ' under any possible ' punishment.' I must premise that about one hundred 
and seventy or one hundred and eighty drops had been my ordinary allowance for 
many months. Occasionally I had run up as high as five hundred, and once nearly 
to seven hundred. In repeated preludes to my final experiment, I had also gone as 
low as one hundred drops, but had found it impossible to stand it beyond the fourth 
day, which, by the way, I have always found more difficult to get over than any of 
the preceding three. I went off under easy sail — one hundred and thirty drops a 
day for three days ; on the fourth I plunged at once to eighty. Tho misery which 
I now suffered ' took the conceit ' out of me at once, and for about a month I 
continued off and on about this mark ; then I sank to sixty, and the next day to 
none at alL This was the first day for nearly ten years that I had existed without 
opium. I persevered in my abstinence for ninety hours, that is, upwards of half a 
week. Then I took — ask me not how much ; say, ye severest, what would you have 
done ? Then I abstained again, then took about twenty-five drops, then abstained, 
and so on." 

What are you to do if you are a confirmed opium-eater ? If you have been for 
years in the habit of taking opium in small quantities, and if you find that not only 
has your health . not suffered, but that your powers, both mental and bodily, have 
improved, by all means let well alone, taking especial care, however, not to increase 
the quantity or the frequency of the dose. This, we confess, is a hypothetical 



opium. 853 

case ; practically they never occur, and the circumstances which would justify you 
in continuing the habit of opium-eating are exceptional in the extreme. If, on the 
contrary, your health has suffered, if you feel, or if your friends notice, that you 
cannot work as you used to, and that you are not the man you were, you must lose 
no time in abandoning at once and for ever the use of the drug. Go to a medical 
man and tell him without reservation the circumstances of your case, and trust your- 
self implicitly in his hands. If you feel that you have not the power or energy to 
deny yourself your accustomed stimulus, and if you are in sufficiently good circum- 
stances, do not hesitate to have a medical attendant with you constantly, to watch 
you day and night, and guard you from yourself and your enemy, until you have 
attained sufficient strength of mind to take the task in your own hands. If you are 
not in a position to do this, place yourself under conditions in which it will be im- 
possible for you, under any pretence whatever, to obtain access to your favourite drug. 
Go to a hydropathic establishment, or to some institution conducted upon a similar 
principle, where you can obtain nothing but what is allowed you by the physician 
and the rules of the place. If you like, go on a long walking tour with a strong- 
minded friend who is acquainted with your infirmities. Give him your purse, lest 
you should be tempted, and let him cater for you. You may, if you like and can, take 
a sea voyage, although the absence of active employment and the monotony of the 
life are less favourable conditions for conquering your habit. If you find it im- 
possible to get away from your work, still do not trust to your unassisted efforts, but 
confide in a clear-headed friend, in your wife, or in any one in whom you can place 
implicit confidence, and who will take an active and intelligent interest in your case. 
Do not try and cure yourself little by little by gradually reducing the dose, but take 
the right step and break through your bonds at one bold sweep, and never, under any 
circumstances, touch another drop of opium. The struggle will be a severe one, but 
it will not kill you. You will have a rough time of it just at first, but you must 
stand up and bear it like a man. If you were going to have a tooth out, would you 
rather have it out fang by fang, or tell the dentist to give a long pull and a strong 
pull, and have done with it 1 It is painful, but you must grin and bear it. You 
may break your fall, if you like, by smoking in moderation, or by taking tonics. Try 
the gentian and soda mixture (Pr. 14), and follow this up by a course of quinine 
(Pr. 9) or iron (Pr. 1). Take plenty of exercise, go in for long walks and thoroughly 
tire yourself out, so that when you go to bed you will fall asleep and sleep the sleep 
of the innocent. Put your shoulder to the wheel, make up your mind to win, and in 
a month you will be another man 

Even on grounds of economy alone it may be desirable to discontinue the habit. 
Opium is by no means an inexpensive drug, and the man who smokes fifteen-cent 
cigars would probably consider himself perfectly justified in complaining of the 
absurd and unwarrantable extravagance of the habitual opium-eater. It must be 
remembered that, in the words of Dickens's " Hopium Puffer," " the market price is 
dreffle high just now." 

It may appear almost superfluous to state that opium is one of the most valuable 
drugs in our materia medica. At the same time, it is not a drug which is to be used 
lightly and without due consideration. It will relieve almost all kinds of pain, but 



854 MATEEIA MEDICA. 



the mere fact of your having a pain is not to be considered as a justification for 
using opium. It is not to be used for little pains ; you must wait till your pain 
is very bad indeed — in fact, almost agonising — before you begin even to think of 
opium. A man who would use opium for every little trivial ache and pain would 
take an 80-ton gun to go rabbit shooting. You must remember that opium is your 
sheet-anchor, and you must reserve it for your very bad pains. 

In the first place, What will opium do for us when applied externally 1 } A 
mixture of equal parts of opodeldoc and laudanum, when rubbed in over the painful 
spot, will usually quickly relieve neuralgia, lumbago, sciatica, and similar complaints. 
The same application often relieves the pain in the side resulting from pleurisy, 
inflammation of the lungs, and other diseases. 

Laudanum rubbed into the gums, or applied on a little cotton-wool to a hollow 
tooth, will often cure toothache. If a drop or two should be accidentally swallowed, 
it is of very little consequence, as the ordinary dose for an adult is from fifteen to 
twenty drops. 

The ointment of galls and opium is a favourite application for piles, and in mild 
cases will usually effect a cure. It is made by mixing eighty grains of finely-powdered 
galls and twenty-six grains of powdered opium with an ounce of lard. 

Opium is given internally for the relief of pain and spasm of all kinds. Thus 
it is useful in cancer and ulcer of the stomach, and in inflammation of that organ 
occurring in those who habitually indulge too freely in stimulants. It will give 
relief in all forms of colic, even when dependent on the passage of a calculus or gall- 
stone. Laudanum is nearly always at hand, or is readily procurable, and a dose of 
from twenty to twenty-five drops in a glass of water will, in the case of an adult, 
usually relieve pain, from whatever cause arising. It is often advantageous to add 
fifteen drops of chloric ether to the mixture, but it is not essential. 

In nearly all forms of diarrhoea, the administration of opium proves beneficial. 
It is useful not only in the ordinary summer diarrhoea, but in those severer forms 
which accompany the progress of typhoid fever, dysentery, and other organic diseases. 
It may be administered alone, as laudanum, or preferably in combination with some 
astringent, as we have it in the diarrhoea mixture (Pr. 28). On the other hand, 
drop or half-drop doses of laudanum, given hourly or oftener, will prove beneficial 
in an obstinately confined state of the bowels. In all cases of obstruction of the 
bowels, when ordinary purgatives have failed to produce an evacuation, it is desirable 
to resort to the use of opium. 

In some forms of cough, opium, or its alkaloid morphia, may be given with 
great advantage. Its use is indicated in nasty little "hacketing" coughs, and when 
the cough is violent and frequent, but unaccompanied by expectoration. Opium 
should not be given when there is much expectoration, for it may cause profound 
sleep, during which the phlegm, not being coughed up, will accumulate in the chest, 
and may cause suffocation. 

The following is a very useful formula for allaying cough : — 

Morphia Linctus — Solution of morphia 90 drops; chloric ether 90 drops; 
syrup of lemons four ounces by measure. These are to be well mixed together, and 
a tea-spoonful is to be taken occasionally when the cough is troublesome. When it 



opium. 855 



has to be made on a large scale, and expense is an object, treacle -and-water, or 
honey-and- water, may be substituted for the syrup of lemons, without in any way 
detracting from its efficacy. It is as well to retain the dose for as long a time as 
possible in the mouth, and to swallow it slowly, as by its viscidity it proves very 
soothing to the throat when inflamed or ulcerated. The opium and morphia lozenges 
of the Pharmacopoeia, and the lozenge pills (Pr. 69), are used for a similar purpose, 
but the linctus will often succeed when they have failed. 

It is well known that a small dose of opium taken at bed-time will, if resorted 
to at the commencement of the attack, frequently cut short a cold in the head. Ten 
grains of Dover's powder may be taken for this purpose, or, better still, ten or 
fifteen drops of laudanum in a good stiff glass of grog. 

Opium frequently produces sleep when everything else has failed, a matter of no 
little importance, for in fevers sleeplessness, by quickly wearing out the strength, is 
one of the most dangerous symptoms. Laudanum may be given with signal benefit 
in the muttering delirium occurring in the course of many severe illnesses. 

ISTow-a-days the hypodermic or subcutaneous injection of morphia plays a 
prominent part in the relief of pain and the treatment of disease. The drug by 
being introduced under the skin is more quickly absorbed than when taken in the 
ordinary way, and there is less likelihood of its upsetting the stomach or disagreeing 
with the digestive organs. It is an operation which, though perfectly simple and 
easy, should be resorted to only under the immediate personal advice and superin- 
tendence of a medical man. 

There are certain circumstances under which opium should not be used. It is 
not safe to give it in Bright's disease, or when the patient is known or suspected to 
be suffering from disease of the kidneys. It should not be given in bad cases of 
bronchitis, especially if there is much difficulty in breathing, or any blueness about 
the face or lips. It should not be given in brain disease, as in most cases injury 
would result from its employment. And, above all, it should not be given to 
children. There are exceptions to these rules, but they are not many, and they 
should be departed from only under professional guidance. It is very important 
not to give opium to children. It is to be feared that the practice of dosing 
the poor unfortunate innocent with " teething powders " and " soothing syrups " is 
greatly on the increase, and a more pernicious or dangerous custom it is difficult to 
conceive. Opium is poisonous to children, a single drop of laudanum being sufficient 
to kill an infant. It should be distinctly understood that all the most extensively 
advertised "cordials," "carminatives," and "soothing syrups", contain opium in 
some form or other, in spite of the assertions of their proprietors to the contrary. 

Chlorodyne is a popular remedy for many diseases, and is undoubtedly a 
valuable composition. It is said to be made as follows : — Chloroform, 4 oz. ; ether, 
1 oz. ; rectified spirit, 4 oz. ; treacle, 4 oz. ; extract of liquorice, 2 \ oz. ; muriate 
of morphia, 8grs. ; oil of peppermint, 16 minims; syrup, 17Joz.; prussic acid 
(2 per cent. ) 2 oz. Dissolve the muriate of morphia and the oil of peppermint 
in the rectified spirit, mi-x- the chloroform and ether with this solution ; dissolve 
the extract of liquorice in the syrup, and add the treacle ; shake these two solu- 
tions together, and add the prussic acid. The dose for an adult is ten drops in 



856 MATERIA MEDICA. 



a little water. It is frequently given for diarrhoea, colic, &c. It will often ease 
cough, and we have known it relieve a paroxysm of asthma after almost every 
remedy had been tried in vain. 



PHOSPHORUS — PHOSPHATE 01 UME-— \XYPOPHOSPHITE OF LIME. 

Phosphorus was discovered about the midvlle of the seventeenth century, but 
was little used as a curative agent until some four or five years ago, when its 
success hi che treatment of neuralgia and general nervous debility ensured for it 
an amount of attention and consideration it had not previously received. 

Phosphorus is usually made by acting on bone ashes with oil of vitriol, and 
distilling the product with charcoal. Its appearance and characters are more or 
less familiar to most of us. It is usually met with in transparent or cloudy 
colourless little sticks, which at first sight are readily mistaken for wax. It 
is always kept under water, for even on a cold day it gives off fumes which 
are luminous in the dark, and at ordinary summer temperature it catches fire 
on the slightest provocation, burning with a vigour and energy by no means 
easy to suppress. Phosphorus should never be taken up in the lingers or handled 
incautiously, for it is apt to burst into flame with very little warning, inflicting 
burns which are usually extensive, and heal with the greatest difficulty. Phos- 
phorus, though insoluble in water, readily dissolves in ether and many oils. The 
smell produced by the fumes somewhat resembles that of garlic. 

The prolonged inhalation of the fumes of phosphorus frequently gives rise 
to disease of the lower jaw. This complaint was at one time very prevalent 
amongst those employed in lucifer match manufactories, the " dippers," or people 
who immerse the slips of wood in the inflammable substance, being the chief 
sufferers. The disease, which was known as the " lucifer match disease," usually 
Commences with loss of appetite, and a general feeling of weakness and inapti- 
tude for muscular exercise. This is followed by toothache, then by the loss of 
the teeth, more especially the grinders, and finally, by disease or even death of 
a portion of the jaw. These cases are far less common than formerly, and are, 
in fact, now rarely met with. Careful attention to good ventilation in the 
workshops, and more particularly to personal cleanliness on the part of the 
operatives, have done much to stamp out the disease, and the introduction of 
red or non-fuming phosphorus in the matches will, we trust, ere long deal it 
its death-blow. 

Phosphorus may be administered in solution, either in ether or olive oil, but it 
is much less objectionable if taken in the form of a pilL These pills are, from the 
inflammable nature of their chief ingredient, quite unsuited for home preparation, 
but they are readily made by or pi ocured through the agency of any chemist. Each 
pill should contain one-thirtieth of a grain of pure phosphorus. The dose being so 
small, there is no occasion to make it into a bolus ; a very little baby pill, not more 
than a quarter the size of the ordinary pills, will answer all practical purposes, and 
being so small, no difficulty will be experienced in taking it. An even still better 
and more elegant method is to take the phosphorus dissolved in almond oil, and 



PHOSPHOROUS — PHOSPHATE OP LIME — HYPOPHOSPHITE OP LIME. 857 

enclosed in capsules (Pr. 54). These capsules are largely used on the Continent, 
and form a very agreeable and pleasant mode of taking nauseous drugs. It is a 
great advantage to be able to take one's medicine in a palatable form — it robs many 
of our ailments of half their horrors. 

Let us now consider in what cases we may advantageously use our capsules 01 
pills. First and foremost, in that horrible complaint, neuralgia, the value of phos- 
phorus has been so recently recognised that it is as yet impossible to point out with 
absolute certainty the indications for its employment, and to say exactly when it will 
succeed, and when only temporary benefit will be derived from its use. There is no 
doubt that the large majority of people afflicted with this disease derive considerable 
benefit from the use of phosphorus, and many even regard it as an absolute and 
positive specific. We would strongly urge sufferers who have been unsuccessful 
with other drugs to give this a patient trial, and we can assure them that there is 
every likelihood of success attending their efforts. One pill or capsule should be 
taken every three or four hours. 

Phosphorus is given in a variety of diseases of nervous origin. It often provee 
of great value in nervous prostration, and has been used with success in angina 
pectoris, a disease allied to neuralgia. 

We must now pass on to the consideration of two compounds of phosphorus with 
lime, both of which are valuable therapeutical agents. 

Phosphate of lime is prepared for medicinal purposes by precipitating a solution 
of bone ash in spirits of salts by means of hartshorn. It is a white, tasteless, odour- 
less powder, quite insoluble in water. It enters largely into the formation of the 
bones of the body, helping to build up their structure. It is of great use in young 
people wlw are outgrowing their strength, and in pale, weakly women who have been 
pulled down by the cares of a large family, and perhaps by over-suckling. People 
whose health is broken from prolonged town life, or over-work, or who from other 
causes are languid, hipped, and incapable of much exertion, are frequently benefited 
by this medicine, particularly if it be combined with some preparation of iron. 

The phosphate of lime and iron powders (Pr. 77) will be found very useful 
They often prove of great benefit in rickets. 

Hypophosphite of lime is a white pearly-looking powder made by boiling 
phosphorus with milk of lima A few grains placed on the end of a knife will burn 
almost as readily, and with as bright a flame, as phosphorus itself. 

The value of the hypophosphite of lime in the treatment of consumption 
is a subject concerning which considerable diversity of opinion exists amongst 
medical men. That this method of treatment is often attended with the happiest 
results no doubt can be entertained. Under its influence the cough is lessened, the 
expectoration is eased, the night sweats become less profuse, and the patient rapidly 
increases, both in strength and weight. The hypophosphite may be conveniently 
taken in the form of the hypophosphite of lime mixture (Pr. 55). The dose is a 
tea-spoonful, gradually increased to a table-spoonful, three times a day. It may be 
taken pure, or mixed with a little water, or in any of the ordinary beveiages, such 
as milk, tea, or coffee. 



S5S MATERIA MEDICA. 



PODOPHYLLUM. 

The Podophyllum peltatum, mandrake, may apple, or hog apple, is a plant which 
grows abundantly in the United States, chiefly in moist woods and shady situations, 
and along the banks of rivulets. The stem is usually from eight to ten inches high, 
and the plant bears a fruit which is known as " wild lemons," and is occasionally 
eaten. The portion used in medicine is the root, from which is obtained a resin 
known as podophyllin. This resin is a pale greenish-brown amorphous powder 
which readily dissolves in spirit. It is a purgative, and is so highly esteemed in its 
own country that it is known as American mercury or American calomel. It is 
best administered in the form of the solution (Pr. 51), the dose being two or three 
drops on sugar every three hours. This solution is useful in the constipation oj 
children. Infants a few months old, especially after a previous attack of diarrhoea, 
frequently suffer from a confined state of the bowels, the motions being of a clay 
colour mottled with green, and often so hard that they crumble to pieces. Inis 
condition is accompanied by colic and distension of the belly with wind. The child 
is naturally fretful, and often cries, especially on going to stool. One or two drops 
on sugar twice or three times a day will quickly restore the motions to their natural 
colour, and remove the flatulent distension, so that a marked improvement is soon 
noticeable in the child's health. The medicine should be administered with sufficient 
frequency to relieve the bowels once or twice daily. 

Falling of tlie bowel in children, with which the above condition is frequently 
associated, may be treated in the same way. In adults podophyllin proves of 
service in many forms of chronic diarrhoea. Its use is indicated when the motions 
are dark in colour, and when their passage is attended with sharp cutting pains, 
and more especially when the diarrhoea occurs only in the early morning before 
breakfast. Almost all forms of morning diarrhoea are curable by this medicine, even 
when of long standing. One or two drops of the solution three or four times a day 
will usually answer the purpose. 

In some forms of sick-headache podophyllin is very useful. It should always be 
given when the attacks are preceded, accompanied, or followed by diarrhoea with 
dark-coloured motions. Sometimes, although the motions are dark in colour, 
the bowels are confined, and even then the podophyllin will do good. One or 
two drops should be given three or four times a day, and relief will usually be 
obtained. 

In bilious attacks, when there are nausea and giddiness, a bitter taste in the 
mouth, vomiting of bile, and purging, accompanied by high-coloured urine, we give 
podophyllin. When instead of these symptoms there are pale and costive motions, 
dull pain over the liver, loss of appetite, and depression of spirits, it will do no 
good. 

The unpleasant cankery taste in the mouth known as " coppers," from which 
many people suffer the first thing in the morning, is, when not due to alcoholic 
excesses, usually amenable to podophyllin. 



WtUSSIC ACID, OR HYDROCYANIC ACID. 859 



PRUSSIC ACID, OR HYDROCYANIC ACID. 

A powerful poison ? Quite so, and also a valuable remedy. It is an acid, but is 
never used for its acid properties. Its action is totally different, and is, in fact, sui 
generis. 

Its name is derived from the fact of its having been first obtained from Prussian 
blue. It is contained in small quantities in the leaves and seeds of some of our 
commonest fruits, especially in apple-pips. 

It is totally unfit for home preparation, and we have consequently no intention 
of describing the different modes in which it is procured. It is a colourless liquid 
having a peculiar characteristic odour. For medicinal purposes an extremely dilute 
solution (two per cent.) is employed. The dose of this is from one to five drops. 
A tea-spoonful, and probably half that quantity, would prove immediately fatal. 
The greatest care must of course be taken in dealing with it, and it should 
never be dispensed except by a person fully alive to the necessity for caution in the 
measurement of the dose. 

[n painful diseases of the stomach, such as ulcer and cancer, it often proves 
beneficial. It not only eases the pain, but frequently stops the attendant vomiting. 
Palpitation depending upon indigestion is often relieved by this remedy. It 
is best administered with gentian and soda, as in gentian and soda mixture 
(Pr. 14). 

The tormenting itching of nettle-rash and other skin diseases is often relieved by 
the application of a prussic acid lotion, made by adding thirty drops of the dilute 
hydrocyanic acid to a pint of water. This lotion is a poison, and must not be 
applied to the broken skin, or over any part where there are sores or cuts, for 
fear of absorption. 

Prussic acid acts energetically as a poison through whatever channel it is intro- 
duced into the body ; whether it be swallowed, or dropped into the eye, or applied to 
a fresh wound, or inhaled as vapour, its action is exerted with tremendous energy. 
The rapidity of its action is shown by a case of accidental poisoning which occurred 
some years ago. An apothecary's lad was sent from the shop to the cellar for some 
potash. Almost immediately he was heard by his companions to cry out, in a voice 
of great alarm, " Hartshorn ! hartshorn 1" On rushing down-stairs they found him 
reclining on the lower .steps grasping the rail, and he had scarcely time to faintly 
murmur " Prussic acid !" when he expired. On the floor of the cellar was an ounce 
phial, which had contained prussic acid, but was nearly empty. It is supposed that 
the unfortunate youth, being ignorant of the active properties of the drug, had 
taken it out of curiosity, and from the state of the articles in the cellar it was 
evident that, alarmed at its instantaneous operation, he had tried to get at the 
ammonia or hartshorn, which he knew to be the antidote, but was overpowered by 
the tremendous activity of the poison, even before he had had time to undo the 
coverings of the bottle. 

If the patient survive half an hour he is usually safe. 

Fortunately, prussic acid is not a cumulative poison — that is, the continued use 
of small doses frequently repeated is not believed to possess that property recognised 



860 MATERIA MEDICA. 



in some medicines of accumulating in the body, and then suddenly breaking out with 

dangerous or tatai violence. 



TiSAnfXNT op Poisoning by Prtjssic Acid. 

If tem before the symptoms come on. — 1. Give two tea-spoonfuls of blue vitriol 
*nd a teampoonfol of tincture of steel in a tumbler of water. If the symptoms have 
come on. — 2. Dash the contents of the water-jug over the head and face. 3. Hold 
under the nose a bottle of ammonia, hartshorn, sal volatile, or smelling salts, or some 
bleaching powder (chloride of lime), to which vinegar has been added. 4. Keep up 
artificial breathing as you would in drowning. 5. Above all, be quick. 

Unfortunately, however, from the dreadful rapidity of the action of this poison, 
it is rarely in our power to resort to any treatment quickly enough for success, 
and even when taken in time the dose swallowed is often so large as not to be 
counteracted by any remedy. 

Prussic acid is readily detected in the dead body, not only from the peculiarity 
of its odour, but also from the delicacy of the chemical tests employed for this 
purpose. 

The leaves of the common cherry-laurel (Prunus lauro-cerasus) owe their 
activity to the prussic acid they contain. This well-known plant is a hardy ever- 
green shrub or small tree, extensively used in gardens and shrubberies for ornamental 
purposes. It produces early in May elegant spikes of odorous white flowers. The 
laurel water made by distillation is a dangerous poison, and is so variable in its 
strength that it is unsuited for administration as a medicinal agent. Several fatal 
cases have occurred from its injudicious use. 

The essential oil of bitter almonds also owes its tastes and properties to the 
presence of prussic acid. It is very variable in strength, but is usually about four 
times as strong as the officinal prussic acid. It would be considered too powerful 
and dangerous a preparation to use in medicine, but we nevertheless trust it freely in 
the hands of our cooks to proportion the dose they consider requisite for flavouring 
pastry, blanc-mange, <fcc. The so-called " almond flavour," " spirit of almonds," or 
"essence of peach kernels," is a mixture of one part of the essential oil with 
seven of spirit, and even this is often nearly equal in strength to prussic acid. It 
is sold entirely without restriction, and is so readily procurable that it has recently 
become quite a favourite agent for suicidal purposes. In five years there were 
thirty-one registered deaths from oil of bitter almonds, a striking testimony to its 
popularity. It is only the bitter almond which yields this active principle, the 
sweet variety being odourless and free from prussic acid. It may be mentioned in 
this place that the sweet almond contains a large proportion of oil which, from 
being purer and less rancid than olive oil, is largely used in perfumery and in the 
composition of nostrums for the hair. The far-famed "Macassar oil" is said to 
consist of oil of almonds, coloured red with alkanet root, and flavoured with oil of 
cassia. 



PULSATILLA. 861 



PULSATILLA. 

The pulsatilla (Pulsatilla nigricans), or meadow anemone {Anemone pratensis), u 
a plant which flourishes abundantly on the Continent. By the older writers it was 
known as the " wind floure," not from any siLuacy in the treatment of flatulence, 
but because it nearly always grows in exposed situations, where it is perpetually 
agitated by the air. It usually flowers in May, and a second time in August or 
September. 

Pulsatilla appears to have a special affinity for the mucous membranes. It is 
useful in many forms of dyspepsia or indigestion. It is given when the tongue is 
thickly coated with a rough fur, and when there is nausea with little vomiting, and 
an absence of much pain. It will often act beneficially in indigestion caused by fat 
or rich food, although the most rational treatment is to get rid of the offending 
substance by means of an emetic. In dyspepsia pulsatilla exerts a greater influence 
over heartburn than over water-brash. 

Pulsatilla does very well in discharges from tJie ears in children, and often proves 
curative in deafness the result of a cold, or coming on after measles. 

In many diseases of t/ie eyelids it proves very useful. Thus when they discharge 
freely, and stick together in the morning, pulsatilla is indicated. This drug may also 
be used for styes, and if given early will often arrest their progress. 

Pulsatilla is a drug which is especially adapted for women, and in many of their 
complaints may be implicitly trusted. Thus it is given in scanty or suppressed 
menstruation, whites, &c. 

Subacute rheumatism, occurring in young delicate people, often yields to this 
remedy, especially when the knees, ankles, or small joints of the hands and feet are 
affected. It is also frequently employed in rlieumatic gout, being almost curative in 
the acute forms, and very useful in the chronic. 

The whole plant is used in the preparation of the tincture of pulsatilla, the 
strength of which is one in ten. It is conveniently given in the form of the mixture 
(Pr. 43), a tea-spoonful every ten minutes for the first hour, and subsequently hourly. 
In chronic complaints half a table-spoonful may be given every three hours. 



QUASSIA; CHIRETTA, CUSPARIA, AND CASCARILLA. 

The Jamaica quassia (Picrcena excelsa) is a beautiful, tall, stately tree, some- 
what resembing our ash. It is known as the " lofty bitter-wood tree," and it not 
unfrequently attains a height of one hundred feet, its trunk being straight and 
tapering, and sending off branches towards the top. The wood is white, but by 
exposure to the air becomes yellowish. It is imported from Jamaica and the other 
"West India islands in billets of various sizes, which are sometimes a foot in 
diameter and several feet in length. The smaller pieces are often cut up and sold 
as quassia chips. The wood has no odour, but an intensely bitter taste. It is 
said to be fatal to nearly all insects, and it has long been known that the infusion 
W an excellent fly poison, and that it or the tincture is used in the preparation of 



MATERIA MEDICA. 



some of the French fly-papers. Insects never trouble cabinet-work made from this 
wood, they, it is to be presumed, not being partial to bitters. 

Quassia is a simple bitter, and may be used in the same class of cases as 
gentian or calumba. The infusion is made by steeping sixty grains of quassia 
chips in half a pint of cold water for an hour, and then straining. The dose is 
from two to three table-spoonfuls. When it is given to improve the appetite it, 
like other bitters, must be given shortly before meals ; it is of no use taking it 
after. Quassia may be given with iron, as they do not turn black when mixed. 
It is one of the ingredients of the iron and quassia mixture (Pr. 2). Sometimes 
the infusion is employed in the case of children, as an injection for the destruction 
of the little thread-worms which so frequently infest the lower bowel. It may 
succeed when given by the mouth, but the method which we have indicated will be 
found much more effectual. 

Chiretta {Ophelia chirata), or bitter plant of the Kiratas, a mountain tribe in 
the north of India, has long been esteemed by the Hindoos, and is as universally 
employed throughout the Bengal Presidency as gentian is in Europe. The entire 
plant is used medicinally, and is commonly administered in the form of an 
infusion, prepared by steeping a quarter of an ounce of the plant cut small in 
half a pint of warm water for half an hour, and then straining. The dose is two 
table-spoonfuls. 

Cusparia (Galipea cusparia) is a tree varying much in size, and is a native of 
South America. Its bark is known as "angostura bark." When first imported it 
was occasionally mixed with the bark of the nux vomica tree, which from that 
circumstance is often called " false angostura." The marks of distinction between 
the two barks were soon recognised, but not before several deaths had occurred 
from the unfortunate accident. There is little danger of the mistake being 
repeated, but should there be any doubt on the subject it will be at once removed 
by chewing a fragment, for cusparia bark has a disagreeably aromatic flavour, 
whilst that of the nux vomica has a pure and intensely bitter taste. The infusion 
of cusparia is made by steeping half an ounce of the bark in coarse powder in 
half a pint of hot water for two hours, and then straining. The dose is two table- 
spoonfuls or more. It differs from chiretta and gentian chiefly in the fact of its 
being more aromatic. 

The cascarilla {Croton eleutria) is a member of the Spurgewort family, the natural 
order which yields us croton and castor oils. It is a shrub or small tree, a native 
of the Bahamas, and the thickets of Jamaica, and the other West India islands. 
The bark, the only part used in medicine, is found in quills from two to three inches 
long, which have a dull brown colour, a warm, bitter taste, and emit a fragrant odour 
when burned. The powdered bark is the essential ingredient of the fumigating 
pastilles. It may be "given internally in powder in from ten to thirty-grain doset^ 
either with carbonate of soda or in milk An infusion is made in the proportion 
of one ounce of bark to half a pint of boiling water, the dose being as usual — two 
table-spoonfuls. It may be described as a slight stimulating tonic, and it Lb chiefly 
employed in dyspepsia and other allied complaints. 



RHUBARB. 863 



RHUBARB. 

The characters and properties of rhubarb are so well known that it may appear 
almost superfluous even to enumerate them. The rhubarb used for medicinal pur- 
poses is obtained from Thibet and Chinese Tartary. The root is dug up, cleaned, 
peeled, and cut into pieces, which are bored with a hole through the centre, and are 
then hung up in the sun to dry. It is imported from Canton, and is brought over- 
land by way of Moscow. This rhubarb is generally known as " Turkey rhubarb," 
but the true Turkey rhubarb is a thing of the past, for as the rhubarb of the 
Levant disappeared from trade, that of Bussia took not only its place, but its 
designation. Bhubarb has been cultivated for medicinal purposes at Banbury, in 
Oxfordshire, for nearly a century. 

There are several preparations of rhubarb largely used for their purgative pro- 
perties. The " infusion of rhubarb " is made by infusing a quarter of an ounce of 
rhubarb root, in thin slices, in ten fluid ounces of boiling water for an hour, and then 
straining. The dose of this horrible preparation is about a wine-glassful. ''Com- 
pound rhubarb pills " are made as follows : — Mix 3 ounces of powdered rhubarb, 
2\ ounces of Soco trine aloes in powder, and 1 J ounces each of powdered myrrh and 
hard soap, with 1J fluid drachms of oil of peppermint; then add four ounces of 
treacle, and beat the whole into a uniform mass, after which it is to be divided into 
pills, each containing about five grains. One or two may be taken for a dose." 
" Gregory's," or the " compound rhubarb " powder, is a sifted mixture of two ounces 
of powdered rhubarb root, six ounces of light magnesia, and one ounce of powdered 
ginger. The dose for a child is from fifteen to twenty grains. 

Bhubarb, like many other drugs, has a double action, for in large doses it acts as 
a purgative, whilst in small doses it is an astringent, and confines the bowels. It 
is used largely for children, why it is difficult to say, for nine times out of ten it 
does infinitely more harm than good. The horrors of the Inquisition, the greatest 
enormities charged even against the vivisectors, sink into insignificance before the 
horrible cruelties which are constantly inflicted on children by the forcible adminis- 
tration of rhubarb and other equally nauseous drugs. If the bowels are confined, it 
generally arises from some error in diet, or want of attention to the general prin- 
ciples of health, and the temporary difficulty is often readily removed by giving the 
child a little fresh fruit, or a few figs. Bhubarb is said to be a stomachic tonic, and 
is used for dyspepsia, but we have already indicated several equally efficacious and 
far more agreeable remedies for this complaint. 



SAL AMM0NIAC1. 

This salt rejoices in a multiplicity of names. In addition to sal ammoniac it is 
known as chloride of ammonium, muriate of ammonia, and sometimes as hydro- 
chlorate of ammonia. It was well known to the ancients, and its most popular 
name is said to be derived from Ammonea, a district in Libya, where the oracle of 
Jupiter Ammon was situated. In Egypt sal ammoniac was and is still obtained 
by burning camel's dung. In this country, however, it is derived from a more 



864 MATERIA MEDICA, 



abundant source, the refuse products formed in the manufacture of coal gas. Thia 
" gas liquor " is an offensive, tarry, and strongly ammoniacal liquid. On the addition 
of hydrochloric acid there is an abundant evolution of a mixture of different gases, 
and on concentrating the fluid impure crystals of sal ammoniac are obtained. These 
are separated, and after being roasted to expel the tarry matter, are sublimed in an 
iron pot furnished with a dome-shaped cover, upon the inner surface of which the 
salt is deposited in a hard thick cake. It is usually sold in colourless, inodorous, 
fibrous masses which are pieces of this hemispherical cake. It is tough and ex- 
tremely difficult to powder, but dissolves readily in either hot or cold water. The 
rusty-looking stain often noticed on the outer surface of pieces of this salt is derived 
from the iron pots used in its preparation. 

Sal ammoniac is a valuable remedy for all forms of neuralgia, more especially 
for neuralgia of the face. In the treatment of this complaint it is to be reckoned 
only second to phosphorus, of the beneficial effects of which we have already 
spoken. In pain in the muscles of the side, in neuralgia of the side, and the mild 
forms of sciatica, it is extremely useful. In these cases it should always be given 
in large quantities. Doses of less than half a drachm usually prove useless, and 
sufferers who have taken it in smaller quantities without avail will do well, to give 
it a second trial under more favourable auspices. The only objection that can be 
urged against its use is that it is extremely nasty. It may be conveniently taken 
in the form of the following mixture, every two table-spoonfuls of which contain 
half a drachm of the salt :— Sal ammoniac half an ounce, chloric ether one and a 
half tea-spoonfuls, water eight ounces. Two table-spoonfuls should be taken every 
four hours. 

Fortunately, sal ammoniac is a drug which acts quickly. If the first bottle fails 
to relieve the pain, it is useless to continue taking it, and it may be concluded that 
the form of complaint is not one over which the drug will exert any beneficial 
influence. 

These large doses of sal ammoniac are often taken with considerable success in 
long-standing cases of bronchitis and winter cough, more especially when the phlegm 
is thick and abundant. In this complaint Pr. 36 may be used with advantage. 



SALICINE AND THE WILLOW. 

As many as sixty-four indigenous species of willow have been recognised ill 
England, but of these a few only are useful for medicinal purposes. The " Bedford 
trillow," the " crack willow," and the " common white willow " have already earned 
their laurels as curative agents. At present we are unable to say positively which 
of these is the most energetic in its action, but a good practical rule is to select 
those barks which possess the greatest bitterness combined with astringency. Wil- 
low bark, of course, varies somewhat in its characters according to the species from 
which it is obtained, but it is usually thin and flexible, and readily rolls up into 
quills. It has a slight odour, but a powerful bitter and astringent taste. It has in 
many parts of the country long enjoyed a reputation for the cure of ague, and it has 
been largely used as a substitute for quinine. Its activity depends chiefly on the 



BAL VOLATILE. 



presence of a substance known as " salicine." This salicine may be obtained in little 
white, silky needles or scales, which are soluble in water, and more so in hot water 
than in cold. It is now largely employed in cases of rheumatic fever or acute rheu- 
matism, and very favourable results have followed its administration, It is the 
remedy upon which the greatest reliance is now placed in the treatment of this 
terrible disease. It should be given in thirty-grain doses every two hours, or, in 
bad cases, every hour — smaller doses are of little avail. Pr. 12 should be 
used. The same method of treatment may be adopted in ague when quinine is not 
procurable. Tea-spoonful doses of this mixture are sometimes used in the treatment 
of singing in tfie ears. 

SAL VOLATILE. 

Thero are probably few medicines more commonly used for slight ailments 
than sal volatile, or, as it is called in scientific language, aromatic spirit of ammonia. 
This preparation is not a simple drug, but a mixture or composition of several 
substances. As probably not one person in fifty who uses this popular prepara- 
tion has the slightest idea what it is composed of, we will enumerate its ingre- 
dients. It is a mixture of carbonate of ammonia, strong solution of ammonia, 
volatile oil of nutmeg, oil of lemon, rectified spirit, and water. The spirit is by far 
the largest constituent, and an habitual sal volatile taker is every bit as much a spirit 
drinker as the man who " fuddles " himself with gin-and- water over the bar of a 
public-house. 

Sal volatile is undoubtedly a valuable diffusible stimulant, but there are unfor- 
tunately hundreds of people who employ it with such injudicious frequency, and 
upon every trivial occasion, that its use has been greatly abused. A physician of 
the last century narrates the following case illustrative of the ill effects resulting 
from the long-continued use of one of its constituents, carbonate of ammonia : — 

" I had lately under my care," he observes, " a gentleman of fortune and family, 
who so habituated himself to the use of vast quantities of volatile salts, that at length 
he could eat them in a very astonishing manner, as other people eat sugar and 
carraway seeds. The consequence was that he brought on a hectic fever, vast 
bleedings from the intestines, nose, and gums ; every one of his teeth dropped out, 
and he could eat nothing solid ; he wasted vastly in his flesh, and his muscles became 
as soft and flabby as those of a new-born infant ; and he broke out all over his body 
in pustules. He was at last persuaded to leave off this pernicious custom ; but he had 
so effectually ruined his constitution that though he rubbed on in a miserable 
manner for several months, he died, and in the highest degree of wasting. And 
I am persuaded he would have died much sooner had he not constantly drank 
very freely of the most fine and generous wines, and daily used large quantities 
of asses' milk and anti-scorbutic juices, acidulated with juice of lime." 

Sal volatile and other preparations of ammonia or hartshorn are largely used 
for fainting, hysteria, nervous headache, spasms, wind, dec. The dose of the sal 
volatile is from twenty drops to half a tea-spoonful in a wine-glass of water. 

In cases of fainting it is customary to place a bottle of sal volatile or smelling- 
salts to the nose, for the purpose of assisting the patient's restoration to consciousness. 
55 



866 MATERIA MEDICA. 



In applying preparations containing ammonia to the nostrils of a person in a state of 
insensibility, we must be careful to avoid using our remedy too energetically. We 
should always employ it with caution, for if used injudiciously serious or even fatal 
consequences may ensue. It is a good plan to ascertain by our own sensations the 
distance at which the bottle should be held from the nose. A few years ago a 
French physician, who suffered from epileptic fits, was found by his servant in a 
state of insensibility. The devoted attendant, in order to arouse his master, applied 
to his nose a handkerchief moistened with ammonia, and continued the application 
with such unwearied but destructive benevolence, that he not only restored him 
to consciousness, but excited an attack of bronchitis which proved fatal on the third 
day. 

Ammonia is largely used as an external application in the form of hartshorn 
and oil. It is employed somewhat indiscriminately for the relief of rheumatic and 
neuralgic pains, lumbago, sore throat, sprains, bruises, <bc. 

Hartshorn and oil. — Solution of ammonia, one fluid ounce; olive oil, three fluid 
ounces; mix and shake well together. The liniment should be made in a wide- 
mouthed bottle, as a difficulty is sometimes experienced in getting it to flow out 
when the neck is narrow. 

SARSAPARILLA. 

Sarsaparilla is a drug whose reputation is rather of the past than of the present. 
It consists of the roots of plants growing chiefly in the West Indies. It is generally 
imported in bundles some two or three feet or more in length, and weighing several 
pounds. At one time it was regarded almost as a " cure-all," and was administered 
for almost all chronic diseases. As a proof of its efficacy, it was stated by its advo- 
cates that patients who commenced taking it often continued to do so for months or 
yeara. This we should regard rather as a proof that it was inert, for if it were 
possessed of active properties it would surely either have killed or cured them long 
before. The fact is that sarsaparilla was seldom given alone, but was used as a 
vehicle for the administration of mercury, iodide of potassium, and other powerful 
and efficient drugs, so that it often obtained credit which it by no means deserved. 
We believe that sarsaparilla itself is utterly without effect upon the economy, and 
that its reputation as a "blood purifier," whatever that may mean, is all rubbish. 
There is one thing to be said in its favour — if it does no good, it can do no harm. 
If there is any one who still retains a latent belief in its virtues, he may indulge 
himself with perfect safety, with the full assurance that he will not suffer in any 
way, unless it be in pocket The decoction of sarsaparilla is made by steeping two 
and a half ounces of sarsaparilla cut into small pieces in a pint and a half of boiling 
water, and gradually evaporating it down to a pint. The dose is anything under a 
bucketful 

SENBGA AND SQUILLS. 

These drugs are employed chiefly to loosen the phlegm in cases of bronchitis. 
Senega is the root of a plant growing abundantly in Kentucky, Ohio, and Tennes- 
see, and was originally used by the Senegaroo Indians as an antidote for the bite of 



the rattlesnake. It has a sweetish and somewhat acrid taste, and increases the flow 

of the saliva. It is usually used in the form of an infusion, made by pouring half 
a pint of boiling water over half an ounce of senega root in coarse powder, letting 
it stand for an hour, and then straining. The dose is from two to three table- 
spoonfuls. Not only does it loosen the phlegm, but it increases the perspiration, 
It is seldom given alone, but is combined with carbonate of ammonia, ipecacuanha 
wine, and other expectorants. 

The squill is a thoroughly old-fashioned medicine. It was employed by the 
ancient Greeks, and is said to have been worshipped by the Egyptians. It is to 
be feared that now-a-days its reputation is somewhat on the wane. It grows 
abundantly on the sandy shores of France, Spain, Portugal, and Italy. The bulb, 
which is something like a large onion, is the portion used for medicinal purposes. 
We usually obtain it in dried slices, yellowish- white in colour, bitter, translucent, 
and somewhat horny. There are several valuable preparations of squills, of which 
the tincture and syrup are the most frequently employed. The former is given in 
half tea-spoonful, and the latter in tea-spoonful doses, usually with other cough 
medicines. The ipecacuanha and squill mixture (Pr. 20) is a useful combination. 
The dose for an adult is two table-spoonfuls every four hours. 

In larger doses, squill produces vomiting and diarrhoea. It is seldom used as an 
emetic, on account of the depression it produces. 



8ENNA. 

The plants which furnish the leaves known to us by the name of senna are low 
shrubs growing wild in Syria, Arabia, and Upper Egypt, whence the drug is imported 
into Europe. There has always been some little difficulty about the plants yielding 
this drug, which has arisen from the fact that different plants have been called by 
the same name, and different names have been applied to the same plant, a practice 
which is apt to lead to confusion. If we examine an ordinary specimen of senna 
we shall find that the leaves are not all alike, but that they vary considerably both 
in shape and size. Some are long and narrow and sharp-pointed, others are short 
and broad and blunt at the apex, whilst in addition there are all kinds of inter- 
mediate varieties. They have a faint, sickly odour, and the taste is at first sweetish, 
but afterwards nauseous and bitter. 

Senna has long been famed, even proverbially, for its purgative properties ; thua 
Shakespeare says in Macbeth : — 

" What rhubarb, senna, or what purgative drag 
Would scour these English hence ? " 

It is generally used either as an infusion or in the form of the ever-popular " black 
draught" The infusion is made by pouring half a pint of hot water on an ounce of 
senna and thirty grains of sliced ginger, letting it stand for an hour in a covered 
vessel, and then straining. The black draught is prepared as follows : — Dissolve 
four ounces of Epsom salts and half an ounce of extract of liquorice in fourteen 



868 MATERIA MEDIC A, 



fluid ounces of infusion of senna with the aid of gentle heat, then add two and a 
half fluid ounces of tincture of senna and ten fluid drachms of compound tincture of 
cardamoms, and, finally, a sufficient quantity of infusion of senna to make it up to 
a pint The dose of either of these preparations is from two to three table-spoonfuls. 
Senna is very apt to gripe unless given in combination with salines or some aromatic 
substance. The confection of senna is a very useful laxative in cases of habitual 
constipation. It contains, in addition to its essential ingredient, figs, prunes, 
tamarinds, cassia pulp, extract of liquorice, coriander fruit, and refined sugar. Its 
efficacy may be greatly increased by the addition of a little sublimed sulphur, as in 
the confection of sulphur and senna (Pr. 59). Another preparation of senna, an 
excellent purgative for children, is the compound liquorice powder — powdered senna 
one ounce, powdered liquorice root one ounce, refined sugar three ounces. It is 
essential that all the ingredients should be finely powdered : they should be 
thoroughly mixed, and then sifted. The dose for adults is one or two tea-spoonfuls 
stirred in a little water or milk, and half the quantity may be given to children. 

In cases of indigestion, complicated with constipation, senna and gentian are 
often used in combination, as in the mixture Pr. 1 6. Two table-spoonfuls are to be 
taken three times a day before meals. 



STAVESACRE. 

This, again, is a drug which was used by the ancient Greeks. 

The stavesacre, or palmated larkspur (Delphinium staphisagria), is a native of 
Provence, and many other parts of the south of Europe. It is a handsome plant, 
attaining a height of one or two feet, and bearing beautiful blue or purplish flowers 
supported on long footstalks. Our climate is too cold to admit of its cultivation in 
the open air in this country. The seeds have the reputation of being very poisonous. 
They are not administered internally, but are made into an ointment which has the 
property, by no means to be despised, of destroying lice. The best and cheapest 
method of making this preparation is to bruise two drachms of the seeds and throw 
them into an ounce of melted lard, stirring them well together. After an interval 
the hot mixture must be strained through linen, and the ointment so obtained will 
be found efficacious in destroying the disagreeable visitors to which we have 
referred. 



STRAMONIUM. 

The thorn apple (Datura stramonium) is an annual plant originally imported 
from Ajnerica, where it is known as the "apple of Peru," "devil's apple," and 
" Jamestown weed," also " Stinkweed." It is found in every part of the United 
States, Canada, Mexico, South America, also in Europe, Africa, and Asia. The 
flowers are large, white, or occasionally light purple, and grow singly from the side 
of the stem opposite the origin of the leaves. The plant has a nauseous smell, is 
handsome only when in flower, and consequently is not a general favourite. The 
action of the stramonium is in the main similar to that of belladonna. The dred 



SULPHATE OF ZINC AND OXIDE OF ZING, 



869 



leaves are frequently used either in the pipe, or in a cigarette, for the relief of 
spasmodic asthma. The smoke must be drawn well into the lungs, although it 
sometimes excites a good deal of cough. Its beneficial effects are more manifest 
when it is resorted to at the very commencement of the attack, before the paroxysm 
is fully developed. Dryness of the throat and mouth are to be regarded as 
indications that too large a quantity is being taken. As it is not always easy to 
obtain good stramonium, asthmatics living in the 
country would do well to grow the plant, and 
collect and dry the leaves themselves. An allied 
species, Datura tatula, is also used in the treatment 
of asthma. It may be smoked either in a pipe or 
cigarette. 



SULPHATE OF ZINO AND OXIDE OF ZINO. 

There are only two preparations of zinc ad- 
ministered internally for medcinal purposes. These 
are the sulphate of zinc, or white vitriol, and the 
oxide of zinc. 

The oxide of zinc was formerly known by 
several names which are more remarkable for their 
fantastic character than for conveying any very 
definite information respecting the substance to 
which they were applied. Amongst these the most 

generally known are "tutty," a word, apparently, of Oriental origin; "lana 
philosophica," or philosopher's wool, and flowers or calx of zinc. These terms 
are frequently met with in old works on medicine and chemistry, but. their use 
is now for practical purposes discarded. 

The process employed in the preparation of oxide of zinc is somewhat similar 
to that used in making quick lime. Carbonate of zinc is heated to a dull red heat 
in a crucible until all the carbonic acid gas is driven off — in other words, until it is 
completely slaked. The success of the operation is tested by dropping a little of 
the oxide of zinc into some oil of vitriol and water, when, if any of the carbonate 
remain, its existence will be at once indicated by the effervescence caused by the 
escape of the gas. The preparation should be kept in a well stoppered bottle, as, 
like lime and magnesia, it absorbs carbonic acid from the air, and becomes 
reconverted into a carbonate. Oxide of zinc is a soft, white, tasteless, inodorous 
powder, insoluble in water. 

It is used occasionally for hysteria, epileptic fits, St. Vitus's dance, neuralgia, 
whooping cough, and other diseases supposed to be of nervous origin; but there are 
other remedies on which we should place greater reliance in the treatment of these 
complaints. 

There is one condition, however, in which its use is of considerable value. 
Its power of arresting the profuse night sweats, which so frequently reduce the 
little remaining strength of consumptives, is unquestionable. We have many 




16.— FRUIT OF TEE STRAMONIUM. 



870 MATERIA MEDICA. 



remedies for this purpose, but few upon which greater reliance can be placed. It 

should be given every night at bed-time in five-grain doses. It is convenient!/ 
administered in the form of the oxide of zinc pills (Pr. 66), each of which contains 
two and a half grains ; but it may be given, if thought desirable, as a powder, 
mixed with a little white sugar. Two are to be taken every night at bed-time 
when the perspiration is troublesome. 

Sulphate of zinc, or white vitriol, is found native at Holywell in Flintshire and 
in a few other places. It is usually prepared by dissolving zinc in dilute oil of 
vitriol, and then evaporating down the solution so obtained until it crystallises. 
Commercial zinc is usually contaminated by traces of iron and lead, a circumstance 
which renders the purification of the salt advisable. It may readily be freed from 
its impurities by immersing in the solution a strip of zinc, on which the other metals 
are soon deposited. 

White vitriol cannot be better described than by saying that in its characters it 
closely resembles Epsom salts, the crystalline form of the two bodies being identical. 
It possesses a metallic styptic taste. 

Sulphate of zinc is used as an emetic, particularly in cases of poisoning. It is 
speedy in its action, usually emptying the stomach in a single evacuation, a point of 
considerable importance in cases where a short delay may make the difference between 
life and death. Moreover, it produces but little prostration or nausea, another 
advantage which, particularly with attempted suicides, should not be altogether 
disregarded. The dose of sulphate of zinc as an emetic is from thirty to sixty 
grains, but in cases of emergency a tea-spoonful may be thrown into a little water, 
hot by preference, and taken immediately it has dissolved. Large draughts of hot 
water, by distending the stomach, promote vomiting. The emetic draught (Pr. 27) 
consists chiefly of sulphate of zinc. 

"White vitriol is often useful in St. Vitus 's dance, and it succeeds best when 
it is given in doses sufficiently large to make the patient feel sick, or even actually 
to excite vomiting, once or twice a day. The system soon becomes accustomed to 
the administration of this remedy, and to maintain its influence over the complaint 
the dose must be rapidly increased. It is well in the case of children to commence 
with half a grain three times a day, and to increase it by degrees to two grains every 
two hours. Sometimes such an amount of tolerance is established that as much as 
ten grains have to be given every two hours before the slightest feeling of sickness is 
produced. It may be administered in a little water or in any of the ordinary 
beverages. A striking improvement is often effected by the drug when given in this 
way. The occurrence of pain at the pit of the stomach, accompanied by loss of 
appetite, is to be regarded as an indication that the dose is too large, and it should 
be discontinued for a time. 

There are several other preparations used for external application in addition to 
those already mentioned. 

The oxide of zinc is slightly astringent in its properties, and when mixed with 
starch is often used asa" dusting powder " (Pr. 80). It is applied to sores and 
abrasions of all kinds, and frequently to the damp oozing surface left when many 
akin diseases have imperfectly healed. 



SULPHIDE OP CALCIUM. 871 



Native carbonate of zinc, or " calamine," which is found in great abundance in 
several parts of England, is sometimes preferred to the oxide of zinc in making the 
" dusting powder," but there is no advantage in its substitution. 

Oxide of zinc enters into the composition of zinc ointment, an ointment the 
uses of which are legion. It is largely used spread on lint as a dressing in many 
affections in which the skin is broken, such as ulcers, burns, &c. 

Zinc ointment is made as follows : — Take an ounce of lard, melt it, add eight 
grains of benzoin, then strain it, and when cold mix thoroughly with it eighty 
grains of oxide of zinc. The object of the benzoin, which is a balsam, is to preserve 
the ointment. Zinc ointment made with ordinary lard soon becomes rancid, and if 
applied in this state to a raw surface acts as an irritant, and would probably do 
more harm than good. 

Chloride of zinc is a white, semi-transparent, very deliquescent salt, having 
powerful and penetrating caustic properties. It is made by dissolving zinc in 
hydrochloric acid, the resulting product being submitted to a process of purification. 
It is usually met with in colourless opaque tablets, or rods, which are almost entirely 
soluble in water. It is used for the removal of tumours, and for the destruction of 
mothers' marks, large warts, and rapidly spreading skin affections. It is a powerful 
deodorising agent, and is largely used for this purpose. Burnett's disinfecting and 
antiseptic fluid is a solution of chloride of zinc, containing 200 grains in the 
ounce. It is diluted before being used, one pint being added to five gallons of 
water. It should be remembered that it is a powerful poison when taken internally, 
and that several fatal accidents have occurred through its administration. A young 
woman who swallowed an ounce of Burnett's solution died in four hours, in the 
greatest agony. 



SULPHIDE OF CALCIUM. 

This is the active constituent of some of our most valuable mineral waters. 
There are several different methods of preparing it, but one of the best is by mixing 
equal portions of clean finely-powdered oyster-shells and flowers of sulphur, and 
heating them to a white heat in a crucible for ten minutes. It is often asked 
where all the old oyster-shells go to. This is one of their uses, although we can 
hardly venture to adduce it as a solution to this often-enunciated problem. 

When used in the form of baths sulphide of calcium exerts a beneficial influence 
on old long-standing shin diseases. Care should be taken not to employ them so 
long as there is any inflammation or rawness of the skin ; but when this has subsided 
they may be employed with the greatest advantage. The use of these baths at a 
high temperature will often relieve chronic rheumatism and gout, and will restore 
suppleness to joints which have been distorted and stiffened by these complaints, or 
by rheumatic gout. 

There are several forms in which sulphide of calcium may be given internally. 
A solution may be made of nearly the same strength as the Harrogate waters by 
dissolving one grain in half a pint of water. The dose of this is for a child one 
tea-spoonful every hour, and for an adult twice as much. The disadvantage of this 



872 MATERIA MEDICA. 



preparation is that it rapidly decomposes, so that in order to obtain any beneficial 
effect it is essential that the solution should be freshly prepared daily. This is often 
inconvenient, and as the drug can be given with equal advantage as a pill or in powder 
it is usually better to employ one of those formulae (Prs. 68 and 78). 

Undoubtedly the most remarkable property of these preparations is the influence 
which they exert over the formation of matter. When a part is inflamed, and it 
is feared that matter will form, our drug will not only avert this undesirable 
consummation, but will frequently speedily reduce the inflammation. 

Should there be already a discharge from a boil or abscess the matter will, by 
the administration of this remedy, be rendered thicker and healthier, and the 
healing process will be promoted. 

In all kinds of abscesses, or threatening abscesses, the sulphide of calcium pilules 
should be given. 

For boils and carbwncles this drug is simply invaluabla No time should be lost 
in commencing treatment by taking either one of the pills, or one of the powders, 
every hour. In the case of children the latter preparation is, for obvious reasons, to 
be preferred. The sulphide of calcium lessens the inflammation, breaks down the 
hard core of the boil, and in this manner greatly shortens the duration of the 
complaint In addition to this it in most cases prevents the formation of other 
boils and carbuncles, and does much to remove the accompanying debility, and 
improve the general condition of the health. 

Children occasionally suffer from lumps in the neck, which after a time burst, 
and discharge a little thin watery matter, Sulphide of calcium will do good in these 
cases. One or two of the pills must be taken every two or three hours. 
Sometimes the complaint is of long duration, the discharge going on week after 
week, and month after month. In such chronic cases the medicine will have to be 
continued without intermission for some weeks before any marked improvement ia 
noticeable, but the ultimate result is nearly always satisfactory. 



SULPHUR, OR BRIMSTONE. 

Native or virgin sulphur is found chiefly in volcanic regions, our principal supply 
being obtained from Sicily. It is freed from its impurities by a process of 
" sublimation," that is to say, it is heated, and the vapour is allowed to condense in 
the form of a light powder on the walls and floor of a large room or chamber into 
which it passes. This powder is known as sublimed sulphur, or flowers of sulphur, 
and is the form most used for medicinal purposes. The common " stick sulphur," 
or "brimstone," usually contains impurities which render it unfit for internal 
administration. There is another form of sulphur known as " milk of sulphur," or 
"precipitated sulphur," which i3 obtained by throwing it down, or precipitating it 
by means of an acid, from a mixture of lime and sulphur. It is not uncommonly 
largely contaminated by the lime used in its preparation, a circumstance which 
would greatly impair its activity. 

It is necessary to be acquainted with the character* and appearance of the two 



8TTLPHUR, OR BRIMSTONE. 873 



forms of sulphur used in medicine, so that they may not be confounded with other 
drugs, and in order that their freedom from impurities or adulteration may be 
ascertained. Sublimed sulphur is a bright yellow powder, somewhat gritty to the 
touch, destitute of smell or taste — a great advantage in a medicine. It will not 
dissolve in water, and has consequently to be taken in the solid form. If thrown 
on the fire it burns with a blue flame, giving rise to a powerful irritating odour 
familiar enough to every one who remembers the old sulphur matches. The 
milk of sulphur is a pale yellow powder much lighter in colour than the other 
form. It is free from grittiness, and burns with the suffocating odour already 
mentioned. 

Sulphur is taken internally chiefly as a laxative. It is very useful in piles, the 
motions which follow its administration being of a soft yielding nature, an advantage 
which every sufferer from this distressing complaint will readily appreciate. It may 
also be used with a similar view, and with equal advantage, yd. falling of the bowel, 
and in fissure in the neighbourhood of the passage. 

Many people take sulphur in the form of " brimstone and treacle," every spring 
and autumn, probably on the theory enunciated by Mr. Squeers, that it " purifies the 
blood." It is a custom in favour of which little can be urged, and it is decidedly 
better to abstain from the use of medicine in any form unless there is a real 
necessity for taking it. The habitual use of sulphur is apt to impair the digestion 
and spoil the appetite, a fact which did not escape the acute observation of the 
talented mistress of Dotheboy's Hall. 

There are several ways in which sulphur may be taken, the old-fashioned and 
ever popular " brimstone and treacle," or " flowers of sulphur and molasses," being 
in all probability one of the best, the treacle aiding the laxative power of the 
sulphur. The following is another and equally efficacious form in which it 
may be given :— 

Confection of Sulphur.— Flowers of sulphur, four ounces; cream of tartar, in 
powder, one ounce; syrup of orange-peel, four ounces. These ingredients, when 
mixed, form an electuary or conserve, one or two table-spoonfuls of which may be 
taken once or twice a day, or oftener, if the bowels are confined and the motions 
hard. 

Sulphur is used largely in the form of an ointment for the cure of the itch and 
other skin diseases, it proving in many of these cases a most valuable remedy. The 
ordinary yellow sulphur ointment is made by rubbing up one part of flowers 
of sulphur in four parts of benzoated lard. Ordinary lard may be used for the 
same purpose, but the ointment so made is apt to become rancid, and may irritate 
the skin, and perhaps do more harm than good. 

The little black and red spots which so frequently disfigure the complexion and 
mar the physical beauty of young growing women are best removed by the following 
lotion : — 

Sulphur Lotion. — Flowers of sulphur, a tea-spoonful; glycerine, two table- 
spoonfuls ; rose water, half a pint — mix. This is to be applied to the face on an 
old and soft towel, or pocket-handkerchief, two or three times a day. It is not to be 
taken internally. 



874 MATERIA MEDICA. 



TAR AND CREASOTE. 

There are two different kinds of tar, wood-tar and coal-tar, the former only being 
used in medicine. Tar is prepared by the destructive distillation of Scotch fir, the 
process being carried on largely in Stockholm, and also in some parts of America. 
The method pursued is almost identical with that practised in this country for making 
charcoal, the essential difference being that in the former case a special provision is 
made for the collection of the tar which exudes from the smouldering wood. 

It would be superfluous to enter into any detailed description of the characters 
of tar ; it is so frequently used for purposes of a domestic or semi-domestic nature 
that it is familiar enough to everybody. 

About a century ago the virtues of tar water were strongly advocated by Bishop 
Berkeley, in a work entitled " Siris ; a Chain of Philosophical Reflections and In- 
quiries concerning the Virtues of Tar Water, and divers other Subjects connected 
together and arising one from the other." This curious work, which may be regarded 
as a dissertation on all subjects, from tar water to the Holy Trinity, seems to have 
been a great success, for it passed through several editions in a very short 
time. 

The learned and reverend writer appears to have had considerable personal 
experience of the use of tar, for he says : — " I esteem my having taken this medicine 
as the greatest of all temporal blessings, and am convinced that under Providence I 
owe my life to it" He gives the following directions for making the tar water : — 
" Pour a gallon of cold water on a quart of tar and stir and mix them thoroughly 
with a ladle or flat stick for the space of three or four minutes, after which the 
vessel must stand eight-and-forty hours, that the tar may have time to subside, when 
the clear water is to be poured off and kept covered for use ; no more being made 
from the same tar, which may still serve for common purposes." He directs that 
half a pint should be taken night and morning on an empty stomach. It may, he 
says, be made more palatable by mixing with each glass a drop of oil of nutmeg, or a 
tea-spoonful of mountain wine. 

Bishop Berkeley speaks of tar water as being a cure for "foulness of blood, 
ulceration of the bowels, consumptive coughs, pleurisy, pneumonia, erysipelas, asthma, 
indigestion, cachectic and hysteric cases, gravel, dropsy, and all inflammations." In 
fact, about a century ago tar water was for a time regarded as universal panacea. 

When the tar water mania was at its height an ingenious hoax was perpe- 
trated on the Royal Society. It appears that a sailor who had broken his leg was 
advised to communicate to that learned body a report of his case. The account he 
gave was that having fallen from the top of the mast and fractured his leg he had 
dressed it with nothing but tar and oakum, and yet in three days he was able to walk 
as well as before the accident. The story at first sight appeared quite incredible, 
as no such efficacious qualities were known in tar, and still less in oakum ; nor 
was a poor sailor to be credited, on his own bare assertion, of so wonderful a cure. 
The Society very reasonably demanded a fuller relation, and the corroboration of the 
evidence. Many doubted whether the leg had been really broken. That part of 
the story had been amply verified. Still, it was difficult to believe that the man had 



TAB AND CREASOTB. 875 



made use of no other application than tar and oakum ; and how they could cure a 
broken leg in three days, even if they could cure it at all, was a matter of the utmost 
wonder. Several letters passed between the Society and the patient, who persevered 
in the most solemn asseverations of having used no other remedies, and it appeared 
beyond a doubt that the man spoke the truth. But charming was the plain, honest 
simplicity of the sailor : in a postscript to his last letter he added the words : " I 
forgot to tell your honours that the leg was a wooden one." 

After a time the use of tar in the treatment of diseases was, in this country, 
almost abandoned. There is no doubt that the statements made as to its efficacy 
were greatly exaggerated, but at the same time it must be admitted that tar is 8 
very valuable remedy for many complaints. It is of very great value in the treat- 
ment of winter cough, chronic bronchitis, and asthma. It is largely used for these 
complaints both in France and Belgium, and patients>*who have tried it usually speak 
of it most enthusiastically. They say that by its use they are enabled to curtail the 
duration and lessen the severity of their attacks, and there can be no doubt that 
such is the case. An improvement is, as we can certify, usually noticeable in from 
four to seven days, it rapidly increases, and in about three weeks the cough ifl 
practically well. 

There are several ways in which tar can be administered. We have already 
spoken of Berkeley's tar water. The French call it eau de goudron, and take it 
with sugar and water, or with claret at dinner, the combination being almost taste- 
less — a point of no small consideration with them. Anybody who would make a few 
gallons of tar water at the commencement of the winter for the benefit of the old 
people with coughs and colds would, we are sure, be doing them a service. They 
will not make any difficulty about taking it. 

It is often convenient to be able to give tar in a more portable form. By the 
addition of a little wax and powdered liquorice root it can be made into pills, each 
containing a dose of two grains. Small capsules are also made containing from two 
to three grains, and may be obtained from any French chemist. Larger capsules 
are also sold, but they contain a dose larger than it is necessary to administer in 
cases of winter cough. There are several other preparations containing this drug in 
use on the Continent ; for example, the dragees de Christiania au goudron de Norvege, 
which are elegant — and expensive — little bonbons, each containing five grains of tar. 
The tar pills (Pr. 70) will be found very useful, one to be taken every four hours. 

Creasote is a substance obtained by the distillation of wood tar. It is an almost 
colourless liquid, having a powerful characteristic odour. It is a favourite remedy 
for the toothache, and when a few drops are introduced into the hollow of a decayed 
and painful molar, it will usually afford relief. It is also a good remedy for checking 
vomiting of all kinds, and is largely used in the treatment of the sickness of preg- 
nancy, cancer and ulcer of the stomach, and Bright's disease. It is frequently 
recommended for sea-sickness. It is used in the treatment of coughs and colds, and 
is especially useful in chronic bronchitis or winter cough. Either the creasote linctuB 
(Pr. 58) or the creasote mixture (Pr. 23) may be used for cough. For other 
complaints it should be given in two-grain doses every four hours, and is best made 
into pills. 



876 MATERIA MEDICA. 



TARTAR EMETIC. 

This salt is a combination of tartaric acid with potash and antimony, and is 
known chemically as " tartrate of antimony and potash." 

It forms small colourless transparent crystals, freely soluble in water, destitute 
of odour, and having a sweetish metallic taste. 

For internal use it is by far the best and most active of all the antimony prepa- 
rations. It is often given in the form of antimony wine, but for most purposes a 
simple freshly -prepared solution in water is preferable. Antimony wine is made by 
dissolving forty grains of tartar emetic in a pint of sherry. 

The ordinary dose of tartar emetic, when used to excite vomiting, is two grains 
dissolved in a little water. The corresponding dose of the wine is a fluid ounce, or 
two table-spoonfuls. Tartar emetic is somewhat tardy in its action, and often 
requires from twenty minutes to half an hour to produce vomiting, a circumstance 
which renders it almost useless in cases of poisoning. All nauseating medicines 
produce more or less weakness and prostration, but in tartar emetic these properties 
are pre-eminently developed. 
, When tartar emetic is administered for its constitutional effects, and not to 
produce vomiting, it is most advantageously given in small doses, and frequently. 
It is a good plan for many complaints in which antimony proves useful to dissolve a 
grain of tartar emetic in half a pint of water (Pr. 46), and to give a tea-spoonful of 
this every quarter of an hour for the first hour, and subsequently hourly. 

Tartar 3metic is a powerful remedy, and even this small dose may, when first 
given, cause vomiting. Should such be the case, the disagreeable complication may 
usually be avoided by adding sufficient water to make the mixture up to a pint, 
giving tea-spoonful doses of this diluted solution. 

This drug, administered as above directed, is pre-eminently useful in pneumonia 
or inflammation of the lungs. Since the general adoption of this mode of treatment 
the number of deaths from this disease has greatly decreased. In the majority of 
cases the tartar emetic reduces the frequency of the pulse and breathing, eases the 
pain in the side, and, above all, checks the further spread of the inflammation. The 
earlier the drug is given the greater the chances of success. 

In bronchitis or a bad cold on the chest, especially when the phlegm is copious, 
frothy, and difficult to expel, tartar emetic may be employed with considerable 
advantage. It may be given in the form of the mixture, or five drops of the wine 
may be added to each dose of the effervescing ammonia mixture (Pr. 99), and taken 
every four hours. 

Children from six to twelve years of age are often attacked on the slightest ex- 
posure to cold with wheezing on the chest and difficulty of breathing. The wheezing 
is often so severe as to be heard at some distance, and the shortness of breath may 
be so troublesome as to necessitate the propping up of the little sufferer in bed. There 
may be, in addition, a nasty, hollow, barking cough, and very often the voice is 
quite hoarse. The attacks are often quite like those of asthma in their character 
and intensity. The tartar emetic mixture is in these cases invaluable, and will 
generally effect a cure. 



TEA. 877 

That form of cold on the chest which in children is associated with vomiting and 
diarrhoea is usually quickly arrested by tartar emetic. 

This drug is usefully employed in typhus and other fevers when there is much 
excitement and furious delirium. 

Years ago there was no more popular medicine, and none more valued, than 
u James's powder." Now-a-days it is seldom or never used. It was a white, gritty, 
tasteless, odourless powder, consisting chiefly of antimony and phosphate of lime. 
It enjoyed a reputation for the cure of almost every disease, but even its strongest 
advocates were obliged to admit that its action was extremely uncertain. So highly 
was it esteemed that it frequently sold for half a guinea an ounce. Its reputation 
is of the past. 

TEA. 

It is estimated that tea is habitually consumed bj not less than five hundred 
millions of people, or about one-half of the human race. Amongst the Chinese and. 
the inhabitants of Japan, Thibet, and Nepaul it is drunk by all classes three or four 
times a day. In Asiatic Russia, in a large portion of Europe, in North America, 
and in Australasia it is a favourite beverage. 

In China, tea has been used as an article of diet from a very remote period of 
antiquity. Curiously enough, they have no record or tradition respecting its first 
introduction. The Japanese, however, tell us that in the year 519, a holy man 
named Darma, the son of an Indian monarch, took refuge in China, and publicly 
taught that the only way to attain happiness was to eat nothing but vegetables 
and go without sleep. This enthusiastic vegetarian and anti-morpheusian was, 
however, on a hot summer's day overcome by drowsiness, and fairly nodded before 
his congregation. When he awoke to a knowledge of his violation of his own 
precept, great was his self-reproach, and being determined that he would not trans- 
gress a second time, he cut off his eyelids and threw them on the ground. In due 
time they took root, and gradually developed into the plant now known as tea. 

Tea was probably first introduced into Europe about the middle of the seven- 
teenth century, for in 1661 Pepys writes in his diary, "I sent for a cup of tea (a 
Chinese drink), of which I had never heard before." At first its use was not very 
common, as in the same century the East India Company considered it a rare gift 
to present the King of England with two pounds and two ounces of tea. 

The plant which yields the tea leaves i? a native of China, and still grows wild 
on the hills both of that country and Japan. The tea plants are raised from seed, 
which is sown in March. When a year old, the young bushes are planted out, and 
when placed in rows three or four feet apart have some resemblance to gooseberry 
bushes. The season for gathering varies in different districts, but the principal leaf 
harvest is in May or June. The leaves are plucked by women, and are usually 
gathered at three successive periods. The youngest and earliest leaves are the most 
tender and delicate, and give the highest flavoured tea. The second and third 
gatherings are more bitter and woody, and yield less soluble matter to water. The 
refuse and decayed leaves and twigs are sold under the name of " brick tea." 

Tea leaves, when freshly gathered, are destitute of odour and flavour. The 



878 



MATERIA MEDICA. 



pleasant taste and aroma for which they are so highly valued are developed in 
the process of drying. The tea is rolled both to diminish its bulk and to enable 
the leaves to preserve their flavour. It is not fit for use until it is at least a year 
old. and the rich and luxurious Chinese usually keep their finest teas in porcelain 

jars furnished with narrow necks, in order 
to prevent the aroma from escaping. The 
quality of the tea depends chiefly on the 
method employed in drying. Either 
black or green tea may be prepared at 
will from the same leaves gathered at 
the same time and under the same cir- 
cumstances. It is by lengthened exposure 
to the air in the process of drying, 
accompanied by perhaps a slight heating 
and fermentation, that the dark colour 
and distinguishing flavour are given to 
the black teas of commerce. 

The principal varieties of black tea are 
known as Bohea, Congou, Souchong, and 
Pekoe. The chief green teas are Twankay, 
Hyson, Imperial, and Gunpowder. 

The practice of scenting teas is very 
common, and various odoriferous plants 
are employed for that purpose in different 
parts of China. Many teas, especially the 
green teas, are artificially coloured by 
the addition of blue, white, and yellow 
colouring substance. A mixture of 
Prussian blue and burnt gypsum was 
formerly extensively used for the pur- 
Fig. 17— branch of the T*A plant. pose, but indigo is now coming into 

fashion. It is said that one day an 
English gentleman in Shanghai, being in conversation with some Chinese 
from the green-tea country, asked them what reasons they had for dyeing 
the tea, and whether it would not be better without undergoing that process. 
They acknowledged that tea was much better when prepared without having any 
such ingredient mixed with it, and that they never drank dyed tea themselves ; 
but remarked that as foreigners seemed to prefer having a mixture of Prussian 
blue and gypsum with their tea, to make it look uniform and pretty, and as thes* 
ingredients were cheap enough, the Chinese had no objection to supply them, 
especially as such teas always fetched a higher price. 

It is curious that although tea is so extensively used, there is still considerable 
diversity of opinion as to the best method of preparing it. The Chinaman puts 
his tea in a cup, pours hot water over it, and drinks the infusion off the leaves 
without the addition of either sugar or milk. The Japanese powder the leaves 




TEA. 879 

before putting them in the pot. In Morocco they put green tea, a little tansy, 
and a great deal of sugar into a tea-pot, and fill up with boiling water. In Russia 
a squeeze of a lemon often takes the place of our milk or cream ; and in Germany, 
where tea is made very weak, it is common to flavour it with rum, cinnamon, and 
vanilla. 

On the first introduction of tea into Great Britain it was lauded as a remedy for 
almost every ailment afflicting mankind. It was said to remove lassitude, purify 
the liver, improve the digestion, create appetite, strengthen the memory, cure aguea 
and fevers, and act as a specific for consumption. One panegyrist says that while 
never putting the patient in mind of his disease, it cheers the heart without 
disordering the head, strengthens the feet of the old, and settles the heads of the 
young, cools the brain of the hard drinker, and warms that of the sober student, 
relieves the sick, and confirms the healthy. Epicures drink it for want of an 
appetite, bon-vivants to remove the effects of a surfeit of wine, gluttons drink it as 
a remedy for indigestion, politicians for the vertigo, doctors for drowsiness, prudes 
for the vapours, wits for the spleen, and beaux to improve their complexion. 
He sums up by declaring tea to be a treat for the frugal, a regale for the 
luxurious, a successful agent for the man of business, and a healthy amusement 
for the idla 

Tea is a very useful drug, but this picture, we need hardly say, is somewhat 
over-drawn. Nevertheless, tea exerts a very decidedly stimulant and restorative action 
on the nervous system, which is perhaps aided by the warmth of the infusion. As 
an article of diet it proves of the greatest value for soldiers. The hot infusion is 
particularly useful in over-fatigued conditions of the system, and under these 
circumstances there can be no doubt that it is infinitely preferable to alcoholic 
drinks. The hot infusion is potent against both heat and cold, and is a most 
valuable accompaniment on long journeys. It possesses, moreover, the valuable 
property of purifying even the most brackish waters. 

There are certain complaints in which the use of tea is distinctly prejudicial In 
flatulent dyspepsia, or indigestion accompanied by the formation of large quantities 
of wind, it is especially injurious, and its use often greatly retards the progress of 
cure. Many women ruin their digestive powers by taking large quantities of weak 
tea three or four times a day. The excessive consumption of tea, especially when 
combined with a poor diet, leads to a condition of nervousness and irritability which 
is quite pitiable. This habit is especially prevalent among dressmakers and others 
whose occupations are of a sedentary nature. In the out-patient department of many 
of our hospitals the effects of excessive tea-drinking are almost as noticeable as the 
results of intemperance as regards alcohol, and that is saying a great deal. It is 
not an uncommon practice with enthusiastic students to resist the claims of nature 
for repose, and keep themselves awake at night by the use of green tea. The object 
is attained, but at a great price, the destruction of health and vigour, both of 
body and mind, being too often the penalty. 



880 MATERIA MEDIOA, 



TOBACCO. 

Tobacco claims consideration in a work on. Materia Medica, not so much from 
its value as a medicinal agent as from the fact that it is almost universally used for 
the production of its sedative or narcotic effects. 

The tobacco (Nicotioma tabacvm) is probably a native of America — at all events, 
it was extensively cultivated and used by the inhabitants of various parts of that 
continent long before its discovery by Europeans. The aborigines of tropical 
America must have rolled up their tobacco leaf and dreamed away their lives in 
smoky reveries ages before Columbus was born. With them the pipe was a great 
diplomatist. In making war, in concluding peace, in all their deliberations, both 
public and domestic, it played an important part, and no treaty was ever ratified without 
the passage of the calumet. The transfer of the pipe from mouth to mouth was a 
token of amity and friendship, and with the chivalry of the forest it was a gage of 
honour which was seldom violated. From America tobacco was introduced into 
Spain, and in a few years a knowledge of its properties spread all over Europe. 
When Walter Raleigh brought the plant from Virginia to England, in 1586, whole 
fields of it were already under cultivation in Portugal. It is probable that the 
cultivation of this plant in Europe preceded that of the potato by from 120 to 140 
years. 

The generic term, " Nicotiana," was bestowed on the plant in honour of Jean 
Nicot, who brought some tobacco from Lisbon and presented it to Catherine de 
Medicis as a herb possessing valuable properties. It is usually stated that the name 
tobacco was given to the plant by the Spaniards, who took it from Tobaco, a rirovince 
of Yucatan. Humboldt, however, asserts that the word belongs to the ancient 
language of Hayti, or Saint Domingo, and that originally it was applied not to the 
herb, but to the tube through which the smoke was inhaled. 

On the first introduction of tobacco into Europe every effort was made by 
writings, imposts, and bodily punishment, to restrict or put down its use. It is said 
that more than a hundred books were written to condemn the use of tobacco, fore- 
most among them being the celebrated Counterblaste to Tobacco of James I., in 
which he speaks of it as being " a custom loathsome to the eye, hateful to the nose, 
harmful to the brain, dangerous to the lungs, and in the black, stinking fume 
thereof nearest resembling the horrible Stygian smoake of the pit that is bottomless." 
There is an old tradition of the Greek Church which ascribes the inebriation of the 
patriarch Noah to the temptation of the devil by means of tobacco, so that the king 
was not altogether without authority for the black Stygian parentage which he 
assigns to its fumes. In Russia, smoking was absolutely prohibited, the knout being 
the punishment for the first, and death for the second offence. In Bern so much 
importance was attached to the custom that in the list of offences it followed the 
crime of adultery. In some of the Swiss cantons a council cited all smokers before 
them, and the innkeepers were ordered to inform against those who were found 
smoking in their houses. Urban YIII. was so enraged against the practice that 
he went in State to the Vatican and thundered excommunication on every soul who 
book the accursed thing in any shape or form into a church. As might have been 



TOBACCO. 881 



expected, opposition and persecution excited only more general attention to the 
plant, awakening curiosity regarding it, and tempting people to try its effects, so that 
the use of the drug spread rapidly. The Turks and Persians have become the greatest 
smokers in the world, although their priests and sultans declared that smoking was 
a sin against their holy religion. The custom is now almost universal, as has been 
truly said, or rather sung : — 

11 Tobacco engages 
Both sexes, all ages, 

The poor as well as the wealthy ; 
From the court to the cottage, 
From childhood to dotage, 

Both those that are sick and the healthy." 

Tobacco thrives in nearly every part of the globe. Amongst narcotic plants it 
occupies a place similar to that of the potato amongst food plants. It is the most 
extensively cultivated, the most hardy, and the most tolerant of changes in 
temperature, altitude, and general climate. The plant was formerly grown in many 
parts of England, particularly in Yorkshire, but now its cultivation is by law 
restricted to half a pole " in a physic or university garden, or in any private garden 
for physic or chirurgery." 

What are the effects produced by smoking? In the case of the novice the 
symptoms produced are nausea, vomiting, extreme weakness, relaxation of the 
muscles, and a depressed action of the heart, the last mentioned being indicated by 
pallor of the face, weakness of the pulse, cold sweats, and a general tendency to 
faint. The effects produced on the habitual smoker are, of course, widely different, 
and of a much more pleasurable description. It is very difficult to analyse the sen- 
sations produced by the use of tobacco ; we are usually content to recognise the fact 
that they are pleasurable, and to smoke on in peace. By the use of tobacco some 
people seem able almost to liberate the mind from the trammels of the body, and to 
give it a freer range and more undisturbed liberty of action. Bulwer, in his " Night 
and Morning," exclaims, " A pipe ! it is a great comforter, a pleasant soother ! 
Blue devils fly before its honest breath ! It ripens the brain, it opens the heart, 
and the man who smokes thinks like a sage, and acts like a Samaritan." 

There is no want of testimony in favour of the use of the drug. The " souveraine 
weed," as Spenser calls it, has been extensively lauded both in prose and verse. 
Kingsley, in " Westward Ho ! " speaks of it as "a lone man's companion, a 
bachelor's friend, a hungry man's food, a sad man's cordial, a wakeful man's sleep, 
and a chilly man's fire." Old Hobbes of Malmesbury, the first and clearest of 
English philosophers, regularly had his twelve pipes a day, and kept to it till he 
was nearly as old as old Parr himself. Robert Hall, the most eloquent of English 
preachers, and John Foster, the most original of English essayists, were smokers ; 
Campbell was a patron of the weed, and Byron's lines to " Sublime Tobacco" are as 
well known as Campbell's address to the " pungent nose-refreshing weed." Sir 
Walter Raleigh took it to the day of his death, for Aubery says " He tooko a pipe 
of tobacco a little before he went to the scaffolde, which some female persons were 
scandalised at, but I think 'twas well and properly donne to settle his spirits" 
56 



882 MATERIA MEDICA. 



Thackeray was a great admirer of the weed, and in one of his essays says that he 
would rather smoke up the chimney than not smoke at all. 

Is the use of tobacco injurious to the health ] This is a question which it is very 
difficult to answer. By the non-smokers it is said that it causes blindness, 
palpitation of the heart, paralysis, diseases of the teeth, mouth, and tongue, dyspepsia, 
diarrhoea, and even falling of the bowel. The smokers, on the other hand, assert 
that you may smoke to all eternity without in the slightest degree injuring your 
health — in fact, you are rather likely to improve it. Of course, no one doubts for a 
moment that smoking is a very bad thing for boys, and that many of the pallid 
sickly-looking lads that one sees in the streets with dirty short pipes in their mouths 
would be benefited by a substitution of a fair allowance of birch for tobacco. The 
weight of evidence is in favour of the view that tobacco smoked in moderation by 
full-grown, healthy adults is not injurious to the system. We cannot undertake to 
define the term " in moderation " — each man must decide that for himself. There 
can be no doubt, however, that a man who lights his pipe or cigar in the morning 
before breakfast is decidedly overstepping the bounds of moderation. Smoking in 
excess is undoubtedly a very harmful habit, disordering digestion, lessening the 
appetite, inducing restlessness at night with disagreeable dreams, and weakening 
both body and mind. Sore throat and chronic dyspepsia may often be clearly 
traced to excessive smoking, and it will be found that the habitual smoker has 
generally a thickly coated tongue. There is one thing to be said, however, and that 
is, that the symptoms quickly disappear when the habit is discontinued. 

Does smoking make people drink 1 There is a great diversity of opinion even 
on this subject. Let us avail ourselves of the experience of a distinguished 
scientific observer, who has devoted especial attention to the subject. He says : — 

"The first time our reader walks down Regent Street after seven in the 
evening, let him drop into any place he chooses, and let him see who gets to 
his fifth glass of grog soonest — the smoker, or the man who does not ; who 
soonest, with a voice, increasingly husky and indistinct, indulges in a pro- 
miscuous style of conversation, more amusing than convincing — certainly not 
the smoker. Not that no smoker is ever overcome in a moment of temporary 
weakness — the best of us, alas, are but men ! To err is human. We ourselves 
have risen from our bed with a slight sensation of headache, and a conviction, by 
no means slight, that we had made fools of ourselves the previous night. But it 
stands to reason that you, with a cigar in your mouth, should drink slower than 
the man who has nothing else to do but drink. You cannot drink equal. While 
you have lit your cigar and drawn half a dozen whiffs, and drank the health, 
temporal and eternal, of your divine Adele or dearly beloved Ellen, your friend, who 
does not smoke, has left nothing in his glass but a silver spoon. This is not 
random assertion — what a gent might term chaff. We have tried the experiment 
over and over again, and are quite ready to repeat it, my dear sir, at your expense." 

Tobacco contains an alkaloid known as nicotia, which is the active constituent 
of the plant. It is a colourless, volatile, oily liquid, having a powerful odour of 
tobacco and a burning taste. It is almost as powerful a poison as prussic acid. 
A single drop given to a rabbit killed it in three and a half minutes. It is 



TOBACCO. 883 



supposed that the "juice of the cursed hebenon," with which Hamlet's father was 
poisoned, consisted of this substance. 

A small quantity of nicotia, or at all events of the products resulting from its 
decomposition, is always found in tobacco smoke. The form and construction of 
the pipe undoubtedly influence the proportion of the active ingredients which it 
contains. Thus, the Turkish and Indian pipes, in which the leaf burns slowly and 
the smoke bubbles up through water, absorb a large proportion of the poisonous 
vapours. The reservoir of the German pipe retains the larger portion of the oily 
and other products of the burning tobacco; and the long stem of the Russian 
pipe performs a similar function. The Dutch and English clay pipes retain least 
of any. 

In what cases should tobacco be used medicinally 1 Smoking increases the flow 
of saliva, and many on this account maintain that it aids digestion and is useful in 
dyspepsia. In an old song we are told that 

" It helpeth digestion, 
Of that there's no question ; 

The gout and the toothache it easeth. 
Be it early or late, 
'Tis never out of date, 

He may safely take it that pleaseth." 

This, however, can hardly be said to sum up the therapeutics of tobacco. For 
example, it acts as a slight purgative, and a pipe or cigar smoked after breakfast is 
often sufficient to ensure an easy and satisfactory relief of the bowels. The practice 
is not without advantage for persons troubled with habitual constipation. Ladies are 
occasionally recommended to use cigarettes for a similar purpose — the thin end of 
the wedge. 

Tobacco is often used with advantage in spasmodic asthma. 

It is usually unsafe to use tobacco as an external application, as sufficient may 
be absorbed to cause symptoms of poisoning. 



TREACLE TAMARINDS — FIGS — PRUNES HONEY MANNA. 

These substances are all sufficiently familiar to us, and have long been valued 
medicinally for their laxative properties. 

Treacle is the uncrystallisable syrup which drains from the moulds in the pre- 
paration of loaf sugar. In doses of a tea-spoonful and upwards it forms a very 
pleasant laxative, and is often given in combination with sulphur as " brimstone and 
treacle." 

Tamarind is the pulp of the fruit of the tamarind tree, growing in the East and 
West Indies. In the preparation and preservation of tamarinds the fruit, having 
been first stripped of its shell, is placed in a cask, and then covered with warm water. 
It possesses an agreeable sweetish taste, and is considered no little luxury in hot 
climates. Medicinally it is used as a mild, cooling laxative. The dose is a quarter 
of an ounce or more, and it is sometimes made into a whey with milk. 

Figs from the earliest ages have been held in great repute. In a primitive 



884 MATERIA MEDIOA. 



condition of society they served to famish the nations of the East with an article, 
not of occasional luxury, but of daily and constant food. So highly wer3 they 
esteemed by the Athenians that their exportation was prohibited under a heavy 
penalty. In Rome they were carried after the wine in the processions in honour of 
Bacchus, and the old gentleman himself is supposed to have owed his corpulence 
and vigour not to the grape but to the fig. By the Jews a bad fig year was regarded 
as a most serious calamity. Fresh figs, when ripe, are soft and succulent, and are a 
digestible, wholesome, and delicious fruit, which may be used with advantage in 
habitual constipation. When the fresh fruit is not obtainable, we must be satisfied 
with the dry, although as a medicinal agent it is far less efficacious. 

Prunes are the dried fruit of the common plum, prepared by exposing them 
alternately to the heat of an oven and to the open air. They are very nutritious 
and form an excellent laxative for children. We have the most implicit confidence 
in stewed prunes. 

In honey we have another, very useful and agreeable medicine. It, as everybody 
knows, is secreted by the nectaries of flowers and sucked by the bees into their crops, 
where it undergoes some slight change, and is then stored up in the comb. The 
finest honey is that which is allowed to drain from the comb, and if obtained from 
hives which have never swarmed it is called " virgin honey." It partakes of the 
aroma of the plants from which it has been collected. It may be clarified by 
melting it in a water-bath, and straining it while hot through flannel. It is composed 
chiefly of sugar and water, but contains in addition gum and wax and a little volatile 
oil derived from the flowers. It is often used to cover the taste of other medicines, 
but taken alone it acts as a laxative. A mixture of honey and vinegar forms a 
useful gargle for sore throats. 

Manna is an exudation obtained by making incisions into the trunk of the 
flowering ash, cultivated for the purpose in Sicily and Calabria The tree is a native 
of Southern Europe, but is not uncommonly met with as an ornamental plant in our 
gardens and pleasure grounds. Although we are principally indebted for our manna 
to the ash, yet other trees, such as the larch, fir, orange, willow, mulberry, and oak, 
also produce it, although in smaller quantities. The trees are not tapped until July 
or August, when they have ceased to produce new leaves. Incisions about two 
uiches in length are made in the stem by means of a hooked knife, and from these 
apertures the juice exudes and gradually solidifies. The best description of manna, 
called " flake manna," forms long white pieces not unlike stalactitic masses, from one 
to six inches in length, and an inch or two in breadth. It is a pleasant adjunct to 
many purgative medicines, and in doses of half an ounce or more acts as a mild 
laxative. 



HYGIENE. 

" Hygiene is the art of preserving health : that is, of obtaining the most perfect 
action of body and mind during as long a period as is consistent with the laws of 
life ; in other words, it aims at rendering growth more perfect, decay less rapid, 
life more vigorous, death more remote." 

The above is the definition of hygiene given by Dr. Parkes, in his incomparable 
work on " Practical Hygiene." 

We cannot do better than begin by offering a few practical remarks on the 
hygiene of the past, hoping in that way to bring forcibly under the reader's notice 
how the necessity for hygienic science has arisen, what it has already effected, and 
what we may expect from it, both for good and for evil ; and since these points have 
been very concisely put forth in a lecture by Dr. Poore, published in the Medical 
Times and Gazette for June 6th, 1874, we have, with the author's permission, 
made extensive quotations from it. 

" There may have been a time in the history of the world — when it was very 
young, however — when the public health took care of itself, and the conditions of 
existence were such as not to be likely to cause disease. When populations were 
very thin ; when man was a noble savage, almost untrammeled by clothing, living by 
hunting, never residing in dense crowds, leaving his effete matters to be disinfected 
by the earth, the air, and the sun \ frequently changing his camping-ground ; and 
before he had learnt to become luxurious, and to spend his time in habitations 
artificially warmed and artificially lighted, and to eat and drink a great deal more 
than is good for him — when, in fact, he lived a life more like that of a wild animal 
(perhaps he might have been rightly regarded as a wild animal), it is possible that 
disease was rare, that men attained to the years of some of the Biblical patriarchs, and 
died at last of sheer old age, without ever having had even measles or hooping- 
cough, which nowadays none of us escape. 

" If we look at the history of the world, we find that wherever man has been 
collected into crowds there disease has broken out. 

"The Bible is full of such instances. The Israelites in the desert were frequently- 
smitten by pestilence, and many of the laws promulgated by Moses had most direct 
bearing upon public health. He at least seems to have recognised the importance 
of separating the sick from the healthy, and of thoroughly disinfecting the persona, 
clothes, and even the houses, of those afflicted with leprosy or other forms of sick- 
ness. The plague which broke out amongst the hosts of Sisera, and the plague 
recorded by Homer as occurring at the Siege of Troy, are familiar ancient examples. 

"It is not too much to say that, in the history of every great city, man/ 
chapters would have to be devoted to the history of its pestilences. 

" From the fourteenth to the seventeenth centuries, at a period when art warn ft£ 
its zenith ; when many of the cities of Europe were as crowded with inhabitant! afl 



HYGIENE. 



they are at present ; when Genoa, Rome, Naples, Venice, Paris, and London were 
already great centres of commercial or political activity, filled with inhabitants sunken, 
for the most part, in the grossest superstition — in the pre-scientific era, when men 
lived as artificially as they do at present, without the least knowledge of warding off 
the evils which such an artificial existence certainly brings with it — in an age when 
flourished the greatest painters,' sculptors, poets, and architects which the world has 
seen, but before the dawn of the Baconian philosophy — disease was more rampant, 
perhaps, than at any period of the world's history. 

" In 1348, 100,000 persons are said to have died in London alone of the 'black 
death '—a number frightful enough, but small when compared with the 40,000,000 
deaths which occurred from the same cause throughout Europe. In the sixteenth 
century there ^ere five outbreaks of the sweating sickness, an epidemic scarcely less 
fatal than the ' black death ;' and in the first sixty-six years of the seventeenth 
century there were five outbreaks of plague, the last of which, in 1665, claimed 
nearly 70,000 victims in London alone. 

" Let us look at the bill of mortality for London in the year 1661. I have 
selected 1661 because it seems to me to be a good average bill, neither very high 
nor very low ; and from it we may learn what were the diseases which our ancestors 
had to fear in an ordinary way. 



"BiU of Mortality for the Year 1661. 



Abortive and stillborn 

Aged . 

Ague and fever 

Apoplexy and suddenly . 

Bedrid . 

Bleeding 

Bloody flux, scowring, and flux 

Burnt and scalded . 

Cancer, gangrene, and fistula 

Canker, sore mouth, and thrush 

Childbed .... 

Chrisomes and infanta . 

Cold, cough, and hiccough . 

Colick and wind . 

Consumption and tissick 

Convulsion .... 

Cut of the stone and stone . 

Dropsy and tympany . 

Drowned .... 

Executed .... 

Frighted .... 

Flox and small-pox 

Found dead in the streets, fields, etc. 

French-pox . . 

Gout and sciatica . 

Grief . m 

Griping in the guts 

Hanged and made away themselves 

Head-mould-shot and mould-fallen 

Jaw-fallen 

Jaundies . . . . . 
Imposthume 



511 

1302 

3490 

108 

3 

6 

314 

4 

69 

95 

224 

1400 

14 

186 

3788 

1198 

36 

967 

67 

16 

2 

1246 

8 

44 

11 

17 

1061 

13 

28 

2 

141 

160 



Killed by several accidents . • . 26 

King's evil 48 

Lethargy 11 

Leprosy 1 

Lunatick, distracted, and frenzy . . 11 

Megrims 3 

Measles 188 

Mother 4 

Murdered, slain, and shot ... 52 
Overlaid and starved . • • .37 

Palsy 26 

Plague 20 

Planet 3 

Plurisy . 11 

Poisoned 2 

Quinsy and sore throat . ... 13 

Rickets 413 

Rising of the lights . . . .227 

Rupture 18 

Scurvy 85 

Sores, ulcers, broken and braised legs . 61 

Spleen 5 

Spotted fever and purples . . .335 
Strangury ...... 23 

Stopping of the stomach • • .170 

Surfeit . 212 

Swine-pox 6 

Teeth and worms 1195 

Vomiting ...... 20 



Total 



19,771 



"The gross mortality was 19,771, which, if we take the population of that time 



INTRODUCTION. 887 



at half a million (for which there seem many good reasons), gives us an annual death 
rate of 39*5 per 1,000 people living. 

" The average death-rate at the present day in London may be put at 24 per 
1,000 ; so that, whereas the average age attained by the population was then only 
twenty-six years, it may now be stated as averaging nearly forty-two years. If, then, 
we may say that the science of public health has, in the first two centuries of its 
existence, lengthened the average lives of us Londoners by sixteen years, I think I 
need add no more facts to recommend the subject to your serious consideration. 

" An inspection of this bill of mortality forces many reflections upon us. There 
are causes of death which have now almost or completely disappeared. For in- 
stance, ague is very rarely seen at all in London, and when seen is never fatal. This 
fact is surely due to hygienic improvement in the matter of draining. Bloody 
flux, which was probably dysentery, has also almost disappeared, and from similar 
causes. Small-pox, which then seldom claimed less than its thousand victims a year, 
has now been robbed of all its terrors, and might, probably, if there were more 
prudence and less fanaticism abroad, be quite abolished. Plague is no longer a 
cause of death with us. Spotted fever and the purples visit us but rarely ; and 
scurvy, which then killed its eighty or ninety a year, has wholly vanished. 

" It will be obvious, too, to you that there are on the list many death-causes 
which, although they still remain, are far less operative now than then. 

" If we add together the deaths from violent causes, we find that they amount to 
178. This gives us one violent death in every 111 deaths. 

"If we glance at the first return of the Registrar-General for the year 1837, we 
find that out of a total, for the latter half of the year, of 24,959 deaths, 580 were 
from violent causes. This gives us one violent death in every forty-three deaths. 

" In the return for the year 1854 we find that (excluding deaths from cholera) 
there was one violent death to every thirty-five deaths. 

"Thus we see that, whereas the general death-rate from disease has steadily 
decreased, the deaths from violent causes have increased in an undue proportion, and 
we are forced to reflect that railways, machinery, and lucifer-matches have been for- 
midable opponents to the efforts made by the science of hygiene to lower the death- 
rate. 

" In these bills of mortality there is a frequently-recurring cause of death — viz., 
' blasted ' and ' planet-struck,' and in one of them we find * apoplexy, blasted, 
and planet-struck ' grouped together, as though there was some relation between 
them. These facts, as well as the consideration of the immense mortality, make us 
appreciate the spirit in which was written that verse of the Litany : — ' From light- 
ning and tempest ; from plague, pestilence, and famine ; from battle and murder, 
and from sudden death : Good Lord, deliver us.' The nomenclature and classifica- 
tion of disease employed in these bills show us more plainly than could anything else 
the immense progress of medicine made since the dawn of science. The great 
mortality of these times was due in a small degree (at least, it is flattering to 
ourselves to think so), to the absence of anything like scientific medical knowledge. 
Mainly, however, it was due to faulty hygienic arrangements in the matter of 
houses, food, water, and drainage. 



838 HYGIENE. 

" With regard to the houses, the following letter of Erasmus tells its own tale, 
and needs no comment : — 

"Letter of Erasmus to Francis, Physician to the Cardinal of York, 1518 or 1519. 
" ' I often wonder and lament how it happens that for so many years Great 
Britain has been afflicted with pestilence without intermission, particularly with the 
sweating sickness, a malady which seems peculiar to itself. We read of a city being 
delivered from a pestilence which had long ravaged it by the destruction and re- 
newal of its buildings, in accordance with the advice of some philosopher. Either I 
am greatly deceived, or by some such plan must England be delivered. In the first 
place, they never think whether their doors and windows face north, south, east, or 
west ; and, in the second place, the rooms are generally so constructed that, contrary 
to Galen's rule, no thorough draught can be sent through them. Then they have a 
large part of the wall fitted with sheets of glass, which admit the light but keep out 
the air, and yet there are chinks through which they admit that filtered air, which is 
all the more pestilential because it has been lying there a long time. Then the floors 
are generally strewed with clay, and that covered with rushes, which are now and 
then renewed, but so as not to disturb the foundation, which sometimes remains for 
twenty years nursing a collection of spittle, vomits, excrements of dogs and human 
beings, spilt beer, and fishes' bones, and other filth that I need not mention. From 
this, on any elevation of temperature, there is exhaled a vapour which, in my judg- 
ment, is by no means beneficial to the human constitution Besides, England is not 
only surrounded on all sides by the sea, but many parts of it are very marshy, and 
it is intersected with salt rivers, to say nothing just now of the salt fish, of which 
the common people are wonderfully fond. I should have confidence in the island 
becoming more healthy if the use of rushes could be abolished, and the bedrooms so 
built as to be open to the sky on two or three sides, and if all the glass windows 
were so made as to open or shut all at once, and to shut so fast as to leave no chinks 
through which noxious winds could force a passage : since, as it is also sometimes 
healthy to admit the air, so is it sometimes healthy to exclude it. The vulgar laugh 
if you complain of their cloudy sky. I can only say, that for thirty years past, if I 
entered a room in which no one had been for some months, I would immediately 
begin to feel feverish. It would be an advantage if the vulgar could be persuaded 
to live more sparingly, and to be more moderate in the use of salt fish. Then there 
might be policemen, who should have the charge of seeing that the streets were kept 
clean from filth, and they should also look after the neighbourhood of the city. I 
know you will laugh at me for making myself anxious about these matters, but I do 
so out of friendship for a country which has so long afforded me hospitality, and 
where I would willingly spend the remainder of my life, if I could. I doubt not 
that you in your wisdom know far more about these things than I do, but I wished 
to mention them, in order that, if my judgment should accord with yours, you may 
commend them to the consideration of the leading men of the countiy : for these 
things used to be the care of monarchs. I would very gladly have written to his 
Reverence my Lord Cardinal, but I had neither time nor anything to say, and I 
know well how immersed he is in the affairs of State.' 



INTRODUCTION. 889 



" As to the diet of our ancestors, we have abundant evidence that it was excessive 
in amount, and largely consisted of salted animal food. To this was due the constant 
presence of 'scurvy' as a death-cause; and there can be no doubt that an ill- 
nourished population like that of Old London was little able to resist the ravages of 
the various epidemics which worked such fearful havoc amongst it. 

" Of the water supply of Old London I have been able to find very little reliable 
information. In a plan of Roman London, which is given in Mr. Walter Thorn- 
bury's account of 'Old and New London,' several streams, tributaries of the 
Thames, are indicated. Langbourne, Sherbourne, and Walbrook were then bond fide 
rivulets, but now remain to us only in name. The Fleet river is called in the plan 
1 the River of Wells,' and with some show of justice, for on its banks were Bride- 
well, Clerkenwell, Sadler's Wells, and Bagnigge Wells, as also the wells of St. 
Pancras. Into this river of wells flowed, from the westward, the Old Bourne, which 
we still have only in name as Holborn. This word bourne, which most certainly 
means brook, and is the same probably as the Scotch burn, is to be found also in the 
words Cranbourne, Tyburn, &c. It admits of no doubt that much of the water con- 
•umed by the inhabitants was taken direct from the brooks and from the Thames. 

" If we may take the names of streets and districts as any indication, we may 
infer that there were other brooks and wells from which the inhabitants were sup- 
plied, as the names of Shoreditch, Houndsditch, Shad well, Goswell, Chiswell, and 
Holywell seem to bear witness. Private wells were probably common, and were, 
one would suspect, to be found in most of the better class of houses. 

"The earliest form of water-works were the conduits, which were apparently 
reservoirs set up in some of the most crowded parts of the town, and which received 
their supply from the water-sources on the neighbouring high ground. 

" Timbs tells us that New Bond Street was, in 1760, an open field, called Conduit 
Mead, from one of the conduits which supplied this part of the town with water ; 
and Conduit Street received its name for the same reason. Carew Mildmay, who 
died between 1780 and 1785, told Pennant that he remembered killing a woodcock 
on the site of Conduit Mead when it was open country. 

" Spring water was formerly conveyed to public reservoirs in the city by leaden 
pipes from various sources in the suburbs — viz., from Tyburn in 1236, from High- 
bury in 1438, from Hackney in 1535, and from Hoxton in 1546. 

" A drawing of the time of Charles I. shows a stone conduit in St. James's 
Square. 

"Lamb's Conduit was founded in 1577 by William Lamb, citizen and cloth- 
worker. The conduit head was in the fields near the street which bears its name, 
and Ormond Street, whence the water flowed in pipes 2,000 yards long to the 
conduit on Snow HilL 

" Tyburn furnished nine conduits, and, with Bayswater, was viewed periodically 
by the Lord Mayor. In 1562 it is recorded that, on the occasion of viewing the 
conduits, they dined at the Banqueting House, which stood on the site of Stratford 
Place, and that they killed a hare before dinner and hunted a fox afterwards. At 
the south end of the Serpentine one may see the remains of the conduit head which 
■applied Westminster Palace, 



890 HYGIENE. 

" Mr. Thornbury gives us the following particulars concerning the conduits in 
Cheapside : — ' The great conduit of Cheapside stood in the middle of the east end of 
the street, near its junction with the Poultry, while the little conduit was at the 
west end, facing Foster Lane and Old Change. Stow, that indefatigable stitcher- 
together of old history, describes the larger conduit curtly as bringing sweet water 
" by pipes of lead underground from Tyburn for the service of the city." It was 
castellated with stone and cisterned in lead about the year 1285; and again new- 
built and enlarged by Thomas Ham, a sheriff, in 1749/ To these conduits repaired 
the water-carriers, ' who were hired to supply the houses of the rich goldsmiths of 
Chepe, and who, before Sir Hugh Myddleton brought the New River to London, 
were indispensable to the citizens' very existence.' In the reign of Edward III. the 
supply of water for the city seems to have been derived chiefly from the river, the 
local conduits being probably insufficient. We read further that in the reign of 
Henry Y. complaints were made by the poor that the brewers, who rented the 
fountains and chief upper pipe of the Cheapside Conduit, also drew from the smaller 
pipe below ; and the brewers were warned that for every future offence they would 
be fined 6a. Sd. There is, I believe, still at Pentonville a house called the ■ White 
Conduit Tavern,' which stands partly upon the site of a notable but not very 
reputable place of entertainment, called White Conduit House, which was much 
frequented by the citizens of London a century ago. There were the remains of an 
old stone conduit here as recently as 1831. It was built in the reign of Henry VI., 
and repaired in 1641. It supplied the Carthusian Friars, and afterwards the boys 
at the Charterhouse School. In 1654 the supply fell short, and a supply from the 
New River was decided on. 

" The difficulty of supplying a sufficient quantity of water to the inhabitants by 
means of wells, conduits, and water-carriers, continued to increase until the year 
1582, when Peter Morice, a Dutchman, undertook, as the inhabitants could not go 
to the Thames for the water, to carry the Thames to them. With this object he 
erected an ingenious pumping-engine in the first arch of London Bridge, worked by 
water-wheels, driven by the rise and fall of the tide, which then rushed with great 
velocity through the arches. This machine forced the water through leaden pipes, 
which were laid into the houses of the citizens ; and the power with which Morice's 
forcing-pumps worked was such that he was enabled to throw the water over St. 
Magnus's steeple, greatly to the wonderment of the Mayor and Aldermen, who 
assembled to witness the experiment. The machinery succeeded so well that, a few 
years later, we find the Corporation empowering the same engineer to use the second 
arch of London Bridge for a similar purpose. The river-pumping leases continued 
in the family of the Morices until 1701, when the then owner sold his rights to Sir 
Richard Soams for £38,000, and by him they were afterwards transferred to the 
New River Company. — (Smiles' ' Lives of the Engineers/ Yol. I.). 

" There is no room to doubt that the water-supply was wretchedly bad ; and since 
it is certain that these various bournes, wells, and ditches, as well as the Thames 
itself, received the drainage of the soil and the sewage of the inhabitants, we cannot 
wonder that when the germs of some of those diseases which we call zymotic, and 
which are capable of being disseminated by water as well as by other means, were 



INTRODUCTION. 891 



imported amongst the population, those zymotic maladies spread like wildfire, and 
proved disastrous, in the manner that we read the black death, the sweating sickness, 
and the plague were disastrous. Even the most wholesome water which the 
Londoners could obtain was conveyed, we read, from Tyburn in leaden pipes, and 
stored in a leaden cistern ; and it would be curious to know how many of the 
inhabitants of Chepe suffered from attacks of colic or had blue lines upon the gums. 
It is true that the Thames, Kent, and Hertfordshire waters, with which London is 
supplied at present, seem incapable of acting upon lead, but of the power of the 
surface-water in the neighbourhood of London to dissolve lead we know little. It is 
at least possible that the heading ' Griping in the guts/ which is so common in the 
old bills of mortality, may have included some cases of lead-colic. 

" The fact that, in the reign of Edward III. — a reign memorable for one of the 
most fearful pestilences that this or any other country has ever seen — the inhabi- 
tants apparently preferred to take their water directly from the river, renders it 
probable that the brooks and bournes had lost even then that coarse purity of which 
->ur senses can take cognisance. "Walbrook, Oldbourne, and Langbourne, the very 
sites of which have passed away, were probably little better than open sewers, and 
had lost those characteristics which a wholesome brook should have — 

* * With here and there a lusty trout, 
And here and there a grayling ; ' 

" The drainage of Old London consisted probably of cesspools and surface-drains ; 
and the lines of Swift, in which he describes a city shower, coarse though they be, 
seem worthy of quotation, as giving a vivid picture of metropolitan hygiene, even as 
late as the reign of Queen Anne : — 

11 ' Now from all parts the swelling kennels flow, 
And bear their trophies with them as they go : 
Filth of all hues and odours seem to tell 
What street they sailed from by their sight and smelL 
They, as each torrent drives its rapid force, 
From Smithfield to St. Pulchre's shape their course, 
And in huge confluence joined at Snow Hill ridge, 
Fall from the conduit prone to Holborn Bridge. 
Sweepings from butchers' stalls — dung, guts, and blood — 
Drowned puppies, stinking sprats, all drenched in mud, 
Dead cats, and turnip-tops, come tumbling down the flood.' 

"Since the great plague of 1665, London has not, happily, been visited by any 
pestilence of at all similar proportions. This is attributable to several facts, fore- 
most among which is doubtless our improved knowledge of disease and its causes ; and 
we must not forget that the epochs of these last great plagues were also the epochs 
in which flourished two such men as William Harvey and Thomas Sydenham. Froude 
('History of England,' Vol. L, p. 61), speaking of the change that gradually came 
over the English nation at the period of the Reformation, says : — < The paths trodden 
by the footsteps of ages were broken up ; old things were passing away, and the 



892 HYGIENB. 

faith and the life of ten centuries were dissolving like a dream. Chivalry was dying, 
the abbey and the castle were soon together to crumble into ruins, and all the forms, 
desires, beliefs, convictions of the old world were passing away, never to return. A 
new continent had risen up beyond the western sea. The floor of heaven, inlaid 
with stars, had sunk back into an infinite abyss of immeasurable space, and the firm 
earth itself, unfixed from its foundations, was seen to be but a small atom in the 
awful vastness of the universe I In the fabric of habit which they had so laboriously 
built for themselves, mankind were to remain no longer.' 

"Philosophers had begun to inquire methodically into the meaning of, and to 
seek for reasonable interpretations of, natural phenomena; and the science of 
medicine could not— as we know it did not — escape the influence of that general 
change of thought which was going on around it. 

" Another cause of the improved health of the metropolis was the Great Fire of 
1666, which destroyed upwards of 13,000 houses, many of them of the class 
which Erasmus had condemned, and which, there can be little doubt, were 
fever-dens of the worst description. 

" The only writer who has had the hardihood to advocate the systematic use of 
fire as a purifier is an American. Nathaniel Hawthorne, in his well-known novel 
1 Transformation,' says, speaking of the old buildings so common in Italy : — 

"' Gazing at them, we recognise how undesirable it is to build the tabernacle of 
our brief life-time out of permanent materials, and with a view to their being occupied 
by future generations. All towns should be made capable of purification by fire, or 
by decay, within each half-century. Otherwise, they become the hereditary haunts of 
vermin and noisomeness, besides standing apart from the possibility of such improve- 
ments as are constantly introduced into the rest of man's contrivances and accommo- 
dations. It is beautiful, no doubt, and exceedingly satisfactory to some of our natural 
instincts, to imagine our far posterity dwelling under the same roof-tree as ourselves. 
Still, when people insist on building indestructible houses, they incur — or their 
children do — a misfortune analogous to that of the Sibyl when she obtained the 
grievous boon of immortality. So, we may build almost immortal habitations, it is 
true, but we cannot keep them from growing old, musty, and unwholesome, 
dreary, full of death-scents, ghosts, and murder-stains ; in short, habitations such 
as one sees everywhere in Italy, be they hovels or palaces.' 

" A third cause, and a cause which has not, I think, been sufficiently recognised, 
was the construction of water-works for bringing wholesome water to London. 

" It is stated that, as early as the reign of Queen Elizabeth, leave was granted to 
the citizens to convey a stream to London from any part of Middlesex or Hert- 
fordshire. It was not, however, till 1609 that Mr. Hugh Myddleton, a Welsh 
goldsmith, who had enriched himself by mines in Cardiganshire, persuaded the 
Common Council to transfer their powers to him, and he undertook in four years, at 
his own risk and charge, to bring the Chad well and Amwell Springs from Hertford- 
shire to London by a route more than thirty-eight miles long. The scheme met 
with much opposition from the landholders of Middlesex and Hertfordshire, and 
before the work was completed the projector's resources were exhausted, and he wai 
obliged to petition the king to assist him. 



nmtoDucTioir. 893 



" The date of the opening of the New River Head at Clerkenwell was September 
29, 1613. 'It was a considerable time, however,' says Thornbury, * before the New 
River water camo into full use, and for the first nineteen years the annual profit 
scarcely amounted to twelve shillings a share.' 

"Smiles computes the cost of the New RiU«r at £18,000. The pipes at first 
used were of wood. The leakage was so great through these wooden pipes that it is 
computed that about a quarter of the whole water was wasted. When these wooden 
pipes were in vogue — which we may be sure quickly rotted — it is no wonder that ft 
prejudice existed against them. Water-carriers, therefore, long continued to drive ft 
trade in water carried directly from the New River Head or the river itself, their 
cry being ' Fresh and fair New River water ! None of your Pipe Sludge 1' At the 
source of the New River at Chadwell, near Ware, a memorial stone has been erected, 
bearing the following inscription : — ' Sacred to the memory of Sir Hugh Myddleton, 
Baronet, whose successful care, assisted by the patronage of his king, conveyed this 
stream to London : an immortal work, since no man cannot more nearly imitate the 
Deity than in bestowing Health.' 

" Besides the prevention of disease, one of the great aims of the science of publio 
health is, or most undoubtedly ought to be, the improvement of the race. We have 
only to look at the children — pale, wretched, pinched, crooked-limbed, and fighting 
with disease — who swarm in the London streets, and compare them with the sturdy, 
rosy-cheeked boys and girls that one encounters in well-cared-for country districts, to 
be sure that the town-bred children of the poor whose resources are not sufficient 
to counteract the adverse surroundings which encompass them, must be vastly 
inferior as citizens — physically as well as morally — to the children who enjoy from 
their birth all the advantages of fresh air, free exercise, and healthy parentage. 

" The theory of ' natural selection,' broached a few years since, ought certainly 
to have a great influence upon the science of public health, and upon the enactments 
which may be necessary for the forwarding of that science. According to the theories 
of natural selection, the weak members of a family are sure to be worsted in the 
battle of life, and the strong will alone survive the struggle and bear off the 
rewards of victory. In this way the gradual improvement of the race is insured by 
the eradication of the weeds and the giving of more room for the healthy plants to 
flourish in. 

" Now, the science of public health must have the effect, and doubtless has had 
the effect, of lessening the enemies with which man has to contend, and thus there 
can be no doubt that many more sickly weeds survive to manhood than formerly ; 
and, therefore, against the great good which public health enactments doubtlessly 
effect for us, must be placed the counter-balancing reflection that excessive protection 
interferes with that process which bears good fruit in the long run — I mean 
'natural selection.' 

" 'To Plato,' says Lord Macaulay, 'the science of medicine appeared to be of very 
disputable advantage. He did not, indeed, object to quick cures for acute disorders, 
or for injuries produced by accidents ; but the art which resists the slow sap of a 
chronic disease, which repairs frames enervated by lust, swollen by gluttony, or 
inflamed by wine — which encourages sensuality by mitigating the natural 



894 HYGIENE. 



punishment of the sensualist, and prolongs existence when the intellect has ceased to 
retain its entire energy — had no share of his esteem.' ' The exercise of the art of 
medicine ought, he said, to be tolerated so far as that art may serve to cure the 
occasional distempers of men whose constitutions are good. As to those who have 
bad constitutions, let them die ; and the sooner the better.' 

" If this Platonian doctrine were acted upon, there can be little doubt that the 
remnant of the present population which would remain would be a remnant having 
robust constitutions, and therefore calculated to transmit strength and stamina to the 
generations which should succeed them. 

" In centuries gone by the elimination of the physically, mentally, or morally 
weak was more abundantly effected than at present. All the diseases bred of 
ignorance and overcrowding assailed the population in the most virulent manner ; 
and perhaps I shall not be thought wanting in respect to the mighty dead if I put 
forward a doubt as to whether the treatment of the physicians of that time, with 
their antiphlogistics, bleedings, purgings, hot regimens, and barbarous nostrums, 
had even the merit of doing no harm. It must have been very seldom that the 
prescriptions and remedies ran counter to the ideas of Plato by repairing the 
enervated frame or resisting the slow sap of a chronic disease. 

" The mentally weak were eliminated in the same way. In those dark ages a 
man who became mentally deranged was regarded from different points of view, 
according to the form which his derangement took. 

" 'If,' says Dr. Maudsley, 'the ravings of the person took a religious turn, and 
his life was a fanatical practice of some extraordinary penance ... he was 
thought to have reached the ideal of human excellence, and was canonised as a saint; 
more often his state was deemed to be a possession of the devil or other evil spirit, 
or the degrading effect of a soul enslaved by sin. ... It was" the natural result 
of such views of madness that men should treat him whom they believed to have a 
devil in him as they would have treated the devil could they have had the good 
fortune to lay hold of him. When he was not put to death as a heretic or a 
criminal, he was confined in a dungeon, where he lay chained on straw ; his food 
was thrown in, and his straw raked out through the bars ; sight-seers went to see 
him as they went to see the wild beasts — for amusement ; he was cowed by the whip 
or other instrument of punishment, and was more neglected and worse treated than 
if he had been a wild beast. Many insane persons, too, were, without doubt, 
executed as witches, or as persons who had, through ^ itchcraft, entered into compact 
with Satan.' In this way, the insane were quickly or slowly, but nevertheless 
surely, to a great extent eliminated from the ranks of the people. 

" The elimination of the morally depraved was effected in a no less thorough 
manner. By an Act of Henry VIII. it was enacted that vagrants, beggars, and 
such as could give no good account of themselves, should suffer as follows : — 

" If caught begging once, being neither aged nor infirm, he was whipped at the 
cart's tail. If caught a second time, his ear was slit or bored through with a hot 
Iron. If caught a third time, being thereby proved to be of no use on this earth, but 
to live upon it only to his own hurt and to that of others, he suffered death aa 
a felon. 



INTRODUCTION. 895 



"Thieves, when convicted, were generally sentenced to death, and the sentence 
was not infrequently carried out ; and although Mr. Froude discredits the assertion 
which has been made that as many as 72,000 criminals were executed in the reign 
of Henry VIIL, there can be no doubt that the numbers of such executions was 
enormously great. Thus we see that disease, the State, and the gallows were great 
eliminators of worthless characters ; and although, through these, as well as other — 
and probably more important — causes, the population remained numerically almost 
at a standstill, there can be no doubt that the race who conquered the Spanish 
Armada, and which produced a Shakespeare, a Raleigh, a Drake, and a Bacon, was a 
race which had approached to no mean degree of physical and mental excellence, and 
that, too, almost without the aid of sanitary legislation or compulsory education. 

" The nineteenth century differs from the sixteenth in this — that it is far more 
benevolent in its treatment of the sick and erring. At the last census in 1871 it was 
found that of the 3,250,000 persons inhabiting the metropolis, no less than 60,000 
were living as the inhabitants of workhouses, hospitals, asylums, and prisons, at the 
expense of the rest. 

"We cherish our weeds. The patient with mental disease is allowed to go 
abroad as soon as the solicitous care of the physician has restored to him his 
reason; the hardest and most inveterate scoundrels in our prisons are often set 
at liberty with a ticket of leave; prostitutes are still permitted, except in a few 
favoured localities, to ply then calling and disseminate disease without restraint; 
and it is hardly too much to say that the hangman's office has become a sinecure. 
We adopt the same tactics with mental and moral diseases as we do with physical 
maladies, and in our treatment of them we are actuated by the feeling that 
prevention is better than cure. And so indeed it is ; and no one will deny that, for 
all concerned — the healthy as well as the sick and erring — the less harsh we are in 
the treatment of our unfortunate brethren, the better. It is certainly more rational, 
more humane, and more in accordance with Christian doctrine, to prevent than to be 
ready to adopt capital measures for eradication. 

" The only objection which can be raised against our humane course of action 
arises from the knowledge that much disease, both of mind and body, is hereditary ; 
and when we reflect that the consumptive when he leaves the hospital, the madman 
when he quits the asylum, and the habitual criminal when he gets his discharge or 
ticket of leave, are all capable of transmitting their several taints to generations yet 
unborn, we can hardly repress the doubt which arises in our minds as to whether 
Plato was not in the right after all. 

" 'All persons,' says Dr. Maudsley, 'who have made criminals their study, 
recognise a distinct criminal class of beings, who herd together in our large cities in 
a thieves' quarter, giving themselves up to intemperance, rioting in debauchery, 
without regard to marriage ties or the bars of consanguinity, and propagating a 
criminal population of debauched beings. ... In addition to the perversion or 
entire absence of moral sense, which experience of habitual criminals brings pro- 
minently out, other important facts disclosed by the investigation of their family 
histories are, that a considerable proportion of them are weak-minded or epileptic, 
or become insane, or that they spring from families in which insanity, epilepsy, of 



896 HYGIENE. 



some other neurosis exists, and that the diseases from which they suffer and of 
which they die are chiefly tubercular diseases and diseases of the nervous system. 
Crime is a sort of outlet, in which their unsound tendencies are discharged; they 
would go mad if they were not criminals, and they do not go mad because they are 
criminals.' 

" The State has so much respect for the liberty of the subject that one can hardly 
expect that any measures will ever be taken to prevent the marriage of those tainted 
with hereditary sickness, or to stop the propagating power of habitual criminals. 

" The only check which we have as yet attempted to place upon certain of the 
evils last enumerated — the evil of unrestrained marriage between people who are 
physically or mentally deranged ; the evil of allowing habitual criminals to wander 
among us and perpetuate their degraded class — is the moral check. We have got 
a compulsory Education Act, and, if evasion of it be prevented, we may hope that, 
within sixty years or so from the present date, every British subject will possess 
the means of educating himself if he choose — i.e., a knowledge of reading, writing, 
and a little arithmetic. 

." Besides the Education Act, which there can be no doubt will do much to 
develop the mental and moral excellence of the nation, there are other means of 
improving the national health which surely ought not to be neglected. Perfect 
health, we are told, consists of 'a sound mind in a sound body' — Mens sana in 
corpore sano. The ideas of the ancients, that body and mind were distinct and 
separable from each other, have long since exploded, and, according to modern views, 
a sound mind is merely the outcome of a perfectly sound body. If, therefore, we are 
to have a national system of mental training, surely we ought to have a national 
system of physical training as well. For us, whose masses are for the most part 
centred in densely-populated and unhealthy cities, this physical training seems doubly 
important. In the early days, of our history, when the feudal system still existed 
among us, every able-bodied man in the country was trained to bear arms; and 
although there was no standing army, no class who made fighting their sole pro- 
fession, and physical training their principal aim in life, we were then dreaded by our 
foes, and rightly regarded as the fiercest nation in the world. In whatever way the 
physical training is to be effected — whether by a term of compulsory military or naval 
service, or otherwise — there can be no doubt that it is absolutely necessary ; and if 
it be not carried out, and with women as well as with men, we shall undergo a great 
risk of physical deterioration, because a large proportion of the inhabitants of our 
cities are wholly unable to receive physical training in any shape except upon 
compulsion and at the expense of the State*" 



FOOD. 

The human body has often been spoken of as a machine, and it will perhaps help 
us to bring graphically under the reader's notice the relation existing between the 
human machine and the food which keeps it going, if we push the analogy a little, 
and ascertain how far this similarity is recognisable. 



foot*. 897 

A steam-engine consists of a collection of skilfully-devised metal cranks and 
levers, which are the instruments for guiding the power generated in it in the desired 
directions. These cranks and levers, if properly oiled, undergo an amount of 
wasting which is surprisingly small in proportion to the work which they accomplish. 
They do waste, however, and repairing is part of the life history of every steam- 
engine. A steam-engine has also a furnace for the production of heat, and a boiler 
in which the heat is transformed into motor power. In the human machine the 
stomach is analogous to the stoke-hole of the engine, but the process of combustion 
goes on, not only in the furnace proper, but in every port of the body to which the 
dissolved food is carried by the blood vessels. The burning of food in the human 
economy is in some degree analogous to the consumption of fuel in a fire, the main dif- 
ference between them being that in the one case it is rapid and visible and in the other 
case very slow and recognisable only by its effects. Now, the work done by a steam- 
engine is exactly in proportion to the amount of fuel consumed, and so it is with the 
body, for it is a well-known fact that hunger is exactly in proportion to occupation 
or labour. In the present chapter we shall endeavour to demonstrate, with all the 
clearness which the present state of our knowledge will allow, how best to keep 
the human machine at work, and what are the proper fuels, or foods, with which 
to supply it. 

Foods are divisible into four classes; these are called, 1, Albuminates; 2, 
Fats ; 3, Carbo-hydrates ; 4, "Water and Salts. 

1. Albuminates. — This class includes all those foods which contain albumen. 
Albumen, in its purest form, is met with in the whites of eggs. It is a straw- 
coloured, transparent, tenacious, viscid fluid. It is soluble in water, and becomes 
solid, or " coagulates," when mixed with certain acids and other chemical re-agents, 
or when heated above a certain temperature. The temperature at which albumen 
coagulates is 180° Fahr. A boiling temperature — i.e., 212° — of course coagulates it 
all the quicker. Now albumen, although found in its purest form in eggs, 
constitutes, it must be remembered, a large proportion of all animal foods, and 
although fats contain no albuminous principle, the lean parts of meat are scarcely 
less albuminous than eggs themselves. All other animal tissues also contain 
albumen, and those which contain the least, such as bones and ligaments, are rich in 
a principle which is nitrogenous, like albumen, and is called gelatin. 

The chief use of the albuminates is for the nourishment of the albuminous tissues 
of the body. They also constitute one of the chief sources of fat. 

The albuminates are often spoken of as the nitrogenous food principles because 
of the large proportion of nitrogen which they contain. They are also called 
the protein principles. They are found in greatest abundance in the animal 
kingdom, but it would be a mistake to suppose that they are not found in 
the vegetable world also. Many vegetables are very rich in nitrogenous 
matter, and the seeds of the leguminous plants, such as peas and beans, are a 
well-recognised source of albuminous food. Almost all vegetable bodies con- 
tain more or less albuminous matter, and in very many it is the preponderating 
ingredient. It is a popular error to suppose that a vegetable diet is incapable of 
maintaining the strength and stamina of a man, and it should be borne in mind 
67 



898 HYGIENE. 



that in the Franco-Prussian war of 1871, the German army was fed to a great extent 
on a sausage which was largely composed of pea-meal. 

2. Fats. — These bodies are found in both the animal and the vegetable kingdoms. 
It is only necessary to mention the fat of meat, the butter which we get from milk, 
and which is almost pure fat, and the valuable oils which are expressed from the 
olive and other fruits and seeds, to convince the reader of the truth of this assertion. 
If we are guided by anthropological considerations, it would seem that the fats are 
chiefly useful in maintaining the heat of the body, for it is well known that the in- 
habitants of northern and cold climates are accustomed to consume enormous 
quantities of fatty material. The tallow-eaters of Russia, and the blubber-eaters of 
the Arctic regions, are familiar examples of this practical and scientific truth. Fats 
are of various kinds,' and between the perfectly fluid oil of the olive and the hard 
dense wax secreted by the bee there are all degrees of hardness, softness, and 
fluidity. 

3. Carbo-hydrates. — These are dietetic principles, into which the two chemical 
elements, carbon and hydrogen, mainly enter. The types of this group are sugar 
and starch, and it is a peculiarity of this group that it is limited almost entirely to 
the vegetable kingdom. All vegetables, with very few exceptions, contain starch. The 
cereals are mainly composed of starchy matter, but by no means entirely so, for 
even in the most starchy of them there is a fair proportion of nitrogenous matter 
and salts. Wheaten flour, rice, maize, arrowroot, tapioca, and potatoes owe the 
chief of their nutrient qualities to the stare] ly material which they contain. Some 
vegetables are very rich in sugar, and it will only be necessary to mention the sugar- 
cane, the beet-root, and the ripe fruits, such as the grape, the apricot, the gooseberry, 
a&d the plum, to bring this fact prominently under the reader's attention. The use 
of the carbo-hydrates is chiefly to generate force and heat It is true, no doubt, that 
heat is always convertible into motion almost at will, and that all heat-producers 
are necessarily producers of motion also, but it is impossible not to feel that the 
inference is justifiable that the fats are probably most useful as mere producers of 
heat, judging from the fact of their large consumption by the not very energetic in- 
habitants of the polar regions, and that the carbo-hydrates are most useful as 
generators of motor force, if we may judge by the stupendous feats of running and 
endurance in other forms which the inhabitants of the tropics can perform on a diet 
of which rice is almost the sole constituent. It would be dangerous, however, to 
argue from premises such as these, and the supposition which we have put forward 
as likely is very far indeed from being proved. It is certain that a man who con- 
sumes large quantities of carbo-hydrates in addition to albuminates is very liable to 
grow fat. 

4. Water and Salts. — The human body is mainly composed of water, and there- 
fore it is that water is necessary in our food. We take very much more water, 
indeed, than most of us are aware of. Absolutely dry food can be taken in only 
very small quantities, and we all know the labour and sorrow of trying to eat too 
large a quantity of biscuit, or other form of perfectly dry food, without drinking. 
All our food is in fact very largely composed of water, and if meat be perfectly 
freed from its water, it is surprising to see how greatly its bulk is diminished. 



pood. 899 

Vegetables contain enormous quantities of water, and some of them, such as turnips, 
really contain only a small percentage of anything else. Salts, i.e., mineral matter 
in a state of solution, are universally present in all foods, and they are so abundant 
in the body, that it is only reasonable to suppose thay they are indispensable articles 
of diet The principal salts in the body are, common salt, or chloride of sodium, 
salts of potash, salts of lime, salts of iron, and others of less importance. 

5. Condiments. — It is sometimes customary to make a fifth class of alimentary 
substances, and to include in it all those bodies which we use as condiments, such as 
pepper, mustard, tea, coffee, and alcohol. Although these bodies cannot be regarded 
as having any great, if indeed they have any true, nutrient power, they must, 
nevertheless, be looked upon as absolutely indispensable for our well-being, and the 
fact that all nations use them in some form must be taken as conclusive evidence of 
their indispensability. 

With regard to the five classes of alimentary principles which we have enume- 
rated, there is one point concerning which there are still some doubts. It is this : 
To what extent are the fats and the carbo-hydrates interchangeable 1 — that they are 
interchangeable to a great extent is proved beyond a doubt by the common 
experience of mankind. Thus voyagers have lived for long periods on meat alone, 
containing its proper quantum of fat and salts, without any serious interference 
with health. Again, it is well known that many tropical races manage to subsist 
on a vegetable diet containing a large proportion of carbo-hydrates, but almost free 
from fat. 

People who consume much starch or sugar are liable to grow fat, and exact 
experiment has shown that the pig when nourished entirely upon albuminates 
and carbo-hydrates is capable of producing an undiminished amount of fat. Bees 
too, when fed entirely on sugar, are capable of making wax These facts prove that 
at all events fatty matters are, in the animal economy, entirely producible from the 
carbo-hydrates, and to a less extent from the albuminates, but the universal custom 
of mankind shows us that the body thrives best on diets in which the carbo-hydrates, 
fats, and albuminates are all represented. Dr. Parkes has the following remarks 
on this interesting subject : " An argument against the fats and carbo-hydrates 
being mutually replaceable under ordinary conditions in the diet of man is drawn 
from a consideration of the diets used by all nations. In no case in which it can be 
obtained is an admixture of starch, in some form, with fat omitted; moreover, in 
all cases — except in those nations like the Esquimaux, who are under particular condi- 
tions of food — we find the amount of fat taken is comparatively small as compared 
with the starches. Why should this be, if the two groups serve virtually the same 
end 1 Is it a matter of chance that Nature has everywhere mixed up fat and 
carbo-hydrates in those foods on which men thrive best, or is it this mixture which 
has aided in making men what they are 1 Analyse almost all the known diets of 
the world which are not, so to speak, diets of necessity, and they consist — besides 
water and salts — of nitrogenous substances, fat, and starches. If the two latter are 
convertible why should we not find in some places diets of albuminates and fat 
only ; in others of albuminates and starches only 1 WTiy should there be this 
singular uniformity of combination 1 Why also should all nations so -agerly seek 



900 HYGIENE. 

after starches and sugars, even when fats are available, so that it seems almost an 
instinct to desire them ? n 

It has been clearly demonstrated over and over again that man cannot live on 
a diet composed of any one of the alimentary principles. Whenever the attempt 
has been made to support life on any one of them, such as albumen alone, or sugar 
or starch alone, or simple gelatine, the result has been a practical starvation. 
Dr. Hammond managed to support life for ten days on a diet composed entirely of 
albumen, derived from bullock's blood, and water. Symptoms of a most alarming 
kind soon showed themselves, and at the end of ten days he was obliged to desist. 
Attempts of a less rigid kind also terminated in & similar way ; and in those cases 
where life has been supported entirely upon lean meat or upon cheese, the health 
has very quickly deteriorated. In some conditions of the constitution, such as 
diabetes, it becomes necessary to deprive the patient of carbo-hydrates, because of 
his inability to assimilate them, and only those who have themselves suffered, or 
have closely watched the sufferings of others, can be aware of the misery which a 
restricted diet of this kind entails on the sufferer, and the terrible longing for the 
forbidden food. 

In the early days of his existence man is dependent entirely on one article of 
diet, viz., milk, and it is a remarkable and most instructive fact that milk contains 
an admixture of all .the alimentary principles we have enumerated — the albuminates, 
carbo-hydrates, fat, water, and salts. Milk may, therefore, be regarded as a typical 
food. 

If milk be allowed to stand the cream rises to the top, and may be skimmed off 
This is the fatty constituent of milk. 

If to the skimmed milk some rennet be added the casein will coagulate, and 
can be separated as curd. This is the albuminate, or nitrogenous constituent of 
milk. 

The fluid which is left after the coagulation of the casein, and which is known 
as whey, contains the sugar of milk or lactin, which is the carbo-hydrate constituent, 
as well as the salts and most of the water. 

Roughly speaking, therefore, butter is almost pure fat, cheese is almost purely 
albuminous, and whey is the vehicle of the sugar and salts. 

An analysis of milk shows that in a hundred parts there are — of 

Water , . . . . . 86 7 part*. 



Albuminate* • 
Fats 

Carbo-hydrate* 
Salts 

Total 



4*0 
S-7 

60 
0-6 



100 



As a food, milk is perhaps rather riclj in albuminate constituents, but it must 
be borne in mind that it is the food par excellence of the period of greatest growth ; 
and that the albuminates are particularly useful for the formation of tissue. 

We have clearly shown that the diet to maintain health must be mixed. "We 
now pass on to consider how much food a man requires in the twenty-four hours. 
It is a question which can only be answered by experience, sinoe it is well known 



FOOD. 



901 



that what will satisfy one man of a certain bulk will not be sufficient for another 
of similar size. Experiments as exact as circumstances will permit have been 
made on this point, since it is of the greatest importance to know in those cases 
where it is not possible to allow every man to be guided by his appetite, as in the 
army, in prisons, and other public institutions, what is a fairly sufficient diet to 
maintain health in men of average weight and stature. In actual practice many 
considerations forbid us to be exact in these matters. Age, for instance, has a more 
evident effect on the food requirements than any other single consideration. No 
one is able to gauge the appetite of a growing school-boy fond of athletic sports, in 
whom the demands of growth and the demands of exercise equally cry out for 
attention; while the lean and slipperel pantaloon who spends his existence in 
dozing by the fire, and whose tissues are waning rather than waxing, requires, 
comparatively speaking, a very small amount of food to maintain life at his 
low leveL 

General experience has decided that the standard water-free diet for a man of 
average size doing an average amount of work is as under: — 



Standard "Watxk-filo Durr. 



Albuminate! • 
Fats 

Carbo-hydrates 
Salts 

Total 



4-5 ounce*. 

3-0 „ 
14-0 „ 

10 » 
22-5 « 



Almost all food contains water, and usually this water is in considerable 
quantity, constituting about half the weight of the foods, so that it may be said that 
every man requires about forty ounces of ordinary food per diem. 

But it will be urged by the unscientific reader, I am not a chemist, and what is 
the use of talking to me of exact quantities of fats, albuminates, and carbo-hydrates, 
when I am quite ignorant of the methods for determining these quantities ] We 
therefore subjoin a tabular statement of the percentage composition of some of the 
commonest foods. 

Pmckntaos C0MFO8IT10X oj Foods. 





Wats*. 


AximciiATU. 


Tats. 


Cass.-Htd. 


Salts. 


Milk 


S6-7 


40 


3-7 


50 


06 


Raw Meat .... 


750 


150 


8-4 


... 


1-6 


Roast Meat .... 


54 


276 


1645 


... 


2-9S 


Egg ...... 


73-5 


13-5 


11-6 


... 


10 


Butter 


60 


03 


910 


... 


2-7 


Cheese ..... 


368 


836 


24-3 


... 


6-4 


AY heat Flour . . . 


150 


110 


20 


70-3 


1-7 


Bread . . • i * . 


400 


8-0 


1-5 


49-2 


1-3 


Rice 


100 


50 


0-8 


83-2 


0-6 


Potatoes 


740 


1-5 


0-1 


234 


01-0 


Oatmeal ..... 


120 


160 


6-8 


63-2 


20 


Peas (dry) . . . • 


150 


220 


20 


630 


2-4 


bugar . . i . . . 


86 


... 


... 


96 5 


0-5 



902 



HYGIENE. 



Looking at this table, we can see at a glance the predominating principles in any 
article of diet. It will be observed that among the animal foods the group of 
carbo-hydrates have no place except in milk. Milk, it must be remembered, differs 
from other animal foods in this, that it is obtained from the living animal, and not 
from the dead, and it is certainly a wonderful instance of the design of Providence 
that this transient tissue, intended for the nourishment of the young, should differ 
from all other animal tissues in containing that which is essential for the proper 
nourishment of the growing animal. 

There is a way of regarding food which has lately come much into fashion, as it 
were, among scientific men. This is to look upon all food from a purely chemical 
aspect, as so much fuel which is to be burnt up in the human furnace. This point 
is well given by Dr. Edward Smith, in his work on " Foods." 

" Food is required by the body for the two chief purposes, viz., to generate heat 
and to produce and maintain the structures under the influence of life and exertion. 
The importance of the latter is the more important since wasting of the body is 
familiarly associated with decay of life : but the former is so much the more urgent 
that whereas the body may waste for a lengthened period and yet live, it rapidly 
dies when the source of heat is removed, or even greatly lessened. 

" The production of heat in the body, so wonderful in the process and amount, 
results only from the chemical combination of the elements of food, whether on 
the minute scale of the atoms of the several tissues, or on the larger one connected 
with respiration, and is thence called the combustion of food. As familiar illustrations 
of the production of heat from chemical change, we may mention that when cold 
oil of vitriol and cold water are added together the mixture becomes so hot that the 
hand cannot bear it ; and the heating of haystacks, and also of barley in the process 
of malting, are well known. This action in the body is not restricted to changes in 
one element alone, but proceeds with all ; yet it is chiefly due to a combination of 
three bodies, viz., oxygen, hydrogen, and carbon, and requires for its support fat, 
starch, or sugar, or other digestible food composed of those substances, precisely as 
coal or wood supply fuel for fire without the body. 

" This effect is made extremely striking by Professor Frankland, in the following 
table, which shows the amount of heat generated from so small a quantity as ten 
grains of certain foods, during their complete combustion within the body, and the 
force which scientific calculations have shown to be equivalent to that amount of 
heat. The original quantity used by Professor Frankland has been reduced by 
Dr. Letheby to ten grains, for the convenience of English readers : — 



Too*. 


The Combustion raises 

lbs. of Water 1 deg. 

Fahrenheit. 


Which is equal to 
lifting lbs. 1 foot high. 


10 grains of Dry Flesh . . . 
„ „ Albumen . . . 
„ „ Lump Sugar . . 
„ ,, Arrowroot . . . 
„ „ Butter .... 
w „ Beef-fat .... 


13-12 
12-86 
8-61 
10 06 
18-68 
20-91 


10-128 

9-920 

6-647 

7-766 

14-421 

16-142 



pood. 903 

" Thus we prove that an ounce of fresh lean meat, if entirely burnt in the 
body, would produce heat sufficient to raise about seventy pounds of water 1° Fahr., 
or a gallon of water about 7° Fahr. In like manner one ounce of fresh butter 
would produce ten times that amount of heat ; but, it must be added, that us the 
combustion which is effected within the body is not always complete, the actual effect 
is less than that now indicated." 

The three great objects of food, then, are : 1, to furnish heat ; 2, to produce 
force ; 3, to encourage growth and prevent waste. It has been a great deal too 
much the custom to look upon meat as the only food which is really nourishing 
and worth eating. The English have held this erroneous doctrine for centuries, and 
if we look at the old bills of fare of the feasts given by kings and great people, it is 
simply astounding to see how the diet was composed almost entirely of animal food ; 
fish and flesh in enormous quantities, and almost every bird that flew, were required 
for the furnishing of the rich man's table. Bread they had, of a coarse kind, but 
vegetables were remarkable for their almost entire absence. The potato had not 
been introduced, and green vegetables were scarce and dear. Those who were rich 
enough to feed on fresh meat did not, perhaps, materially suffer; but the poor, 
whose entire diet almost consisted of salted fish and meat, were liable to a frightful 
extent to those diseases which arise from improper feeding, and of which we shall 
speak at greater length later on. Notwithstanding that in the present day 
vegetables are cheap and plentiful everywhere, and that for the rich the vegetable 
produce of almost the entire world may be said to be easily obtainable, we still 
cling to the old dietetic traditions of our ancestors, and both rich and poor still 
continue to eat a diet which is not so much composed of vegetable articles as, both 
on the score of health and economy, it might be. 

If we go to dine with a very rich man, or a city company, or other public 
body, who constitute themselves the guardians of old sterling hospitality, what do 
we get to eat 1 If it is in the winter or autumn we may begin with six oysters, 
which are almost entirely composed of albuminates ; then perhaps comes the turtle 
soup, which chemically is a pleasant decoction of albumen and gelatine, and it is 
remarkable that a gourmand who would discharge his cook for leaving a few 
drops of fat upon the surface of any ordinary soup, takes with his turtle huge 
quivering lumps of green and yellow fat, such as only the educated palate can 
tolerate and the strongest stomachs manage to digest, even with the help of 
cold punch and cayenne pepper. It is probable that in these first two courses 
sufficient nitrogen has been served to satisfy the requirements of the system ; but 
see what follows, turbot and lobster sauce very likely, which again is almost purely 
albuminate. Then come the entries, which are perhaps three in number, and consist, 
(we quote from an actual menu) of creme de volatile aux truffes, or, in other words, 
puree of chicken with truffles ; mutton cutlets, with which one may or may not get a 
potato; and cliaud-froid de caiUe, which consists of cold quails encased in cold meat jelly. 
Here again, then, in the entrees we are confronted with the almost exclusive use of 
the albuminates. Next, we proceed to the joint, which is a slice of pure roast meat, 
and with it one gets, for a certainty, some potato and green vegetable, and perhaps 
some salad. Then will follow a bird of some kind — grouse, partridge, plover, 



904 



HYGIENE. 



wild duck, guinea fowl, according to season, or perhaps some greater delicacy, such 
as quail or ortolan. With many of these birds it is considered little short of sinful 
to eat any vegetable, and with others there is served, at most, a few bread raspings, 
or a little bread sauce. Then comes the dessert ; and it is remarkable that even 
these are composed very largely of gelatine, and at most houses one finds the jellies 
in the ascendancy when compared with the delicacies composed mainly of starchy 
matter and fruit. Cheese in some form generally brings the typical banquet to a 
close. If a reference be made to the standard diet, it will be seen that the 
albuminates should form one-fifth part of the total food, but in the menu we have 
supposed, and which is scarcely exaggerated, it will be observed that the 
albuminates constitute the major part of the dinner. This is of course quite wrong, 
and it is not to be wondered at that those misguided possessors of wealth who 
indulge almost daily in repasts of this kind should suffer from gout, iyspepsia, and 
derangements of the liver, and be compelled to fly to Saratoga, or even abroad to 
Homburg, Carlsbad, or Bath, to try the experiment of undoing that which has 
been brought about by gluttony, or ignorance, or both. 

That " they manage these things better in France," is undoubtedly true, and the 
quiet contemplation of the menu of the table d'hote of any first-rate Continental 
hotel will generally convince the reader that there is not only art, but science too, in 
French cookery. In almost all the soups we find on the Continent, vegetables or 
starch are an important constituent. The soup itself is never too rich, and in it 
there is tapioca, or sliced vegetables, or vermicelli, or Italian pastes of some other 
kind. The fish is almost invariably served with vegetable and butter. The same 
remark applies to the entrees, and in them we find large quantities of vegetable of 
some kind, in fact, the meat may be said to flavour the vegetables rather than the 
converse. No French dinner is ever served, we believe, without one, and sometimes 
two, purely vegetable courses. French beans, asparagus, potatoes, or cauliflowers, 
are cooked in a variety of enticing ways, and always constitute an important feature 
in the dinner. Then again, the management of the sweets, as they are called, shows 
a proper regard to the requirements of the body. Instead of being mainly 
albuminous, they consist of compotes of fruit, or slices of cakes with preserves. 
Justly celebrated as the French are for their pre-eminence in the culinary art, it 
must be admitted that they are far behind the Austrians and Italians as pastry- 
cooks. A really good cook should possess a French knowledge of savoury dishes, 
and an Austrian or Italian knowledge of pastry. 

Mr. "Buckmaster has lately been doing good service by insisting on a more liberal 
me of vegetables in the diet of the people, and we have been at some pains to show 
that the fault lies very greatly with the rich, who fail to give their poorer brethren 
the benefit of a good example. 

In the middle ages the science of proper dietary was very little understood, and 
indeed the art of husbandry was in such a backward state that there was no choice, 
especially among the poor, except to be ill-fed. In those days, the English, who ate 
large quantities of fresh meat, were considered, and rightly so it would seem, the 
best nourished nation in Europe. Froude, in his " History of England," says : — " In 
the fifteenth century, and previous to it, the English were noted for their liberal diet* 



FOOD. 905 

One of the Spanish nobles who went to England with Philip remarked, * These 
English have their houses made of sticks and dirt, but they fare commonly so well 
as the king.' The relative numbers of the French and English armies which fought 
at Cressy, and Poictiers, and Agincourt may have been exaggerated, but no allow- 
ance for exaggeration will affect the greatness of these exploits ; and in the stories 
of authentic actions under Henry the Eighth, where the accuracy of the account is 
undeniable, no disparity of force made Englishmen shrink from enemies wherever 
they could meet them. . . . Invariably, by friend and enemy alike, the English are 
described as the fiercest nation in all Europe — ' the English wild beasts,' Benvenuto 
Cellini calls them ; and this great physical power they owed to the profuse abund- 
ance in which they lived, and to the soldier's training to which every man of them 
was bred from childhood." 

The amount of food which a man requires varies with a great number of circum- 
stances. The chief of these is necessarily the amount of work which he is called upon 
to perform; in sickness and convalescence, when the only work done by the body is 
that internal work which is necessary to keep the heart, lungs, and other internal 
organs in action, the amount of food which is required is very small indeed. Dr. 
Playfair states that a man can be kept alive on two ounces of albuminates ; twelve 
ounces of carbo-hydrates, and half an ounce each of fats and salts. This is called a 
subsistence diet, and it is sufficient for the internal work, but on it a man will lose 
weight. 

In the English convict establishments the diets are calculated with the greatest 

scientific accuracy according to the amount of work which the convict is called upon 

to perform. 

Hjlrd Labour Diet. Per diem. 

Albuminates ....... 4-075 

Fat . • . • . 1-557 

Carbo-hydrates ....••. 18806 

Salts ........ 1963 

The " dynamic value," i.e., the amount of work which this diet is capable of effecting 

by its combustion is calculated at 4,072 foot-tons, or is capable of raising 4,072 tons 

one foot high. 

Light Labour Dibt. Per diem. 

Albuminates ....... 3-508 

Fats 1-316 

Carbo-hydrates ....... 16 '727 

Salts .... ... 1-716 

Dynamic value, 8,677 foot-tons. 

Industrial Employment Dibt. Per diea. 
Albuminates ....... 3710 

Fats . 1-562 

Carbo-hydrates ....... 17'310 

Salts ........ 1-616 

Dynamic value, 3,787 foot-tons. 

Pbnal Dibt Per diem. 

Albuminates ....... 3-784 

Fats 1-580 

Carbo-hydrates .....•• 19-864 

Salts 0-W* 

Dynamic value, 4,193 foot-ton*. 



906 HYGIENE. 

Punishment Diet. Per diem. 

Albuminates ....... 1*296 

Fats . 0-256 

Carbo-hydrates . . . . . • .8*160 
Salts 0-368 

Dynamic value, 1,541 foot-tons. 

It may be assumed that the diet last quoted is not more than sufficient to sustain 
life when no work is being done. There are some remarkable histories on record of 
persons who have managed to live on incredibly small quantities of food. The Welsh 
fasting girl will occur to most of our readers, for although there can be little doubt 
that her parents were guilty of the grossest deception in the matter, still it is evident 
that the girl herself must have managed to exist on very little food indeed. Dr. Pavy, 
in his work on food, quotes the case of Thomas Wood, the miller, of Billericay, 
reported to the College of Physicians in 1767 by Sir George Baker, in which 
a remarkable degree of vigour is said to have been maintained for upwards of 
eighteen years upon no other nutriment than sixteen ounces of flour made into a 
pudding with water, no other liquid of any kind being taken. In nutritive value, 
sixteen ounces of flour will represent 1*72 ounces of albuminates, 0*32 ounces of fat, 
and 11-28 ounces of carbo-hydrates. "A more striking instance still is that afforded 
by the case of Cornaro, a Venetian of noble descent, who lived in the fifteenth and 
sixteenth centuries, and attained an age of upwards of 100. Impressed with the 
conviction that the older a man gets, and the less amount of power he possesses, 
the less should be the amount of food consumed, in opposition to the common 
notion that more should be taken to compensate for his failing power, he, at about 
forty years of age, resolved to enter upon a new course, and betake himself to a 
spare diet and a scrupulously regular mode of life, after having, as he said, pre- 
viously lived a life of indulgence in eating and drinking, and having been endowed 
with a feeble constitution and fallen into different kinds of disorders, ' such as pains 
in my stomach, and often stitches and spices of the gout, attended by what was 
almost still worse, a continual low fever, a stomach generally out of order, and a per- 
petual thirst.' He also did all that lay in his power f to avoid those evils which we 
do not find it so easy to remove. These are melancholy, hatred, and other violent 
passions, which appear to have the greater nfluence over our bodies. The consequence 
was, that in a few days, I began,' he adds, * to perceive that such a course agreed 
with me very well, and by pursuing it, in less than a year, I found myself — some 
persons perhaps will not believe it — entirely freed from all my complaints. I chose 
wine suited to my stomach, drinking of it but the quantity I knew I could digest. 
I did the same by my meat, as well in regard to quantity as to quality, accustoming 
myself with nutritive matters so as never to cloy my stomach with eating or drinking, 
but constantly rise from the table with a disposition to eat or drink still more. In 
this I conformed to the proverb which says, that a man to consult his health must 
check his appetite, What with bread, meat, the yolk of an egg, and soup, I ate as 
much as weighed in all twelve ounces, neither more nor less. I drank but fourteen 
ounces of wine.' Upon this scanty allowance Cornaro tells us he perseveringly sub- 
sisted, living in possession of all his faculties to write a series of discourses, at the 
respective ages of 83, 86, 91, and 95, urging upon others to follow his example. 



FOOD. 907 

These discourses, which are imbued with vigour and vivacity, and contain many 
shrewd remarks on the subject of living, seem to have excited considerable attention 
at the time they appeared, and many years afterwards." 

Dr. Partes, in his interesting little work on " The Personal Care of Health," has 
some very valuable remarks on the proper diet for old peopla " I would not advise," 
he says, " that the dictates of appetite should be neglected. If an old man has a 
good appetite, and can digest well, and is in good health, he should continue to eat 
as his appetite counsels ; but as a rule the healthiest old people are the rather spare 
eaters. Some writers have indeed advised that all old people should place them- 
selves on an extremely rigid diet, so that there can never be introduced into the body 
any superfluity which the organs of the body are not able to deal with. It is, in 
fact, certain that some of the evils of old age are owing to more food and liquid 
passing in than the emunctory organs can get rid of. Hence arise indigestions, bowel 
troubles, gouty affections, some skin diseases, and general discomfort of feeling, 
all of which can be removed at once by lessening the diet" I would never recom- 
mend any old man of seventy to copy Cornaro's diet, and to weigh out twelve ounces 
of solid food every day, but on the contrary, I advise him to consult his appetite 
and his digestive power. He should, however, watch the effect on his feelings, 
digestion, and weight, and should limit himself to that amount of food which seems 
to secure him perfect health. 

We now pass on to consider another matter in relation to food, namely, its 
digestibility. Some foods are digested in one part of the intestinal canal and some 
in another. Thus all starchy matters are prepared for digestion while they are 
still in the mouth, and it should always be borne in mind that no starchy matter 
can possibly be digested unless it be thoroughly masticated and mixed with saliva. 
The digestion of starch, however, is not completed in the mouth, but it is supposed 
that other secretions which it encounters lower down serve to finish what has been 
begun by the admixture with saliva. All the albuminates are mainly digested in 
the stomach proper, and having passed through this organ they should be almost in 
a state to be absorbed into the blood. The liquid food after it has been acted upon 
by the digestive fluid of the stomach is called chyme. For the proper digestion of 
the fats, the fluid which is formed by the liver, and which is called gall or bile, is 
necessary. The time which food takes to digest depends upon a great many condi- 
tions. In the first place the food must be properly cooked, and to this we shall 
again refer when we come to speak of the cooking of food Again, food must be 
properly prepared by the recipient ; it must be torn asunder by the teeth and 
thoroughly mixed with saliva, and if this be not done, proper digestion in the 
stomach and intestines is impossible. Hence we see how important it is to attend 
most carefully to the teeth, for if they fail us, our power of digestion, and conse- 
quently of healthy existence, is very much impaired, for although the march of the 
art of dentistry has provided us with a most capital substitute, still, false teeth, how- 
ever good, fall short of their prototypes, and it will not be forgotten also that they 
cost a considerable amount of money, so that for many of us the loss of teeth can 
never be made up. 

Most of our knowledge of digestion is derived from the observations made on a 



908 HYGIENE. 



young Canadian who, unfortunately for himself but fortunately for us, had a hole in 
the wall of his abdomen communicating with his stomach, so that the whole process 
of digestion could be accurately observed. This interesting invalid was under the 
care of a man of great intelligence, Dr. Beaumont, and it is hardly too much to say 
that Beaumont by his observation on Alexis St. Martin, for that was the Canadian's 
name, has taught us nearly all we know about the process of digestion. The follow- 
ing is an account of one of Beaumont's experiments. " At half-past eleven o'clock 
A.M., after having kept the lad fasting for seventeen hours, I introduced a gum- 
elastic tube and drew off an ounce of pure gastric liquor, unmixed with any other 
matter except a small proportion of mucus, into a three-ounce phiaL I then took 
a solid piece of boiled, recently salted beef, weighing three drachms, and put it into 
the liquor in the phial ; corked the phial tight and placed it in a saucepan filled 
with water, raised to the temperature of 100 degrees, and kept to that point on a 
nicely regulated sand bath. In forty minutes digestion had distinctly commenced 
over the surface of the meat. In fifty minutes, the fluid had become quite opaque 
and cloudy ; the external texture began to separate and become loose. In sixty 
minutes, chyme began to form. A.t one o'clock p.m. — digestion having progressed 
with the same regularity as in the last half hour — the cellular texture seemed to be 
entirely destroyed, leaving the muscular fibres loose and unconnected, floating about 
in fine small shreds, very tender and soft. At three o'clock, the muscular fibres had 
diminished one-half since the last examination. At five o'clock they were nearly all 
digested, a few fibres only remaning. At seven o'clock the muscular texture was 
completely broken down, and only a few of the small fibres could be seen floating in 
the fluid. At nine o'clock every part of the meat was completely digested. The 
gastric juice when taken from the stomach was as clear and transparent as water. 
The mixture in the phial was now about the colour of whey. After standing at rest 
a few minutes, a fine sediment of the colour of the meat subsided to the bottom of 
the phiaL A piece of beef, exactly similar to that placed in the phial, was intro- 
duced into the stomach, through the aperture, at the same time. At twelve o'clock 
it was withdrawn, and found to be as little affected by digestion as that in the phial ; 
there was little or no difference in their appearance. It was returned to the stomach, 
and on the string being drawn out at one o'clock p.m. the meat was found to be 
all completely digested and gone. The effect of the gastric juice on the piece of 
meat suspended in the stomach was exactly similar to that in the phial, only more 
rapid after the first half hour, and sooner completed." 

Dr. Carpenter gives the following summary of what is known as to the time 
required for digestion : — " The attempt was made by Dr. Beaumont to determine the 
relative digestibility of different articles of diet, by observing the length of time 
requisite for their solution. But, as he himself points out, the rapidity of digestion 
varies so greatly, according to the quantity eaten, the nature and amount of the 
previous exercise, the interval since the preceding meal, the state of health, the 
condition and the nature of the weather, that a much more extended inquiry would 
be necessary to arrive at results to be depended on. Some important inferences of a 
general character, however, may be drawn from his researches. It seems to be a 
general rule that the flesh of wild animals is more easy of digestion than that of 



FOOD. 909 

the domesticated races which approach them more nearly. This may,*perhapis, be 

partly attributed to the small quantity of fatty matter that is mixed up with the flesh 
of the former, whilst that of the latter is largely pervaded by it ; for it appears from 
Dr. Beaumont's experiments, that the presence in the stomach of any substance 
which is difficult of digestion interferes with the solution of food that would other- 
wise soon be reduced. It seems that, on the whole, beef is more speedily reduced 
than mutton, and mutton sooner than either veal or pork; fowls are far from 
possessing the digestibility that is ordinarily imputed to them ; but turkey is, of all 
kinds of flesh except venison, the most soluble. Perhaps the average period required 
for the digestion of an ordinary meal, and the complete emptying of the stomach, 
may be roughly estimated at from three to four and a half hours. Dr. Beaumont's 
experiments further show that bulk is as necessary for healthy digestion as the 
presence of the nutrient principle itself. This fact has been long known by 
experience to uncivilised nations; the Kamschatdales, for example, are in the habit 
of mixing earth or sawdust with the train-oil on which they are frequently reduced 
to live. The Vaddahs, or wild hunters of Ceylon, on the same principle, mingle the 
pounded fibres of soft and decayed wood with the honey on which they feed when 
meat is not to be had ; and on one of them being asked the reason of the practice, 
he replied, * I cannot tell you, but I know the belly must be filled.' It is further 
shown by Dr. Beaumont that soups and fluid diet are not more readily chymified 
than solid aliment, and are not alone fit for the support of the system ; and this also 
is conformable to the well-known results of experience, for a dyspeptic patient will 
frequently reject chicken broth when he can retain solid food or a richer soup. Dr. 
Beaumont also ascertained that moderate exercise facilitates digestion, though severe 
and fatiguing exercise retards it If even moderate exercise be taken immediately 
after a full meal, however, it is probably rather injurious than beneficial ; but if an 
hour be permitted to elapse, or if the quantity of food taken have been small, it is of 
decided benefit ; the influence of temperature on the process of digestion is remark- 
ably shown in some of Dr. Beaumont's experiments ; he found that the gastric juice 
had scarcely any influence on the food submitted to it when the bottle was exposed to 
the cold air, instead of being kept at a temperature of 100°. He observed on one 
occasion, that the injection of a single gill of water at 50° sufficed to lower its 
temperature upwards of 30° ; and that its natural heat was not restored for more 
than half an hour. Hence the practice of eating ice after dinner, or even of drink- 
ing largely of cold fluids, is very prejudicial to digestion." 

"With regard to the caution about ice, we must say that in our experience 
practice does not, in this matter, agree with theory. Ice after dinner is always 
agreeable, and the evidence that it retards digestion is very small indeed. The 
mistake is often made of giving too much ice, and we have been at dinner- 
tables where iced punch d la Romaine has been served in the middle of dinner, 
between the first and second courses ; ice pudding as the piece de resistance of 
the sweet course, and two kinds of ice, cream and water, as the first dish of 
dessert; this, in addition to ice in the wine, is excessive, and is, we opine, as 
vulgar as it is harmful. 

In our chapter on the diseases of children, as well as in that on the nursing of 



910 HYGIENE. 



children, will be found many remarks on the feeding of children, and we have 
incidentally dwelt on the diet for old age. 

It remains for us to say something on the diet which is most suited for robust 
manhood, and for training. The diet for a man in training should be modelled 
on the diet which we have given as the hard-labour diet of our prisons, and 
which is found by experience to allow of a man's performing a maximum 
amount of work without deteriorating in health. It consists of about twenty- 
six ounces of dry food, or twice that amount of food in an ordinary moist 
condition. The diet must include from four to five ounces of albuminates, 
and if the athlete be still growing this amount may even be increased, the best 
criterion being the man's own appetite. It is a great mistake — a mistake which 
is now very generally recognised by trainers — to give the man in training a 
diet which is too exclusively albuminate. His need is mainly for readily 
combustible fuel, to produce the large quantities of force which he is obliged to 
put forth, and if these be not given to him he will consume his muscular tissue, 
and become "stale." A training diet should be very plain, should contain a 
proper admixture of the four dietetic principles, should be very varied, should 
be as digestible as possible, and should be free from all spices, condiments, and 
other articles which are likely to tempt the appetite beyond the requirements 
of the system. Rice puddings, potatoes, butter, bacon, eggs, and fat meat should 
all be given, together with a fair amount of green vegetables. The old plan of 
raw beef-steaks and mutton chops, with a thin slice of stale bread for breakfast, 
luncheon, and dinner, day after day, is happily come to an end. 

"We may now say a few words on the all-important subject of cooking food, 
although we have no intention of trenching on the ground which belongs to a work 
on cookery. Man is distinguished as a " cooking animal," and indeed he is the only 
animal that does not consume his food raw. It is needless to say that it is a sine 
qua non of health and proper nourishment, that the food should be properly cooked. 
Cooking is a delicate chemical operation, and although it is too much the custom to 
relegate the duties of the kitchen to those who have received hardly any education, 
it is, nevertheless, true that those duties demand of those who rightly perform them 
patience, education, and very great intelligence. Dr. Parkes in his latest work 
published by the Society for the Propagation of Christian Knowledge, " On the 
Personal Care of Health," makes the following remarks on the importance of a right 
understanding of the subject of food, and the method of cooking it : — • 

"I question whether an artisan or labourer in receipt of pretty good wages, 
which he does not spend in drink, is not the best- fed man in the community, if he has an 
industrious wife who knows how to cook. If she is an understanding woman she 
will give him enough variety, and he receives every day, at the same hours, well 
distributed over the day, about an equal quantity of well-cooked food, over the 
eating of which he does not hurry. If such a man is a teetotaller, or does not take 
more than two pints of beer daily, it will be seen that he changes little in weight 
during the whole period of maturity, and that years tell little on his appearance. 
If he takes too much beer and spirits, as so many do, he begins to get fat about 
forty, and then ages. 



FOOD. 911 

"Compared with such a temperate working man the wealthy classes as a rule are, 
I think, clearly less well off. They have the best description of food and the best 
possible cookery, but they have neither the regularity of time nor quantity that 
the sober working man has. The perfectly cooked made dishes of our day are, no 
doubt, extremely digestible, but that advantage and their variety leads to a large 
consumption. As a rule the wealthy classes eat too much — with, of course, 
exceptions — and it eventually tells upon them. Both men and women get stout, 
and between forty and fifty years many begin to suffer from affections which are 
called by diverse names and affect diverse organs — lungs, liver, or other parts, 
but which are more or less allied to dyspepsia or gout. It is, of course, always 
hazardous to extend to a class the conclusion drawn from a few instances, but, in 
spite of the excellent health-conditions in which most of our rich people are 
placed, we do not see so great a superiority in health in the latter years of 
manhood as should be the case. 

"Although, also, there is very little intemperance among them, in the usual 
sense of that word, they take a good deal of alcohol in one way and another, and 
I think most medical men will agree that Abernethy's advice is the only cure 
for the manifold ailments of many rich patients, viz., * to live on sixpence a-day, 
and earn it.' There are, however, unhappily, people among us who have neither 
the simplicity of the poor nor the gratification of the rich man's diet, but who 
suffer in another way — I allude to the numerous class who are dependent upon 
ill-trained servants for their cooking. A married clerk receiving some .£200 or 
£300 a year is really very badly off in this way. His wife, having received the 
usual ornamental education of our time, knows nothing useful, and would think 
it a degradation to descend to the kitchen and to busy herself in providing for her 
household." 

Yet what increased health and happiness would arise to her husband and 
children ; what pleasure would come to herself — for labour is pleasure — if she 
were a good cook, and would give three or four hours' work in preparing whac is 
so essential for health and energy. If young ladies would only see that cooking 
is really a branch of chemistry, and that it is, therefore, a scientific as well as a 
most useful art, and if they would get over the ridiculous pride of thinking honest 
labour a degradation instead of what it really is — a blessing, how many of our 
countrymen would dine well instead of badly, and be robust instead of weakly. 
The social effects of such a change in sentiment and in action would be surprising ; 
it would solve many difficulties of servants, which are felt more and more every 
year, and it might even give a reply to the important question which is always 
arising and never answered, viz., " whether it is right to marry on £300 a year." 

Meat may be cooked in a variety of ways, but the chief of these are boiling and 
roasting. Now meat is composed of albuminous matter and fat, the fat melts 
when heated, and the albuminous matter coagulates and gets hard and impervious 
to water when its temperature is raised above 180° of Fahr., which is 32° below 
the boiling point of water. 

Now, first of all, as to boiling. In boiling we want to fulfil one of two objects : 
either to impart all the goodness of the meat to the water, or else to leave all 



912 HYGIENE. 



goodness in the meat without benefiting the water. If the former object ia 
desired, as in making a strong broth, the meat should be cut up in small 
pieces and the water should be poured upon it cold. The vessel should then 
be placed at the side of the fire, where it should be allowed to remain for some 
hours, care being taken that the temperature does not rise above 180°, unless it be 
just at last, in order to extract those few ingredients of the meat which are soluble 
in boiling water. If these rules be adhered to, and if the thermometer be employed, 
as it always should be, the broth must be the strongest possible. 

If it be desired to fulfil the second object of boiling, as is the case when a joint is 
boiled to be served whole at the table, we proceed differently, in order to preserve as 
much of the goodness as possible. To effect this we plunge the joint at once into boiling 
water, and allow it to remain for a few minutes. By this manoeuvre all the albumen 
on the outside of the joint is coagulated, and the joint is encased, as it were, in a 
solid coat of armour. This being done, the joint must be left in the water, and not 
allowed to get to a temperature greater than 170° or 175° during the remainder of 
the operation of cooking. If these very simple rules were attended to we should 
not hear so often of a joint being " boiled to rags." 

However carefully the operation of boiling be conducted there is always some 
loss of weight, owing to the solution of the mineral salts and other soluble consti- 
tuents of the meat The loss of weight in boiling is reckoned at from 20 to 30 per 
cent, of the meat. 

Stewing is a mixture of the two kinds of boiling. We manufacture a strong 
broth and with it we eat the exhausted fibres of the meat, which are very tender 
from the excessive amount of boiling to which they have been subjected. 

Roasting is a very favourite way of cooking, on account of the very pleasant 
flavour which it imparts to the meat. Buckmaster, who may be taken as an 
authority on the practical matters connected with cooking, says, experiments which 
have been carefully made show that a sirloin of beef, weighing twelve pounds, lost 
in roasting forty-four ounces, of which twenty-seven were water and seventeen fat, 
or dripping. A flank of beef made into pot-au-feu or bouilli, and weighing twelve 
pounds, lost twenty-five ounces. It is therefore quite clear that boiling, especially 
when the liquor is turned to account, as it should be, is the most economic kind of 
cooking. Notwithstanding this truth, however, roasting before the fire remains the 
favourite method of cooking in this country. The principles involved in roasting 
are the same as in boiling, and our efforts must be directed to imprisoning the juices 
of the meat. To effect this a good clear fire must be made, and for the first fifteen 
or twenty minutes the joint must be placed as close as possible to it without burn- 
ing. It must then be removed to some distance and the process continued as slowly 
as possible, in order to retain the juices as much as possible. It is a common custom 
to paint a joint with white of egg before roasting, or to encase it in a layer of paste, 
or to wrap it in a piece of oiled paper. 

Broiling is a modified form of roasting, and is done over the fire instead of before 
it. The meat must be put at first quite close to the coals and then be removed from 
them. 

We next turn to consider some of the chief diseases which are caused by food, 



FOOD. 913 

either from its excess or deficiency, or from some deleterious character in the food 
itself. 

Too much food causes plethora, and leads to obesity, to a lethargic habit of body, 
and to a great liability to congestive diseases and gout. If the food is not digested 
it either irritates the bowels, and is passed quickly away, causing diarrhoea, and 
sweeping with it the necessary as well as the unnecessary food. If it do not cause 
diarrhoea, it remains in the intestines, causing pain, and decomposes, giving rise to 
the generation of offensive gas, or to worse troubles. 

If an excess of albuminates be given, the tendency is towards gout ; and it is to 
be remembered that, when a strong meat diet is being consumed, it is of the greatest 
importance that the consumer should take quantities of exercise. Gout is most 
common, perhaps, among those robust gentlemen who have passed their middle age, 
and having been accustomed all their lives to a generous diet, and the strong exercise 
of hunting, forget when they are compelled to forego the pleasures of the chase to be 
sufficiently self-denying at the table. The constant habit of great muscular exertion 
has begot another habit of generous feeding, and the strong digestion which has been 
trained through the whole of a healthy life is often at last far from a blessing to its 
owner. We not long ago encountered a spare, very heal thy -looking, elderly gentle- 
man, who, at the age of sixty years and more, had that day been enjoying, as usual, 
the joys of fox-hunting. On congratulating him on his unfailing powers and hia 
healthy appearance, he accounted for the fact by saying that " he was one of those 
who had been blessed with a weak digestion, that while the friends of his youth 
were dying one by one, carried off by plethora in its various forms, he, compelled 
by his frailty to live carefully, pursued that even tenor of his ways without, as yet> 
being aware of any of the onslaughts of time." 

An excess of starchy food, or of sugars or fats, is very apt to cause obesity, and 
it is well known that the surest way of arresting a tendency to corpulence is to cut 
off carbo-hydrates from the diet. Corpulency is to be avoided, not only on account of 
the disfigurement and inconvenience which it causes to its victim, but 1 ather because 
when there is fat on the surface there is commonly fat beneath also, and an ac- 
cumulation of fat around internal organs interferes often very seriously with their 
efficient action. The diseases which arise from a superfluity of food are confined 
generally to the wealthy classes, and especially to the bourgeois class — successful 
tradesmen, aldermen, and " self-made " men generally, who have never been trained 
to any of the pursuits of fashionable idleness in their youth, and find themselves 
obliged, when fortune gives them an abundance of money, to fall back for their 
amusement to the delusive joys of eating and drinking. 

A deficiency of food is very serious matter to a nation, as those who remember the 
Irish famine and the disasters which followed it can testify. A deficiency of food, and 
especially of fresh meat and vegetables, engenders a habit of body which is called scor- 
butic, and which reaches its most aggravated form in the disease called scurvy. Scurvy 
is happily very rare in the present day, and there are many medical men of large 
experience who have never seen a case. Even among sailors, who formerly were the 
greatest sufferers from scurvy, the disease is seldom seen, because the proper methods 
of providing against it are thoroughly understood. Scurvy is a very terrible disease, 
58 



914 HYGIENE. 



and it is characterised by bleedings, purple patches, and terrible ulcerations of the skin, 
A man with the scurvy is fit for nothing, and the slightest injury may cause 
serious troubles and death. When numbers of scorbutic persons are herded together, 
diseases of a low type are very liable to break out among them. Before the intro- 
duction of the potato into Europe, and before the art of horticulture had placed at 
our disposal such a variety of vegetables, the majority of the lower orders were of a 
scorbutic habit, and this it was which gave such a fearful virulence to the epidemics 
of the middle ages, for it must not be supposed that scurvy merely shows itself as 
such. The diseases known as typhus fever, jail typhus, the purples, spotted fever, 
and even, there is good reason for believing, some forms of dysentery, the black 
death, plague, and sweating sickness, owed their peculiar energy to the scorbutic con- 
dition of the populations which they attacked. 

Dr. Guy, in his most interesting lectures on " Public Health," says : — " About a 
century ago a vessel of war might seem to have been equipped and provisioned with 
a view to the production of the greatest possible amount of disease in the shortest 
possible space of time. Beef badly salted, and often so rotten that, before boiling 
it, it was necessary ' to tie it round with cords ; ' biscuits mouldy and full of ' weevils 
or maggots ; ' and puddings of salt suet and flour made up the dietary. 

" The water was often so thick and green from decomposition and vegetable 
growth, and so offensive withal as to disgust sight, smell, and taste. The ship was 
damp, filthy, and ill-ventilated, and the air of the wells so foul as often to produce 
fatal asphyxia. Personal cleanliness was neglected, the clothing was insufficient, 
and the bedding too, the men having to turn in between blankets unwashed perhaps 
for a year ; little effort was made to amuse the mind and to instruct it ; the sailors' 
only luxury was an exorbitant allowance of spirituous liquors on sea as on land, the 
fruitful source of disease, misery, insubordination, and crime." The account which 
Dr. Guy gives of the famous voyage of Commodore Anson will show under what 
frightful difficulties some of England's greatest navigators have worked. 

" On the 18th of September, 1740, Anson set sail from St. Helen's, and on the 
15th of June anchored at Spitheacl, having been absent from England three years 
and nine months. He left with six vessels of war, and two victuallers, and came 
back with his spoils and a reputation richly earned, but with a single ship, his own 
Centurion. Our interest centres in three of these ships, the Centurion^ the Gloucester, 
and the Tryal, and the 961 men who formed their united crews. Such crews, we 
may hope, were never before or since brought together to tempt Providence, and 
to try the mettle of a gallant commander. Of the seamen some were drafted direct 
from hospital and sick quarters. The land forces were men mostly sixty years old, 
some upwards of seventy, the worst half of a batch of invalids of whom the younger 
and more active had deserted. In lieu of the deserters Anson was furnished with 
210 raw and undisciplined marines, with scarcely more of the soldier than the 
regimentals, some of these too had been lately discharged from hospital. . . . 

" The run to Madeira occupied thirty-seven days instead of the usual ten or 
twelve, and the crews suffered from the fevers then known as the calentures. The 
Centurion lost two men. The ventilation being recognised as inadequate, six air 
scuttles were ordered to be made in each ship, and a supply of water, wine, and other 



tood. 915 

refreshments, was laid in. The forty-seven days' ran to St. Catherine's produced a 
serious sick list ; eighty men were landed sick from the Centurion, of whom 
twenty -eight died ; and yet by the time they left the island the eighty had become 
ninety-six. These were embarked, and in thirty days they reached Port 
St. Julian, which place, after a stay of ten days, they left in good spirits, and, as 
I gather, in good health. It was the 105 days spent between St. Julian and 
Juan Fernandez, amid storms, cold, frosts, and deluges of water, under unparalleled 
exposure, fatigue, and privation, that occasioned the greater part of the sickness and 
mortality of which I am presently to give a summary. In about ten days after 
leaving St. Julian the scurvy began to show itself, and in less than two months 
it had spread to such a degree that there were few on board free from it. Soon 
after we read of forty-two dying on board the Centurion, then in the month following, 
double the number, and by the time the ship arrived at Juan Fernandez there had 
been a loss of upwards of 100 men, and they could not ' muster more than six 
foremast men in a watch capable of duty,' and even some of these were lame, and 
unable to go aloft. I must not detain you with further details of the sickness and 
death on board the Centurion, or with the adventures of the Gloucester and Tryal. 
Suffice it to say, that in the short space of less than nine months, the time spent 
between England and Juan Fernandez, the crews of the three ships had lost 62Q out 
of 961, or, if we limit ourselves to the Centurion and its crew, concerning which we 
have the most exact information, it appears that in less than nine months, her 506 
men were reduced to 214, her fifty invalids to four, and her seventy-nine marines to 
eleven. Of this frightful mortality, by far the greater part occurred in the stormy 
and every way inclement weather encountered in rounding Cape Horn, in the two 
months and a half that elapsed between leaving Port St. Julian and arriving at 
Juan Fernandez. 

" It belongs to this sanitary history to state that at Madeira, St. Catherine's, St. 
Julian, and Juan Fernandez, the foul ships were refitted, cleansed, and purified, and 
that no sanitary precaution seems to have been neglected. Nor were these measures 
ineffectual, for we are told that for some time after leaving Juan Fernandez the 
crews had enjoyed ' a most uninterrupted state of health.' But on leaving the coast 
of Mexico the scurvy again began to show itself, and this time it was not possible to 
attribute it to the stormy and inclement weather, though that which they soon had 
to encounter doubtless added much to their sickness and mortality. At this time 
the crew of the Gloucester was reduced to seventy-seven men and eighteen boys, of 
which number only sixteen men and eleven boys were able to keep the deck, and of 
these several were infirm. The ship had to be burnt, and her crew transferred to 
the Centurion. There were seventy sick among them, of whom ' three to four ' died 
as they were being hoisted on board. And §pon we find that the deaths of the con- 
solidated crews were 'extremely alarming;' that no day passed that they did not 
bury eight, ten, or twelve ; and that ' those who had hitherto continued healthy 
began to fall down again." "When they were able to land on the island of Tinian 
they put on shore 128 sick, many of whom were carried on the backs of the com- 
modore and his officers. On that and the previous day they buried twenty-one men, 
and ten more soon after Anson himself, as we learn, did not escape the scurvy. 



916 HYGIENE. 

" This new attack of scurvy occurred under circumstances so different to the first 
as to puzzle the surgeon and the chaplain. They had fresh provisions in the shape 
of hogs and fowls, they caught fish in abundance, and had an ample supply of fresh 
water ; they kept all their ports open, ' and took uncommon pains in cleansing and 
sweetening the ship.' But no mention is made of vegetables or fruits, and they 
owed their supply of water to rains which must have kept the atmosphere moist, and 
so far unfavourable to them. The crews recovered their health at Tinian, and all 
that now remains of the sanitary history is the simple statement that when Anson 
came to muster the remains of the united crews of the Centurion, the Gloucester, and 
the Tryal, on board his own ship, prior to his attack on the Manilla galleon, he had 
in all only 227 hands, of whom nearly thirty were boys, and twenty-three Lascars 
and Dutchmen, besides other recruits picked up here and there. So that out of the 
original 961 with which Anson left England, the survivors probably fell very far 
short of 200." 

Shortly after this disastrous voyage of Anson's the important discovery was 
made that the occurrence of scurvy depended upon the want of fresh meat and fresh 
vegetables ; and the still more important discovery that these could be substituted 
by so portable and easily procurable a substance as lemon-juice. Lemon-juice has 
now become a necessary part of the commissariat of every ship, and a real bad case 
of scurvy has happily in these latter days come to be regarded as a curiosity. 

The disease par excellence which is liable to break out in times of famine is 
typhus fever, which has also been occasionally spoken of as famine fever. Typhus 
killed its thousands at the time of the Irish famine. It is a noteworthy fact with 
regard to typhus (a disease having nothing in common with typhoid), that it never 
appears except under the circumstances of famine and overcrowding, but when once 
the poison has been engendered in this way it is communicable to all classes, and 
the well-fed and well-to-do fall victims to the disease as readily as others. In 
epidemics of typhus, it has always been observed that doctors, ministers of religion, 
and nurses, succumb very readily. There can be no doubt that the disease which 
ravaged the prisons in the days of John Howard, and which, under the name of 
" gaol fever," struck terror into all those whose duties brought them in contact with 
the criminal classes, was a form of typhus fever which was engendered in the 
prisons by overcrowding, improper dietaries, and general neglect of the laws of 
health. 

Dr. Guy, whose work on " Public Health " is one of the most interesting and 
valuable contributions to popular scientific literature which has been made of late 
years, gives an admirable account of the gaol fever, and the labours of one of 
England's greatest heroes — John Howard. 

Quotirg from Sir John Pringle, he gives the following account, which will serve 
as an admirable illustration of what this gaol fever could, at times, effect. " In the 
year 1750, on the 11th of May, the sessions began at the Old Bailey, and continued 
for some days, in which time there were more criminals tried, and a greater mul- 
titude was present in the court than usual. The prisoners, about 100 in number, 
were crowded into two rooms, measuring fourteen feet by eleven, and seven feet 
high, and in the bail- dock (a small corner enclosure open at the top), into which 



FOOD. 917 

were put some who had been under the closest confinement. The court itself was 
about thirty feet square, and into this narrow crowded space the air from the bail- 
dock and the two small rooms found easy access. An open window at the 
farthest end of the room from the bench occasioned a draught in the direction of 
those who were found to have suffered most These were the persons on the bench, 
of whom four were attacked and died — namely, Sir Samuel Pennant, the Lord 
Mayor ; Sir Thomas Abney, and Baron Clarke, judges ; and Sir Daniel Lambert, 
alderman. The other victims were two or three counsels, an under-sheriff, several 
of the Middlesex jury, and others, to the amount of above forty. This list is 
exclusive of persons of a lower rank and of those who did not sicken within a 
fortnight." 

"With these examples of the dangerous state of mal -nutrition into which popula- 
tions may fall if improperly nourished, we now turn to consider some smaller points, 
but of scarcely less importance in domestic circles. To what extent is bad food — 
food, that is, which from some cause or another has deteriorated in quality — capable 
of causing disease 1 It is more difficult than might have been expected to give an 
accurate answer to this question, since evidence on the point is very contradictory. 

Is it safe to eat food in a state of decomposition 1 The lover of game and 
venison would reply to this, that no amount of rottenness interferes either with its 
agreeable qualities or its wholesomeness. Rotten fish is used in some parts of the 
world as a condiment without any evil resulting. It would seem, however, as if 
occasionally, flesh in the early stage of decomposition, before it becomes tainted either 
to nose or taste, is apt to act as a violent irritant upon the stomach. This has 
happened occasionally with pork, and whole families have suffered severely after 
eating pork, against which nothing could be proved, except that it had been kept 
rather longer than usually is the case. Fish sometimes acts as an irritant poison in 
the same way, and so do mussels. This poisoning by mussels has been supposed 
to be due to the fact that the molluscs were taken from the copper bottom of a 
ship, and that really the poisoning element was the copper, and not the flesh of 
the mussel. Perhaps copper-poisoning has occurred in this way, but there can be 
no doubt that the mussels themselves are occasionally very unwholesome. Other 
varieties of shell-fish are not free from similar imputations of proving dangerous to 
the consumer. 

To what extent do the diseases of animals affect the health of men who may 
consume them'? This is a question of great importance, but exact information on 
the point is very hard to obtain. There can be no doubt that much diseased meat 
is from time to time smuggled into the market, and that much is eaten without any 
very obvious effects resulting is also a matter of fair inferenca At the same time 
we should be inclined to give a general caution that it is never safe to eat meat 
which is known to have come from a diseased animal. 

The flesh of cattle and of the pig is apt to be infested with parasites, and if some 
of the parasites find their way into the stomach of man in a living state they are apt 
to produce serious dip comfort, if not death. 

Both pork and beef is apt to be " measly," and in these cases the flesh is studded 
with small round bladder-like bodies which vary in size from points scarcely visible 



918 fitGIEfffc. 



to the naked eye to masses nearly a quarter of an inch in diameter. These bodies are 
called Cysticerci, and if taken alive into the human stomach, grow into tape-worms. 
The tape-worm which is got from measly pork is called the Tcenia solium. That 
which comes from beef is called the Taenia dmcijdanellaia. Tape-worms are not 
dangerous to life, but are very difficult to dislodge, and cause great discomfort and 
prolonged ill-health. 

Another animal which infests the pig is called the Trichina spiralis, and so much 
has been written in popular literature of late years on the subject of trichines, that 
few of our readers will be ignorant of the prominent facts concerning them. 

The trichinae are small worms which are usually found coiled up in a calcareous 
cyst, in the substance of the muscles of animals. The largest of these cysts are 
about one-twenty-fifth of an inch in length, and many of them are much smaller. 
When once the worm becomes encysted its life is very likely to be prolonged, and 
although in this state they remain quiescent, and give perhaps but little trouble 
to the animal which they inhabit, yet if they be taken into the stomach of another 
animal the cyst may be dissolved, and the animal may become again active, and 
increase and multiply to an alarming extent. 

The flesh of an infected animal may be so crowded that many thousands of 
trichinae may exist in a cubic inch. 

One of the first noteworthy epidemics of trichinous disease occurred at 
Heldstadt, in Prussia, in 1863. Of 103 persons who partook of a dinner at an 
hotel, nearly all were attacked with trichinosis (as the disease is called), and very many 
died. The source of the disease in this case proved to be a peculiar kind of sausage, 
of which nearly all had partaken. The trichina is not found only in the pig, but 
affects other animals as well, and the pig in many cases is supposed to have 
contracted the disease by foul feeding on the flesh of smaller animals. The trichina 
is killed by a boiling temperature, and it is only those who eat raw or under-done 
pig's flesh who are liable to become infested. The custom of eating raw ham and 
raw sausages, which have only been partially smoked, is very common in Germany, 
and hence it is that this disease has been better known in Germany than in this 
country. "It is of interest to know," says Professor Austin Flint, " somewhat of 
the chances that the pork used for food may be trichinous. A committee of the 
Chicago Academy of Science, appointed to make examinations with reference to this 
point, reports that of 1,394 hogs examined in different packing houses and butchers' 
shops in Chicago trichinae were found in twenty-eight. It was therefore estimated 
that of the hogs brought to the Chicago market one in fifty is aflected by trichiniasis 
in a greater or less degree. In this report it is stated that in the city of Brunswick, 
Germany, of 19,747 hogs examined, only two were found to contain trichinae. " The 
trichinous meat being swallowed by the victim, the capsules of the worms are 
destroyed, and the liberated animals increase and multiply in the intestines at an 
alarming rate, so that it has been estimated that the trichinae contained in half a 
pound of meat may be sufficient to give rise to 30,000,000 trichinae in a few days. 
This enormous litter of new-born trichinae at once begins to bore through the wall 
of the intestine, to take up their abode in the muscles. During this period the 
symptoms are those of gastric and intestinal irritation, accompanied by stomach 



FOOD. 919 

pains and diarrheea. As soon as the muscles are reached, the symptoms change 
to those of muscular rheumatism, accompanied by a good deal of constitutional 
disturbance. The best treatment of the disease is probably active purgation in 
the early stage, but when once the muscles are reached no remedy is known which 
possesses any power to dislodge them. 

The statement has several times been rather loosely made that animals fed on 
sewage farms are unwholesome for food. We wish very distinctly to state that 
there is no foundation whatever for such an assertion, and that if sewage farms be 
properly managed, with due regard to scientific and cleanly considerations, the meat 
grown upon them is not only of remarkably fine quality, but perfectly wholesome. 

Milk has, unhappily, been the means of spreading disease upon several occasions 
of late years. It must be remembered, however, that pure milk, if fresh, is very 
rarely unwholesome, and that the instances of typhoid fever and scarlet fever being 
disseminated by milk have been in every instance directly traced to the adulteration 
of the milk with water. The water was the poisonous element in all these cases, 
and not the milk. The celebrated " milk epidemic," which occurred in the parish of 
St. Marylebone in the year 1874 maybe taken as a sample of all " milk epidemics," 
of which several have now been recorded. Several persons, numbering upwards of 
100, were seized at or about the same time, within a few weeks, with typhoid fever 
It was highly probable that there was some common cause, and the health officers 
and others set themselves to work to discover what that cause was. The cases were 
scattered through the parishes of St. Marylebone and St. George ; and it was a note- 
worthy fact that people suffered who were supplied with water from different sources. 
The drainage was above suspicion, and the houses attacked were chiefly the houses 
of the wealthy or the well-to-do persons. The only thing in common between 
the houses was the *sources~of their milk supply, and it was found that these 
scattered families all obtained their supply of milk from the same dairy. It 
was noted also that the denizens of the nurseries and those who were most 
dependent on milk as an article of diet suffered most in this epidemic. There 
were some cases which apparently^ first did not admit of any explanation on the 
milk theory, but most of these, on careful inquiry, were found to yield confirmatory 
evidence of an extraordinary kind. Thus, in one household which was not supplied 
by the dairy implicated two servant-maids were attacked, and the fact was elicited that 
they had, on one afternoon, actually stopped at the shop of the dairy and purchased 
a glass of milk, which they drank. Now, this dairy obtained its supply of milk from 
several farms, and these farms were subjected to minute inspection. All save one 
were beyond suspicion as to their sanitaiy arrangements, but at this one there had 
been cases of typhoid fever, and on careful investigation it was found that the well 
from which the water was taken to cleanse the milk-pails, if not to adulterate the 
milk, had, by the leakage of a drain, become actually impregnated with the excreta 
of the person who had suffered from typhoid fever. This farm was situated at a 
distance of fifty miles from London, and thus we are confronted with the fact of an 
epidemic of an alarming nature, affecting an urban population, being caused by faulty 
arrangements on a farm in a comparatively remote district of the country. 

The vegetable foods do not seem so liable to cause widespread attacks of disease aa 



020 fiYGIENB. 



do the animal foods. Vegetables, of course, may be unwholesome from decom- 
position, and various vegetable articles of diet may be unwholesome from 
adulteration, but it does not behove us in this place to enter into details on such 
questions. It is true that epidemics of cerebro-spinal fever have been attributed to 
the " mouldiness " of the corn upon which the stricken populations have been 
nourished, but such assertions are very devoid of anything like foundation. 

Rye seems, at present, to be the only grain which is liable to recognised disease 
which is likely to prove, and indeed has proved, disastrous to those who have consumed 
it in its diseased state. Rye is liable to be attacked by a fungus, which, commencing 
in the pistil of the grass, grows gradually, and ultimately by its size overshadows the 
normal grass. This fungus growth is called ergot, and at times the growth of ergot 
in the rye has become excessive. Dr. Wood of Philadelphia says : — " Since the days 
of Galen, there have swept over larger or smaller districts of Europe epidemics of 
diseases which have been attributed to ergot When the summer is wet and cold, 
the rye becomes very extensively ergotised, so that the fungus constitutes a large 
proportion of the material entering into the bread. It is under these circumstances 
that there occurs those epidemics of ergotism or chronic ergotic poisoning, which have 
been recorded from time to time since the days of Galen and of Caesar. Jt is not 
always the rye which causes these frightful losses of life, as Hensinger has traced one 
epidemic to diseased oats." 

The usual effect of consuming ergotised rye is the occurrence of mortification or 
gangrene of the extremities of the body, and this gangrenous ergotism has been 
especially observed in France, and is believed to be the same as the Ignis sacer or the 
Ignis Sancti Antonii of the Middle Ages, an affection which, in a.d. 922, killed 40,000 
persons in South-western France; and in A.D. 1128-29, 14,000 in Paris alone. 

There is another form of ergotism in which the symptoms consist chiefly of violent 
spasmodic contraction of the muscles of the body. 

Beverages. — In our remarks on " Food " we have hitherto confined ourselves 
almost exclusively to solid food, and have said nothing about the no less important 
fluids which we find it necessary to take. To the important subject of " Water" in 
all its relations to health, we purpose devoting a separate chapter, and in the present 
section we shall deal with beverages exclusive of water, which, nevertheless, is, of 
course, the foundation of all beverages. 

In the first place we shall be expected to give some expression of opinion on 
that much debated point — the value of alcohol as an article of diet. This is a 
question which requires to be considered with philosophic calmness, and no amount 
of assertion or counter-assertion, unbacked by solid facts, is capable of settling — as 
some of our temperance advocates seem, by their acts, to think — this much vexed 
question. 

As many people are in the habit of talking of " alcohol " without really knowing 
what they are talking about, it will be advisable to begin with some facts with 
regard to the sources of origin of this body. Alcohol is obtained chiefly from sugar 
and bodies containing sugar (such as grapes), by the process known as fermentation. 
Fermentation may be looked upon as a " natural " process, since the bodies which 
cause it are ever present in the air, and it is supposed that these bodies, or germs, 



FOOD. 



921 



falling into the fermentible liquid set up that action which has as its result the 
development of alcohol. Grape-juice, exposed to the air in a suitable vessel, speedily 
begins to ferment, and in process of time becomes wine. This fact must have been 
discovered at a very early period of the world's history, since the oldest writings 
make mention not only of " wine that maketh glad the heart of man," but also of its 
opposite effect of drunkenness. 

All wines and naturally fermented liquids contain alcohol only in comparatively 
small quantities. If it be desired to separate the alcohol from the wine, it is necessary 
to resort to the artificial process of distillation, and in this way a stronger solution of 
alcohol, called " spirits of wine," is obtained. Spirits of wine, obtained by simple dis- 
tillation, is a combination of alcohol and water, and the obtaining of the pure alcohol 
from the spirit is a difficult matter requiring very careful chemical manipulation. 
Pure alcohol, absolute alcohol, as it is called, is a rare article, but alcohol in its 
diluted form of spirits of wine is well known Spirits of wine is a light fluid, of 
less specific gravity than water, on the top of which, if gently poured, it floats. If 
stirred about it readily mixes with water in all proportions. It has a slightly pun. 
gent odour, and if poured upon the back of the hand, it rapidly evaporates, causing 
a sensation of cold. In the mouth it produces a burning sensation, and brought in 
contact with flame it readily takes fire, as all who possess a spirit lamp, or have 
played at " snap-dragon," must be aware. 

This is the " alcohol " then of which we hear so much, and which has proved a 
doubtful blessing to the human raca It is alcohol which endows all fermented 
and distilled liquids with their good and bad properties. Alcohol is contained in 
them in very different amounts, as the following table of percentages will show : — 



Ginger Beer 


. . 




. . 


A trace 




Beer (average sample) 




• . 


6 per cent. 


London Porter .... 




, . 


5-36 


if 


Edinburgh Ale (unbottled) . . • 




. . 


67 


ii 


„ {2 years in bottle) . • 




■ • 


«06 


M 


Port (weakest) .... 




• 


14-97 


N 


„ (strongest) .... 




. 


17-10 


N 


Sherry (weakest) . 




• 


13-98 


» 


,, (mean of 13 wines not long in cask) 




. 


15-37 


W 


„ (strongest) .... 




. 


16-17 


n 


Madeira (long in cask in East Indies) 




• 


1409 


M 


„ (strongest) . 




• 


16-9 


M 


Dry Lisbon . 




. 


16-14 


n 


Marsala (Parkes*) .... 




15 to 25 


■ » 


Bordeaux Wines, Red (mean of 90 determination! 


I 






of different sorts— Chateau Lafitte, Margeaux 








Larose, Barsac, St. Emilion, St. Estephe, 


&c, 








Parkes') .... 




6-85 to 


13 


M 


Bordeaux Wines, White . 






11 — 


18-7 


It 


Rousillon . 






11 — 


16 


M 


Rhone Wines (Hermitage, &c.) 






87 — 


13-7 


1* 


Burgundy, Red (Beaune, Macon) 






73 — 


14-5 


» 


,, White (Chablis, &c.) 






8-9 — 


12 


»» 


Champagnes 






5-8 — 


13 


n 


Moselles .... 






8 — 


13 


n 



922 



HYGIENE. 



Rhine "Wines • • • • . 6*7 to 16 per cent. 

Italian Wines . . • . .14—19 „ 

Brandy . . . . . . 50 — 60 „ 

Gin 49 — 60 „ 

Whisky . . . . . . 50 — 60 „ 

Rum •..-..-.• • • • .60—77 „ 

We have been unable to ascertain the alcoholic strength of some of the more 
fashionable liqueurs, such as chartreuse, curagoa, anisette, &c., but it is certainly 
very high indeed. 

If we wish to ascertain the amount of absolute alcohol which we consume in a 
draught of any of the alcoholic drinks, we can easily do so by means of a rule of 
three sum. 

Thus half a pint of beer contains 10 ounces, and the alcoholic strength of beer is 
5 per cent. — ie. t in every 100 ounces there are 5 of absolute alcohoL Thus — 

As 100 : 6 :: 10 
5 x 10 

= *5, or half an ounce of alcohol. 

100 

Again, a sherry glass equals about 2£ ounces, and therefore in the average 
u 2 glasses of sherry " — 

As 100 : 15-37 :: 6 

15-37 X 5 76-85 

= = -7685 ounces. 

100 100 

Again, take a glass of strong gin (2*5 ounces) — 
As 100 : 60 :: 2-5 
60 X 2-5 

= 1-5 ounces. 

100 

Thus we see that a " glass of gin" (two and a half ounces) is equal in alcoholic 
strength to a pint and a half of beer (thirty ounces), and four glasses of sherry 
(ten ounces). 

Is alcohol a food, and is it in any way serviceable to the human body 1 Now it 
is only fair to assume that anything which is absorbed and disappears when intro- 
duced into the human body is in some way serviceable to it. If it is not used as a 
food it will certainly re-appear in the excretions in the same form in which it was 
introduced. Experiments have been made in this way with alcohol, and all the 
excretions — from bowels, kidneys, skin, and lungs (the breath) — have been carefully 
collected and subjected to the most careful analysis, in order to detect the presence 
of alcohoL 

The result of these experiments tends to prove that when alcohol is given to a 
healthy man (many of these experiments have been conducted on soldiers), a certain 
amount disappears in the body. The body of a healthy man seems capable of appro- 
priating as a maximum about two ounces of alcohol in the day. If more than two 
ounces be given, alcohol begins to appear in the excretions ; it is detected by analysis 
in the urine and by the odour in the breath. It is certainly of great interest to find 
that the results of scientific investigation and practice are in such accord. Two 



food. 923 

ounces of alcohol is the amount contained in one quart of beer of moderate strength, 
and this is about the amount which a man has been allowed by common consent to 
consume in a day without being considered to take too much. It must be borne in 
mind that this two ounces is the maximum allowance for a strong man, and that for 
most of us a much smaller allowance (one ounce or one and a half ounces) would be 
sufficient. 

When considering the question of the dietetic value of alcohol, we must be careful 
to draw a distinction between alcohol and alcoholic drinks, for the latter often contain 
many ingredients of nutrient or dietetic value in addition to the alcohol. In dis- 
cussing the merits of alcoholic drinks, too, it is important to distinguish between 
those which are the result of the natural process of fermentation and those which 
we owe to distillation, a process entirely due to the ingenuity of man. 

The obvious results of alcohol when administered in any form and in moderate 
quantity are : 1. To increase, to a slight extent, the appetite and the digestive 
power. 2. To increase the rapidity and force of the action of the heart 3. It 
perhaps increases the nervous force to a slight extent It certainly gives a feeling 
of comfort, allays terror, and increases the imaginative, if not the other intellectual 
powers of the mind. Given in quantities which are at all excessive, alcohol causes 
first a flushing of the face, which is due to a weakening of the muscular walls of the 
blood-vessels. The odour of alcoholic drink is plainly detectable in the breath, and 
very soon those strong evidences of want of nervous power which we call " drunken- 
ness," are observable. 

The symptoms of drunkenness, be it observed, are all paralytic, and are all due 
to loss of nervous power and of voluntary control. The flushing of the face shows 
the paralysis of the small blood vessels; soon the slipshod utterance shows the 
want of voluntary control over some of the muscles of articulation ; the double 
vision indicates the loss of accommodating power in the eyes ; and the staggering gait 
shows that the loss of control has extended to the larger muscles ; lastly, the 
drunkard falls prostrate in a condition so closely resembling apoplexy that the 
most experienced occasionally fail rightly to distinguish the one from the other. 
If the intemperate use of alcohol be persisted in, there soon results a degeneration 
of all the tissues of the body. The nervous tissues are, perhaps, the first to suffer, 
and the shaking hand and tottering gait are infallibly followed by a similar tottering 
of the intellectual and moral faculties. The stomach resents the constant intro- 
duction into it of ardent spirits, and soon refuses properly to digest food. The 
liver and kidneys give out in a similar way, and the impairment of their functions 
causes terrible dropsy. The heart gets fatty and weak, the lungs lose their fresh 
elasticity, and soon there is not a tissue in the body which has not in one way or 
another succumbed to the ill-treatment to which it has been subjected. 

The first sign, be it observed, of having taken too much alcohol is the flushing of 
the face, and as soon as a man becomes " flushed with wine " he has had too much. 

There are two conditions which undoubtedly aggravate the evils of intemperance. 
One is the taking of alcohol in too concentrated a form — in the form, that is, of 
" neat spirits," or even the fortified ports and sherries. We believe spirits to be an 
unmitigated curse to the world, and we do not believe that their administration is 



924 



HYGIENE. 



ever justifiable, except in case of sickness. In disease it is sometimes necessary 
(but not often) to give considerable doses of alcohol in small bulk, and then spirits 
are of use. 

The other aggravating condition is the taking of alcohol on an empty stomach. 
As a rule, no alcoholic drink should be taken except with food. We feel sure that 
more harm is done by " nipping," as it is called, with glasses of sherry between 
meals, than by any other form of intemperance. If alcohol were always taken in 
a diluted and natural form, and with food, comparatively little harm would result 
from its employment. The " nightcap " of hot spirits and water at bed-time is a 
common cause of morning cough, sickness, and inability to eat breakfast. 

We have shown with tolerable conclusiveness that the excessive use of alcohol 
works unmitigated harm, and that its moderate use does not, as far as can be shown, 
work any harm at all. The more important question, however, is this, Is alcohol 
necessary, and are we the better for taking it 1 

There is no doubt whatever that for a man who is leading a typically healthy 
life, who has no disease, who is well fed and well housed, and who enjoys plenty of 
fresh air and ■ exercise, alcohol is not necessary j and it has been proved again and 
again that " total abstainers " are capable of as much physical exertion either in 
the harvest-field or during a campaign as are those who make a moderate use of 
alcohol. 

Much use has been made of alcohol by men who happen to be " living under 
exceptional circumstances," such as great heat or great cold. It has been con- 
clusively proved, however, that such a use of alcohol is founded on error, and 
observations made on soldiers and sailors have shown that tropical heat and arctic 
cold are withstood by the total abstainer more easily than by the moderate drinker. 
The most common excuse for spirits, perhaps, is "to keep out the cold,''' but it has been 
proved again and again that one of the most certain effects of alcohol is the lowering 
of the temperature of the body, and that instead of enabling the body to ivithstand 
cold it, on the contrary, lays it open to its attacks. We must not forget that there 
are entire races of men who abstain absolutely from alcoholic drink, and if we 
turn to consider what effect this total abstinence has had, for example, on the 
Mahomedan population of the world, we are forced to admit that at one time or 
another of the world's history they have shown themselves unsurpassed in literature, 
in science, in art and in war; and, if the Mahomedans do not, perhaps, hold the 
same preponderating position that they formerly did, no one would think of 
attributing their decadence to the fact of their making no dietetic use of alcohol. 

It seems to us, however, hardly fair to try and make facts which are very 
partial in their distribution of universal application. The Mahomedans and 
Hindoos inhabit, for the most part, the tropical and sub-tropical regions of the 
earth, and their modes of life from this cause, if from no other, would not probably 
be suitable for our co 1 1 northern climate. Again, take many articles of diet in 
common use among us, and try to determine by accurate experiment whether or no 
they were a necessity. The task would prove very difficult Condiments of all 
kinds, perhaps, cannot be considered as necessary for a healthy man. " Hunger is 
the best sauce," and a healthy appetite will despise the cruet-stand, but yet there u 



food. 925 



little doubt that for the majority of us, who are very far from the natural state of 
crude health, the addition of a little pepper, or mustard, or horse-radish, enables us 
to eat with a relish that which our bodies cannot do without, but for which our lack 
of exercise and fresh air had left us no appetite. The same remark might be made 
about tea or coffee, and about many other things which we consume and enjoy, and 
which do no harm to most of us. 

If tea, coffee, pepper, or mustard are not necessary for us why do they grow ] 
The answer might be given that although they are not absolutely necessary in a state 
of crude health, yet we are most of us the better for taking them in moderation — 
that they constitute, as it were, varieties of dietetic medicine, that their use has 
become a " second nature," and that the human race, living as it does under conditions 
which are intensely artificial, is the better for their moderate employment. 

We cannot shut our eyes to the fact that a majority of civilised mankind, in- 
habiting temperate and northern climates, hold to the opinion that fermented drinks 
are dietetically useful. The writer of the present article certainly holds that 
opinion, and he has no doubt of the value to most persons of a small quantity of 
wine or beer taken at meal-tima We must ail have noticed that our appetite for 
alcoholic stimulants varies immensely. At one time we are content to quench our 
thirst with simple water, and at another we feel something like a craving for alcoholic 
or other stimulants. There is little doubt, we think, that this craving for alcohol 
is brought about by unwholesome modes of living. Certain it is that the notably 
drunken classes are such as live unwholesome lives, and follow unwholesome occupa- 
tions. The hair-dresser, the tailor, and the shoe-maker, following a monotonous 
employment in a close, foul atmosphere, are noted for their drunken habits ; and 
those whose lives are spent in pleasanter places, amidst a variety of scenes, and in 
the fresh air, should rather pity than blame those who are unconsciously driven to 
seek a delusive compensation for the depressing influences by which they are 
surrounded. If we were asked to mention the one thing which induces a craving 
for alcohol in most of us, we should say " faulty ventilation." Ill-ventilated theatres 
and ball-rooms, and close offices and workshops, are, we doubt not, directly answer- 
able for much alcoholic excess It is one of the writer's duties to see hospital out- 
patients, and he has often remarked that the one thing which begets in him a 
longing for alcoholic drink, or for tea, is the sitting for two or three hours at this 
work, in a small room crowded with patients and others, and reeking with 
organic effluvia. Much of the drunkenness of society has disappeared before the 
superior education to which the present generation has access. The cultivation oi 
the mind endows a man with moral control, and leads him to appreciate his intellec- 
tual faculties too much to allow himself to get fuddled. The " three-bottle " man 
is happily a thing of the past, and drunkenness effectually excludes a man from any- 
thing like decent society. We have every hope that education will have a like effect 
upon the lower classes. We trust also that the efforts now being made to provide 
the poor with wholesome dwellings will diminish their temptation to seek refuge in 
the comparative comfort of the public-house. 

Wine, as we hinted above, contains many constituents in addition to alcohoL 
Wine is a most complex body, and difficult to analyse, and no analysis gives ua ft 



926 HYGIENE. 



proper notion of the value of the wine, which can only be judged of by experienced 
persons. Besides alcohol (which varies from live to twenty -five per cent.), we find 
ether (which imparts to the wine its bouquet, or odour), sugar (varying from nothing 
in wines of the Bordeaux class to as much as sixty grains in the ounce in some of 
the Madeiras), colouring matter, astringent matter, extractive matter, free acid (chiefly 
due to tartaric acid, and acid tartrate of potash, or cream of tartar), and salts. 

The free acid and the salts in wine add, there can be no doubt, immensely to 
its dietetic value, and the fact is generally admitted that wine is a valuable anti- 
scorbutic. 

Of all the wines of France, claret is most familiar to dwellers beyond the seas, 
as none other is so largely exported. The grape from which it is produced is 
grown in the department of Gironde, a part of ancient Gascony, which stands 
pre-eminent for the quality, the variety, and the quantity of its produce, making 
it the most important from a commercial point of view. For the extent of its 
vineyards^ and for the excellence of its wine, the district of Medoc is the most 
valuable of any in the Gironde. The term claret is applied to the various growths 
of Medoc and the Bordelais. 

Dr. Druitt, in his " Report on Cheap Wines," gives a few simple directions 
which may help a man to use his senses, and his own judgment when called upon to 
taste wine and form an opinion of its value. The points which a good wine should 
have are — 

1. Unity of taste. The wine should have a taste of its own, and not strike us 
as being a compound of many liquids. 

2. Alcoholicity and generosity of taste. A wine should not be fiery, hot, and 
stinging, but should impart a gentle feeling of warmth only. 

3. Good wholesome wine should have a slight detectable sourness, which, how- 
ever, must not be excessive. Only practice will enable one to distinguish between 
natural sourness and the sourness of acid fermentation, but there is the same 
difference between them that there is between the acidity of a ripe grape and 
the acidity of vinegar. 

4. Many wines are sweet. 

5. Wine must have stability, and be free from that mawkish, sickly taste 
which indicates a tendency to ferment. 

6. Most red wines have a certain amount of roughness, or astringency. 

7. A wine should have body, i.e., should hold many things besides alcohol 
in solution. The fullest-bodied wines are the madeiras, the thinnest are the 
clarets. 

8. No wine is perfect without bouquet, or odour, but the bouquet must be 
truly vinous in character, and not the odour of pomade. Bouquet is very easily 
imparted to wine, and when we find the bouquet excessive (as is some moselles) 
we should doubt its genuineness. 

9. Another much-prized (by some) quality of wine is softness. Softness means 
absence of roughness and astringency, and indicates that the wine has been carefully 
made, and that time has been given for the deposit of some of the contained salts. 
Softness is imparted to wine by adding solutions of isinglass (gelatin), which 



food. 927 

combines with the astringent tannic acid and falls to the bottom as an insoluble 
deposit. The deposit of a very thick crust in a wine-bottle may be taken to indicate 
that the process of fermentation has been rapid, or has probably been checked by 
the addition of spirit. Such wines possess great body and fruitiness, but require 
keeping for very long periods in order that they may mature. 

The longer a wine is kept in cask the stronger it becomes, because the wood of 
the cask absorbs the watery constituents more readily than the alcoholic. 

The red colour and the roughness of wine is imparted to it by adding the skins 
(of red grapes) and the stalks to the fermenting vat. The best wines are made from 
the juice of the grapes only. If the reader will only cast his eyes over the analysis 
we have made above of the qualities of wine, it will be evident to him that nearly 
every one of them — alcoholicity, acidity, sweetness, roughness, colour, bouquet, 
astringency, and smoothness — can be imparted by artificial means, and there is too 
much reason to suppose that artificial means are abundantly resorted to, and that in 
this country a glass of really genuine wine is an extremely rare article. The 
inhabitants of northern climates who make no wine of their own, and who never in their 
lives perhaps taste any wine which they, of their own knowledge, know to be genuine, 
have no means of educating their palate, and no access to standard wines of known 
genuine qualities. Kefinement of taste is got by cultivation just as an appreciation 
for good sculpture or good music is got. One might, on a priori considerations, be 
certain that the tastes for wines in climates like ours would probably be debased, 
and coarse, and that it is debased and coarse, except among the few who by travel have 
been enabled to educate the palate, is a fact beyond the possibility of contradiction. 

Among us, almost anything will pass for wine, provided it be sufficiently 
advertised and puffed. It is an acknowledged fact that a large proportion of the 
"sherry" which finds its way into this country or in England has been manufactured 
at Hamburg or Cette ; the foundation of it is spirits of wine, the accessories vary 
according to the demand for rich brown or pale dry sherries. There is often 
no grape-juice in it. 

Dr. Druitt in his "Keport on Cheap Wines," says, " The following statement may 
be relied on as an account of the composition of port wine of the first quality. It 
wag given to me by one who has a better right to know than most men." 

Compositions of Port Wine of First Quality. 
To the Pipe of half -fermented must is added, to check fermentation :«— » 
25 Gallons of brandy. 
Say 5 Gallons of elderberry juice to colony. 
„ 6 |, more of brandy. 

„ 2 „ after racking. 

„ 1 „ on shipment. 

39 Gallons. 

76 „ of wine. 



115 Gallons = 1 Pipe. 

In "Handbook on Wines " Mr. Thomas McMullen says:— " Of all articles of 

commerce there is none that offers a wider field for the most extensive and pernicious 
frauds than wine. By adulterations of wine is not to be understood the mixture 



928 HYGIENE 



of two genuine growths for the sake of improvement, but, in the first place, a 
clandestine amalgamation of an inferior kind of wine with one which is superior , 
and secondly, what may be denominated with more propriety the product of 
fictitious operations passed off as genuine growths, having little or no grape juice 
in its composition. 

" In the vile mixtures which constitute the inferior grades of all strong wines, 
the brandy and sweetness is the great mark for concealing its quality and base 
ingredient. The truth is, that brandy renders bad wine potable. 

" Almost all descriptions of wine are adulterated or imitated. The ignorance of 
most persons of the true taste of champagne has caused large importations of a 
wretched and cheap manufacture from France, which is sold for the genuine article, 
and also quantities of a fictitious wine under the same name are made of common 
ingredients and brought into consumption. 

il Really good champagne cannot be purchased at Rheims for less than three to 
four francs the bottle, yet large quantities bearing this denomination are sold in 
this country, duty and all charges paid, for less than one- half the money. 

One thing seems evident, and it is this, that a reasonable price must be paid for 
articles imported from distant countries, and especially for articles which are yielded 
in varying amounts, and which require a period of some years (at least two or 
three) to come to a wholesome maturity, and which during this period demand 
unremitting and skilled attention. 

Many a connoisseur n cognises this fact, but he also recognises a fact no less 
true, and it is this, that he may give a high price and still not get a good article. 

It is a veiy difficult thing to give the purchaser any sufficient guarantee that 
when he buys wine he is really buying the juice of the grape. The composition is 
so complex that chemical analysis is of no avail, and although the Adulteration Act 
has proved a great boon in ensuring the genuine quality of most articles of food, it 
has not been and is not likely to be of any service in the matter of wina 

"We might at least, however, have some guarantee that wine is the produce of a 
certain district and a certain country ; and it is much to be regretted that wine- 
growers do not seek to protect their interests by trade-marks and labels. At present 
it is only necessary to give a wine some absurd name, which is no indication of its 
source or origin, and to advertise it sufficiently with the aid of medical opinions and 
analysis, to be sure of a large sale and a proportionate profit. The gullible public 
continue to buy, without considering that a wine which year after year continues to 
be sold at the same price, and is always of absolutely uniform composition, can hardly 
have been produced in a country where the products of the vineyards are variable 
both in quality and quantity, where one year the grapes 

"In Bacchanal profusion reel to earth,'' 

and the next are few and shrivelled, starved by drought or consumed by parasitic 
fungi. 

Beer will soon be considered the natural drink of this country, and there is 
no doubt that when it is well brew^ed and not too strong it is a very wholesome 
beverage, 



food. 929 

It is a remarkable fact that the knowledge of brewing seems almost as old as the 
knowledge of the fermentation of grape-jnice. The writer of the article " Brewing/' 
in the " Encyclopaedia Brittanica," gives some very interesting information on the 
antiquity of this art. The Egyptians, the Greeks, and the Romans, all manufactured 
a barley wine, which is mentioned by iEschylus, Pliny, and other writers. Tacitus 
mentions the beer-drinking habits of the Germans. The Kaffirs have made a beer 
from millet seed from time immemorial, and it appears that the inhabitants of Nubia, 
Abyssinia, China, and Russia, have had a knowledge, for many centuries, of the art of 
brewing. Brewing is a very ancient art in this country, and as early as the thirteenth 
century Burton-on-Trent became famous because of its water being so well adapted 
for brewing purposes. 

" Mary, Queen of Scots, in the midst of her troubles, seems not to have been 
altogether insensible to the attractions of English beer, for when she was confined at 
Tutbury Castle, Walsingham, her secretary asked — * At what place near Tutbury 
beer may be procured for her Majestie's use ? ' to which Sir Ealph Sadler, governor 
of the castle, made reply — * Beer may be had at Burton, three miles off.' " 

Beer contains many important ingredients besides alcohol. The composition of 
a pint (20 oz.) of beer is, according to Dr. Parkes, as follows (in addition to water) : — 

Alcohol 1 ounce. 

Extractives, dextrin, sugar 1*2 ounce. 

Free acid 25 grains. 

Salts 13 grains. 

The effect of the alcohol of beer we have already discussed The extractives, 
dextrin, and sugar are present, it will be seen, in very large proportion, and these 
constitute the fattening qualities of beer. That beer is in the highest degree a 
fattening beverage is evident to any one who will inspect the staff of a brewery. The 
free acid and salts also probably give to beer some degree of anti-scorbutic power. 
Beer has undoubtedly some degree of nourishing power, and has more right to be 
regarded as a food than other alcoholic drinks. Beer varies immensely in quality. 
Old college ale, or audit ale, made as strong as a lavish use of malt will allow, has 
such a high degree of alcoholic strength, that it readily burns and flares up when 
thrown upon the fira At the opposite end of the scale eome the very light beers 
of Vienna and Munich, the alcoholic strength of which is so slight that they may be 
said to have no intoxicating power. The following table of alcoholic strength of 

different beers is taken from Dr. Pavy's work on food : — 

Alcohol FreM&t. 

Barclay and Perkins' London Porter . , , , , 6*4 

London Porter (average) . . . , . • • . 4 '2 

Burton Ale ...••••••• 6*9 

Scotch Ale (Edinburgh) 8*6 

London Small Beer ........ 1*28 

Beer, if too strong, or if taken in too large a quantity is a very " heavy n 
beverage, and causes a great tendency to sleep, as the brewer's carmen dozing on 
their drays bear witness. There is no doubt that the inordinate beer-drinker tends 
to become lazy and " fat-headed," as well as corpulent in body. 

The light bitter beers are very valuable drinks, and tend, in small quantities, to 
59 



930 



HYGIENE. 



increase the appetite and help digestion. Good bitter beer is to be had in plenty in 
England, and it is undoubtedly a far more wholesome beverage than " much- 
advertised " wine of doubtful composition. One of the most wholesome and pleasant 
of the bitter beers is that made at Pilsen in Bohemia. It is light, fragrant, and 
agreeable. 

The adulterations of beer are very numerous, and although the excise only 
permits the use of malt, sugar, and hops for brewing, the retailer of beer often seeks 
to increase his profit by adding various articles. The beer is first watered, and then 
various things are added to give this weakened beer the semblance of body, strength, 
or bitterness, 
beer : — 



The following is a list of deleterious articles said to be added to 



Cocculus Indicus. 
Common salt. 
Copperas. 
Opium. 



Indian hemp. 
Strychnine. 
Tobacco. 
Darnel seed. 



Extract of logwood. 
Salts of zinc or lead. 
Alum. 



Beer which has been tampered with is never good, and the " freshness " which is 
the result of the fermentative process, and which is destroyed by adding water, 
cannot be restored again. Owing to the stringency of the licensing laws it is 
doubtful whether the adulteration of beer is so extensively practised as formerly was 
the case. 

Cider and Perry are fermented liquors made from the juice of apples and pears. 
They are very wholesome, and those who drink them are said not to have the gout. 
They contain about 7 per cent, of alcohol, and have considerable anti-scorbutic 
power. It is said that they are much employed as a foundation for cheap factitious 
wines. 

The juice of all sweet fruits is capable of being fermented, and " wine " has 
been and is often made from gooseberries, currants, rhubarb, parsnips, and other 
succulent fruits and vegetables. It is, we think, to be regretted that more attention 
has not been paid to the fermentation of the expressed juice of fruits other than the 
grape. 

Non-alcoholic beverages. — It is a remarkable fact that most of the races on the 
face of the globe make use of a non-alcoholic beverage, to the employment of which 
they have been guided, as it were, by instinct. Tea, coffee, and cocoa are consumed 
by millions of people daily, and chemical analysis has shown that the active 
principle of these three bodies is chemically the same, although they were at first 
distinguished by the three names of theine (the active principle of tea) caffeine 
(coffee) and theobromine (cocoa). 

The composition of tea is (according to Mulder) as follows : — 



Essential oil 
Chlorophyll 
Wax 
Resin 

Gum • 
Tannin • 
Theine • 



lack Tea. 


Green Tea. 


006 . 


0-79 


1-84 . 


2-22 


000 . 


0*28 


3-64 . 


2-22 


7*28 . 


8-68 


12-88 . 


17*80 


046 . , 


. 043 



Black Tea. 


Green Tea. 


21-36 . 


22-8 


19-19 . 


. 23-60 


2*8 . 


30 


28-32 . 


17-08 


5-24 . 


5 56 



FOOD. 931 



Extractive matter 

Colouring substance. 

Albumen . 

Fibre 

Ash 

In the infusion of tea which we drink are dissolved certain proportions of the 
gum, the theine, and the tannin. The tannin is one of the distinctive ingredients of 
tea ; and if the tea be boiled, or if the water be allowed to remain too long on the 
tea-leaves, it becomes bitter, astringent, and unwholesome, from the large quantity of 
tannin which is taken up. 

The way to make tea is as follows : — 

Warm the tea-pot, either by putting it near the fire or by pouring some boiling 
water into it. If this be not done the infusion of tea cools too quickly, and fails to 
extract a due amount of the soluble ingredients of the tea. Take fresh spring water 
and boil it, and the instant that it boils pour the boiling water over the tea placed in 
the warm tea-pot. We are informed that professional tea-tasters are very particular 
to use only water which is freshly boiled. It is too often the custom to fill up the 
pot from the kitchen kettle which has been boiling all day, and from which all the 
carbonic acid has been expelled. Flat water of this kind does not make good tea. 
Let the tea stand iorfive minutes, and then pour the infusion off the exhausted 
leaves. If the tea is to be consumed immediately, it may be poured out into the tea- 
cups ; but if it is to be kept hot for a long time, it must be poured into another 
vessel, and on no account be allowed to stand (covered with a " cozy ") upon the 
leaves. Such a proceeding makes the tea bitter and astringent. The water with 
which tea is made should not be very hard, and must on no account contain iron. 
The infusion of tea may be made of any strength, and the hap-hazard rule of the 
American housewife has been to put into the infusing pot " a tea-spoonful for each 
consumer and one for the pot." This habit of infusing tea by the " spoonful" must 
cause the strength of the infusion to vary immensely, since some teas are, weight for 
weight, far more bulky than others. The space occupied by tea depends mainly on 
the tightness with which it has been rolled. Dr. Edward Smith has made exact 
experiment on this point, and has furnished the following table : — 

Black Teas. 

Weight of a moderate- Number of such 
sized caddy-spoonf uL spoonfuls to the \b. 
Grains. 
Oolong ....... 39 ... 179 

Congou, inferior . • • • • .52. . .138 

Flowery Pekoe 62 ... 113 

Souchong 70 ... 100 

Congou, fine ...... 87 • • • 80 

Green Teas. 

Hyson Skin 53 ... 120 

Twankay 70 ... 100 

Hyson . 66 ... 106 

Fine Imperial 90 . . .77 

Scented Caper .»•••• 103 ... 68 
Fine Gunpowder ...... 123 ... 67 



932 



HYGIENE. 



Hence a given bulk of Gunpowder will be more than three times heavier than 
the same of Oolong, and twice as heavy as Flowery Pekoe. 

It would of course be more exact to make tea by weight, and when tea is mads 
in large bulk this ought always to be done. 

Coffee in its unroasted state has the following composition: — 



O&fieine . . . 


• • a 


•* 


Legumine . . «, , 


* • « 


13-S 


Gum and Sugar « # , 


► • ,• * 


166 


Tannin . . • , 


► * • i 


«*• 


Fat and volatile oil . 


► • • « 


130 


Woody fibre • • , 


► ♦ • < 


S4-S 


Aah . . 


• • « 


6*0 


Water . 


■:'■•'•• 


120 



The composition of coffee has a general similarity to that of tea, but it contain* 
more gum and sugar, and very much less tannic acid. 

The infusion of coffee is always made from the roasted berry. In the process 
of roasting some of the water is driven off, the berry swells and becomes lighter 
(to the extent of 25 per cent), the sugar is turned into caramel (the peculiar principle 
of " burnt sugar ") and the peculiar aroma of coffee is developed. This aroma 
constitutes one of the chief qualities of coffee, and is that to which the beverage 
owes its pleasantness. As soon as roasted the coffee begins to lose its aromatic 
qualities, and if coffee is to be really good it must be fresh roasted The habit which 
we have sometimes, of buying coffee not only roasted but often ground as well, is 
simply barbarous, since it is well known that coffee in such a state cannot retain 
its qualities for many hours. Roasting coffee is a perfectly simple process, and 
throughout the Continent there is not a peasant woman who is not perfectly capable 
of roasting her own coffee. Coffee is roasted in a cylindrical metal box, which is kept 
constantly revolving, in order that all the berries may be properly exposed to the 
action of the fire. The process of roasting should be continued until the well-known 
aroma is developed, and the coffee is of a chestnut colour. Care must be taken not 
to burn it Coffee should not be ground until it is actually required for use. The 
coffee should be placed in a suitable vessel on the hob, in order that the coffee and 
the vessel may both get thoroughly warmed. Boiling water should then be poured 
upon the coffee, and allowed to stand for ten minutes. The infused coffee may 
then be poured off the grounds, and is ready for use. Coffee must on no account 
be boiled, or else the characteristic aroma will be dissipated. 

Dr. Parkes recommends that the grounds left from an infusion should not be 
thrown away but that they should be kept until the next infusion is made, when 
the water required should first be boiled upon the old grounds and then poured upon 
the fresh coffee. In this way we extract from the coffee all that can be got by 
boiling, and at the same time get the aroma and pleasant qualities of the fresh coffee. 
Since coffee is not so rich in tannic acid as tea it does not become unpleasantly 
astringent and unwholesome by boiling, and Dr. Parkes's method strikes us as a 
most admirable one. 

Tea and coffee can hardly be regarded as foods. The amount of nutrient 



peoD. 933 

matter in an infusion of tea is almost nil, but perhaps "coffee" may contain a 
little more. Their chiof use is as a refreshing drink, and the service they render to 
mankind in this respect is enormous. They are powerful stimulants to the nervous 
system. If taken in too large a quantity they cause great wakefulness and 
considerable mental excitement, and even tremor of the hands. A cup of strong tea 
or coffee seems to cause an exaltation of the intellectual faculties, and a clearness of 
understanding which is most pleasurable. At the same time there is an inability to 
sleep, and he who habitually takes tea or coffee for the sake of driving himself 
towards the performance of abnormal intellectual work will undoubtedly suffer for 
it in the end by loss of nervous power. Tea and coffee are supposed to prevent 
waste of tissue, but of this there is really very little evidence. . Coffee is largely used 
abroad as an aid to digestion, and is taken immediately after dinner. 

There is no doubt that the habit of 'taking these nervine stimulants — tea and 
coffee — is one which grows on the practiser, and is as difficult to break through as 
the habit of smoking, or indulgence in alcoholic drinks. That a certain number of 
people damage themselves by over-indulgence in tea and coffee we have no doubt, but 
we also have no doubt that the good effected by these articles is out of all proportion 
to the harm, which is only quite exceptional 

The habit which obtains amongst the poor of drinking tea made by boiling the 
worst samples is utterly bad. The " tea " is, when made in this way, little more than 
a solution of tannic acid, and its consumption causes constipation and indigestion. 

Cocoa, the only other body besides the two we have discussed which is used in 
this country for furnishing a non-alcoholic beverage, must be placed in a very 
different category to tea and coffee, as the subjoined analysis will show. 

Composition op Cocoa (Payen). 

Cacao butter • • 4$ 

Nitrogenous matter ...••••••21 

Theobromine ...••••••• 4 

Starch with traces of lugar •••••••11 

Cellulose ....••••••. 3 

Mineral matter .*•••••••. 3 

Water 10 

100 
It has, to a slight extent, the stimulating power of tea and coffee, but its great 
value is, as a food, as the large amount of fat, starch, and nitrogenous matter must 
make evident. 

In the appendix to " The Personal Care of Health," Dr. Parkes gives a few sani- 
tary hints for working men, and we cannot refrain from giving in full his hints 
on the important subject of " drinks." 

" If you wish to keep good health to old age, never touch spirits, and only drink 
one pint or a pint and a half of strong beer or two pints of weak beer with your 
dinner and supper. Better still if you can abstain from beer altogether, and spend 
the money in more food and better clothing. It is astonishing how much may b© 
done with the money spent in beer. Instead of beer, there are various agreeable 
drinks. If a little rice is washed in cold water, and then is boiled in a good deal of 



934 HYGIENE. 



water, the fluid, if a little sugar is added, is a pleasant and nutritious drink. It is 
muck used in India by our men. In winter, it may be taken warm, in summer 
cold ; and in summer, if you buy an ounce of tartaric or citric acid, which is very 
cheap, and put a small quantity of this in rice-water, a very refreshing beverage is 
obtained. You will soon learn when you have got acid enough ; but it should not 
be too acid ; only just enough to be pleasant. The boiled rice, of course, must be 
used in food. 

" If you live in the country, and can get skimmed milk, nothing can be better 
both for you and your family than to drink this at dinner and supper. It is well 
always to boil it, and a little sugar makes it still more agreeable ; no acid must be 
added to this. 

" If you have a garden, and can get either currants or raspberries, the pressed 
juice boiled in water, and then mixed with a little tartaric acid, and bottled, will 
keep a long time, and is a very wholesome and agreeable beverage. A little oatmeal 
boiled in water, and then a little sugar added, also gives a good drink. So that you 
can have a choice of beverages, if you find the want o£ something besides water. 
But if you can get to like plain water, you are a lucky man. 

" When you have any heavy work to do, do not take either beer, cider, or spirits. 
By far the best drink is thin oatmeal and water with a little sugar. The propor- 
tions are a quarter of a pound of oatmeal to two or three quarts of water, according 
to the heat of the day, and your work and thirst ; it should be well boiled, and then 
an ounce or an ounce and a half of brown sugar added. If you find it thicker than 
you like, add three quarts of water. Before you drink it, shake up the oatmeal well 
through the liquid. In summer drink this cold, in winter hot. You will find it 
not only quenches thirst, but will give you more strength and endurance than any 
other drink. If you cannot boil it you can take a little oatmeal mixed with cold 
water and sugar, but this is not so good ; always boil it if you can. If at any time 
you have to make a very long day, as in harvest, and cannot stop for meals, increase 
the oatmeal to half a pound or even three-quarters, and the water to three quarts if 
you are likely to be very thirsty. If you cannot get oatmeal, wheat flour will do, 
but not quite so well. It is quite a mistake to suppose spirits give strength ; they 
give a spirit to a man, but that goes off, and if more than a certain quantity is 
taken, they lessen the power of work. 

" For quenching thirst, few things are better than weak coffee and a little sugar. 
One ounce of coffee and half an ounce of sugar, boiled in two quarts of water, and 
cooled, is a very thirst-quenching drink. Cold tea has the same effect, but neither 
are so supporting as oatmeaL Thin cocoa also is very refreshing, and supporting 
likewise, but is more expensive than oatmeaL" 



WATER. 
Water must be regarded as the very basis of all sanitation. "Without a good 
supply of water, cleanliness and healthiness is impossible, and it should be the first 
4uty of individuals and communities to obtain a good supply of this, the most 



WATER. 935 



necessary, perhaps, of all the so-called necessaries of life. The purposes for which 
water is required are manifold, and in the following list are comprised the more 
important of them : — 

Drinking. { "Washing household utensils. 

Cooking. Cleansing of houses. 

Personal ablution and bathing. The watering of streets. 

Washing clothing. The flushing of sewers. 

It m & very difficult matter to calculate the proper amount of water which should 
be delivered per head of population in a town or city, and the amount required in 
different places will necessarily differ according to the nature of the industries carried 
on, &c, since some require far more water than others. The extinguishing of fires, 
and the supply of public fountains, also make considerable demands on the supply. 
Ancient Rome (the aqueducts for the supply of which are among the most interest- 
ing relics of antiquity) was noted for its liberal supply of pure water, and it has been 
calculated that more than three hundred gallons per head of population was 
daily poured into the city. A large part of this was doubtless for the supply of the 
public baths, of which there were great numbers, and on a scale of magnificence of 
which it is hard for us to have any adequate conception. The two chief aqueducts 
of ancient Rome, the Aqua Claudia and the Anio JVovus, were respectively forty-five 
and sixty-two miles in length. They were conveyed partly under and partly above 
ground, and about six miles from Rome they were united, and were supported in 
separate channels on a magnificent series of arches, which in places were one hundred 
and nine feet in height. Besides these principal aqueducts there were twelve 
others for the supply of Rome. The most wonderful, perhaps, of the Roman 
aqueducts is to be seen at Nismes, under the name of the Pont du Gard. It is 
estimated tnat the height of this colossal work (which consists of three superimposed 
rows of arches) was in places as much as one hundred and eighty feet. 

The Greeks, no less than the Romans, seem to have paid great attention to this 
all-important matter of water-supply. We are told, for instance, that, in the year 
625 B.C., Poly crates, the tyrant of Samos, engaged a famous engineer, Eupalinus, to 
construct water-works for the city. The main difficulty to be overcome consisted 
of a hill between the source of supply and the town, and through this hill Eupalinus 
cut a tunnel for the water four thousand two hundred feet long, eight feet broad, and 
eight feet deep. Again, between the town of Syracuse and the island of Ortygia, the 
water was conveyed in a tunnel under the sea. These works of antiquity certainly 
put to the blush many modern populations, whose apathy in the matter of pure 
water is certainly as surprising as it is disgraceful. 

Although the ancient Romans were perfectly acquainted with the laws of hydro- 
statics, and knew that water would always seek its original level, this principle 
was never used in their aqueducts, because they had no material from which 
they could manufacture pipes of sufficient size and sufficient strength to withstand 
the pressure of the water. The introduction of cast-iron pipes in the present day 
has done away with the necessity of maintaining the level of the water on enormous 
bridges, and has verv much diminished the cost of constructing water- works. 



936 HYGIENE. 

The following description of the Oroton Aqueduct will give our readers an idea 
of the magnitude of that work : — 

" The Croton Aqueduct," says J. B. Jervis, 1842, " was designed to supply the 
city of New York with an abundance of pure and wholesome water. It commences 
about six miles above the mouth of the Croton river, where a dam has been con- 
structed to elevate the water of the river 40 feet to the level of the head of the 
aqueduct, or 166 feet above mean tide. The course of the aqueduct passes along the 
valley of the Croton to near its mouth, and thence passes into the valley of the 
Hudson. At eight miles from the Oroton dam it reaches the village of Sing-Sing, 
and continues south through the villages of Tarrytown, Dobbs' Ferry, Hastings, 
and Yoakers. 

"At the latter place it leaves the bank of the Hudson, crosses the valleys of 
Sawmill river and Tibbit's Brook, thence along the side of the ridge that bounds the 
southerly side of Tibbit's Brook Yalley, to within three-and-a-half miles of the 
Harlem river, where the high grounds of the Hudson fall away so much as to 
require the aqueduct to occupy the summit of the country lying between the Hudson 
and East rivers. 

"This formation of country continues to, and is terminated by, the Harlem 
river, at the point where the aqueduct intersects it, which is one mile north-westerly 
from Macomb's dam. 

"The length of the aqueduct from the Crofton dam to Harlem river is 32.88 
miles, for which distance it is an interrupted conduit of hydraulic stone and brick 
masonry The high ground that bounds the northerly side of the Harlem river 
yalley is very near the level of the aqueduct at that place ; and the width of the 
valley at the aqueduct level is about 1,450 feet, or a little over a quarter of a mile, 
over which a bridge is designed to be constructed at an elevation of 114 feet above 
the level of the high tide in the Harlem river, on which iron pipes are to be laid to 
convey the water across the valley. 

" The shore on the southerly side of the river is a bold, precipitous rock, rising 
at an angle of about 30 degrees, to a height of 200 feet, or about 100 feet above the 
level of the bottom of the aqueduct. 

" After crossing this valley the aqueduct of masonry is resumed, and continued 
2*015 miles to the termination of the high ground on the north side of Manhattan 
valley. This valley is 0'792 miles wide at the level of the aqueduct, below which it 
descends 102 feet. The conduit of masonry here gives place to iron pipes, which 
descend into the bottom of the valley, and rise again to the proper level on the 
opposite side, from which point the masonry conduit is again resumed, and crossing 
the Asylum ridge and Clendening valley, is continued 2*173 miles to the reservoir 
at Yorkville. 

" This reservoir is bounded by Eighty-sixth Street on the north, Seventy-ninth 
Street on the south, Seventh Avenue on the west, and Sixth Avenue on the east. It 
is 1,826 feet long, and 836 feet wide on the outside angle of the embankment, con- 
taining an area of thirty-five acres divided into two divisions ; and is (a little over) 
five miles from the City HalL From the receiving reservoir a double line of iron 
pipes, three feet in diameter, are laid down in Eightieth Street and Fifth Avenue, to 



WATEE. 937 

convey the water 2*176 miles to the distributing reservoir at Murray Hill. The 
location of this reservoir is on the Fifth Avenue, bet-ween Fortieth and Forty-second 
Streets, and is three miles from the City Hall It is 420 feet square on the cornice 
of the exterior wall, and contains an area of 4*05 acres, divided into two equal 
divisions, and has an average elevation of 44*5 feet above the level of the streets 
around it. 

" The length of the aqueduct from the Croton dam to the distributing reservoir 
is 40*562 miles, to wit : — 

Miles. 

Masonry conduit in Westchester County ........ 32-880 

„ „ on New York Island 4-187 

Receiving reservoir from end of aqueduct to south-eastern affluent gate-houM . 0*172 

Distributing reservoir 0*080 

Iron pipes on bridge over Harlem Valley 0*275 

„ „ across Manhattan Valley ....•••.. 0*792 

„ „ between reservoirg 2*176 

Total length 40-562 

• It is proper to add to the above the length of the Oroton reservoir, which has 
been formed by the union of the Croton dam and other work necessary to obtain 
the water, at a suitable level on the Croton river, as without this dam and reservoir 
the aqueduct would have required an extension of five miles to reach the proper 
level on the river, which is now attained by means of the dam. The entire length, 
therefore, from the point on the Croton, which has the requisite elevation, to the 
distributing reservoir, is 45*562 miles. The large mains running from the distribu- 
ting reservoir through the central part of the city would add about four miles, 
making the total length of the main conduit nearly fifty miles." 

Under date "New York, 27th July, 1842," we find the following extract from 
the report to the Board of Water Commissioners : — " Since the water was intro- 
duced into the aqueduct the velocity has several times been ascertained, though not 
in so perfect a manner as I intend to have it done as soon as other duties will 
allow the time necessary. Sufficient data, however, have been obtained to show 
that the capacity of the aqueduct for delivering water will be at least fifteen per cent, 
greater than the calculated flow. I have not been much disappointed in finding the 
flow of water in the aqueduct to exceed the calculation, as all my observations on 
the currents in canal feeders have led me to believe the formulas laid down give 
rather less than the actual result. The flow of water through the pipes across Man- 
hattan Valley, and also the temporary pipe across Harlem river, being attended with 
circumstances somewhat different, has led some very intelligent persons to predict 
that our expectations would not be realised in these cases ; it therefore may be 
proper to observe that trial has proved such predictions to have been not well 
founded, as the flow through the pipes has in a very exact manner corroborated the 
anticipated capacity, as compared with that in the aqueduct. The Croton reservoir 
(which has received the name of Croton Lake) covers about 400 acres of land, 
and is available as a reservoir for 500,000,000 imperial gallons of water, above the 



938 HYGIENE. 

level that would allow this acqueduct to discharge 35,000,000 gallons per day. The 
flow of the Croton is about 27,000,000 gallons in twenty-four hours at the lowest 
stages, which, continues, with moderate rises by occasional rains, from two to three 
months in the year. This may be considered the minimum capacity of the river. 
When the wants of the city shall require a daily supply of 35,000,000 gallons, it 
will be necessary, during the season of lowest water, to draw daily from the reservoir 
8,000,000 gallons to make up the deficiency in the natural flow of the river. This 
amount the reservoir would supply for sixty-two days, without any aid from occa- 
sional rains, which may safely be relied upon to keep up the required supply from 
the reservoir beyond any drought we have ground to apprehend. The supply of the 
Croton from its daily flow, aided by this reservoir, may therefore be taken with great 
confidence at 35,000,000 gallons, which will be very ample for the wants of the 
city for a long time to come ; and when the day arrives that it will require a larger 
quantity, it may be obtained by constructing other reservoirs further up the stream, 
where there are abundant facilities for such purposes. 

" The total cost of the aqueduct, from the Croton dam to the distributing reser- 
voir inclusive, will be nearly 9,000,000 dollars." 

In a report upon the sanitary chemistry of waters, <fec, by 0. F. Chandler, Ph.D., 
we read as follows : — 

The water supply of towns and cities may be derived from wells, ponds, or 
rivers. 

Wells are either shallow or deep. Shallow wells are usually open, from ten to 
sixty or more feet in depth, and from three to ten feet in diameter. Recently, shal- 
low closed " tube " or " driven " wells have become quite popular in many localities. 
These wells are obtained by driving an iron tube, an inch or more in diameter, into 
the ground, till a water-bearing stratum is reached. A pump is then attached and a 
supply of water is pumped up through the tube. 

Deep or artesian wells are bored through successive strata often many hundred 
feet, and even one or two thousand feet deep ; the water either flowing from them 
spontaneously or being raised by pumping. 



L — NATURE OF THE IMPURITIES CONTAINED IN WATER. 

1. Spring Water. — Water being a great solvent dissolves, to some extent, 
whatever it comes into contact with. Even atmospheric waters, the rain and melted 
snow, are not pure. Rain, as it falls through the air, washes out the solid particles 
of dust, and the germs of animals and plants. And in addition to these it dissolves 
the oxygen, the nitrogen, carbonic acid, and ammonia of the atmosphere — a greater 
proportion of the oxygen than of the nitrogen. The air which is dissolved in 
water is much richer in oxygen than ordinary atmospheric air. The absolute 
quantity is very small. Twenty -five cubic feet of water take up only one cubic foot 
of oxygen. 

Water which is collected from roofs in the city is never pure. It contains gases 
which are only developed in cities, sulphur compounds, products of the combustion 



WATEJtL 



939 



of coal, chemical operations, <fec. After thunderstorms the rain water is always 
found to contain minute quantities of nitric acid, produced by the electric discharges, 
which cause the oxygen and nitrogen of the air to unite. Rain water almost 
always contains a little organic matter, causing it to become putrid when kept for 
some time. 

Terrestrial waters are always impure. Rain falling upon the earth's surface is 
absorbed by the porous soil, and the materials of which the soil is composed being 
to a greater or lesser extent soluble, the water becomes contaminated with mineral 
matter. The character of spring water, therefore, depends upon the character of the 
soil through which it has passed before it issues as a spring. In New England, 
where the rocks are granitic, and the minerals chiefly quartz, feldspar, and mica, 
water is extremely pure. But in limestone countries, where carbonate of lime and 
magnesia abound, we find the spring water largely contaminated with these sub- 
stances. These carbonates are rendered soluble in water by the carbonic acid present, 
which forms bicarbonates with them. To such solutions of bicarbonate of lime are 
due many curious phenomena of nature. 

On boiling solutions of bicarbonate of lime and magnesia, the excess of carbonic 
acid is expelled, and the carbonates having no longer a solvent are precipitated. In 
this way incrustations are formed in tea-kettles and steam boilers. 

Spring water is generally very clear, although it may be quite impure. It holds 
its impurities in solution. The soil through which it has passed, although it has 
conferred upon it its impurities, has at the same time filtered it, and thus rendered 
it clear and sparkling. As it comes from below the surface it is generally cool. For 
these reasons spring water has always been highly prized. 

Ordinary spring waters always contain salts of the alkalies and alkaline earths ; 
chlorides, sulphates, and bicarbonates of potassa, soda, lime, and magnesia. The 
most common salts are the chlorides of potassium and sodium, the sulphates of soda 
and lime, and the bicarbonates of lime and magnesia. 

Besides these alkaline and earthy salts, we almost invariably find silica, the 
substance of quartz, to the amount of a grain or less in a gallon. The total quantity 
of dissolved impurities in ordinary spring waters varies from one or two grains to 
eighty or ninety grains in one U.S. gallon of two hundred and thirty-one cubic 
inches. 

Hard and Soft Waters. — Lime salts in water are the cause of what is called hard- 
ness. They decompose the soap used in washing, forming a flocculent insoluble 
compound, and destroying its detergent properties. In Glasgow, the saving to the 
people in soap, due to the introduction of the pure water of Loch Katrine, in place 
of the hard well waters previously used, is said to amount to one hundred and eighty 
thousand dollars per annum. 

As bicarbonate of lime is destroyed by boiling, with the formation of insoluble 
carbonate of lime, which does not act on soap, it is said to produce temporary hard- 
ness, while sulphate of lime, which is not affected by boiling, produces permanent 
hardness. 

Organic Matter. — Another impurity which is always present in water, but whose 
exact chemical character has not been fully determined, is organic matter. This is 



940 HYGIENE. 

a collective term for a great many different substances derived from decomposing 
vegetable and animal matters. 

Humic, ulmic, crenic, and apocrenic acids are names which have been given to 
harmless products which result from the decomposition of vegetable matters, and 
which are probably always present in spring waters. The objectionable organic 
matters derived from animal decomposition rarely occur in the waters of springs. 

Living Organisms. — In addition to the soluble and suspended impurities already 
mentioned, we find living organisms in water, animals, and plants. These animals, 
when magnified by the microscope, are very frightful in their appearance and 
motions, but they are not really objectionable. The plants even exercise a purifying 
influence on the water. It is stated by a celebrated English author that the provi- 
dential spread of the American weed Anacharis alcinastrum has saved thousands 
of lives by the purifying influence which it has exerted on the water-courses in 
certain districts in England. These plants liberate oxygen which attacks poisonous 
dead organic matter and destroys it, thus ridding the water of its most dangerous 
impurities. 

It occasionally happens, however, owing, perhaps, to some peculiarity of the 
season, that microscopic animals or plants multiply to such an unusual extent in the 
waters of lakes or rivers as to produce serious annoyance. This occurred some years 
ago in the Croton Lake. The subject was investigated by Dr. John Torrey, who 
reported the presence of myriads of animalcules, which by their death and decom- 
position communicated to the water a disagreeable taste and odour. 

It may be considered as fully established that the ova of entozoa (the eggs or 
embryos of parasitic worms) gain, sometimes, entrance to the body by the water we 
drink. We have no reason to believe, however, that the animalculse in the Croton, 
Bidgwood, and other city waters of the United States, are such embryos; or, in 
fact, that they are in any way objectionable. 

In Iceland, however, it is stated that one-sixth of the deaths are caused by 
hydatids in the liver. These are the larval forms of the taenia, or tapeworm of the 
dog. Young leeches, contained in drinking water, sometimes fix themselves on the 
pharynx. In a march of the French in Algiers four hundred men were in the 
hospital at one time from this cause. 

2. Well Water. — Ordinary open wells are supplied partly by sjJrings and 
partly by surface drainage. The water usually contains the alkaline and alkaline 
earthy salts of spring water ; the total quantity of mineral matter and the relative 
proportions of the various salts depending upon the nature of the soiL In the 
neighbourhood of dwellings the proportion of chloride of sodium or common salt is 
generally increased by the drainage of house refuse, which also leads to the con- 
tamination of the water with the products of the decomposition of animal matters, 
such as salts of ammonia, nitrites, and nitrates. In many cases, from the proximity 
of cesspools and privy vaults, the water becomes contaminated with filtered sewage, 
matters which, while they hardly affect the taste or smell of the water, have, never- 
theless, the power to create the most deadly disturbances in the persons who use the 
waters. 

In the neighbourhood of graveyards the water of wells is often impregnated 



WATER. 941 

with animal matters from the recently filled graves. As long ago as 1808 it 
was decreed in France that no one should dig a well within 100 metres of any 
cemetery.* 

The water of driven wells does not differ in any respect from that of open wells 
in the same localities, except in cases where there is near the surface a bed of clay 
or " hard pan," impervious to water. When such a stratum is penetrated by the 
tube, and the water is drawn from beneath it, the well is somewhat protected from 
surface drainage. 

Artesian wells are in some localities of the greatest economic and sanitary im- 
portance, yielding water where it could not otherwise be obtained at all, or pure 
water, when the shallow surface wells are too impure for domestic use. The former 
case is illustrated in the Lybian desert, where there are no rivers or springs, and 
upon which rain never falls ; the latter case in the City of London, where the surface 
wells are contaminated by sewage, while the artesian wells, four or five hundred feet 
deep, bring up from the chalk-beds below a very pure water. 

One of the most celebrated fresh- water artesian wells is that at Grenelle, a suburb 
of Paris. It is 1,798 feet deep, cost 72,500 dollars, and supplies nearly 900,000 
gallons daily. The water is received in a reservoir near the Pantheon, and dis- 
tributed to the adjacent parts of the city. 

Deep artesian wells, though free from organic impurities, often contain so much 
mineral matter as to give them medicinal qualities. This is the case with Dupont's 
artesian well in Kentucky. 

3. Pond, Lake, and River Waters. — Pond, lake, and river waters, although 
containing the same mineral impurities, are generally purer than spring water, for 
the reason that while those bodies of water receive the waters of springs, they also 
receive a considerable quantity of water which has simply run over the surface of the 
earth. When a shower comes up a portion of the water goes through the soil and 
issues as a spring ; but a large portion of it runs over the soil, and goes into the 
lakes and rivers without taking with it much mineral matter. For this reason the 
waters of lakes and ponds are much purer than those of the springs in the same 
locality. One of the purest waters known is the water of the River Loka, in 
Sweden, which contains only one-twentieth of a grain of impurities in a gallon. 
Rivers are more likely to be charged with suspended impurities, for the reason that 
their waters, which have not been filtered through the soil, carry with them a certain 
quantity of mud and organic matter. That is what we see in Potomac water ; it has 
had no opportunity to settle, and has not been filtered out. When water flows into 
lakes, and the sediment subsides, it becomes clear. But in streams where the water 
runs rapidly it has no opportunity to deposit its sediment, and it often appears very 
turbid. The water of the Mississippi contains forty grains of mud per gallon ; and 
it is estimated that this river carries 400,000,000 tons of sediment per annum into 
the Gulf of Mexico. The Ganges is said to carry down 6,368,000,000 cubic feet 
annually. This transportation of mud in suspension has produced large deposits at 
the mouths of these rivers. All of the State of Louisiana, and considerable portions 

* See article by Jules Lefort in " American Chemist," vol. ii., p. 448. 



942 



HYGIENE. 



of other States which border upon the Lower Mississippi, have been formed by the 
deposition of these sediments brought from higher levels. This mud is rich in plant 
food, and the land which it produces is very fertile. The Mohawk flats are famous 
for their fertility ; and the annual overflow of the Nile is the chief reliance of the 
poor Egyptians who cultivate the fields enriched by its sediments. 

Rivers flowing through populous districts, and receiving the drainage of the 
towns on their banks, often become contaminated with sewage to such a degree 
as to make them positively offensive, and dangerous to those who drink their 
water. 

The waters of ponds are more largely supplied by springs ; they are generally 
clearer than those of rivers, as the suspended impurities subside. They often ex- 
hibit more or less colour, due to peaty matters held in solution. This is specially 
the case in the Dismal Swamp, and in new reservoirs. Such matters are entireiy 
harmless. 



II. EFFECT OF THE IMPURITIES CONTAINED IN WATER. 

1. Mineral Impurities. — The quality of the impurities is more important than 
the quantity. It is found that five or six grains of lime or magnesia render water 
unfit for the cooking of leguminous vegetables. On the other hand, it is a great 
advantage in making tea or coffee to use water of about five degrees of hardness, 
that is, containing about five grains of carbonate of lime or its equivalent in the 
gallon. A person of very nice taste can tell the difference in tea or coffee made 
with water in which the difference is not more than two or three grains of lime or 
magnesia to the gallon. It is on this account that certain wells have a great repu- 
tation as "tea wells." In olden times there were two or three such wells in New 
York, and a boy was kept by the corporation to pump water for the benefit of the 
natives. The fine flavour of the tea made with such water is due to the fact that 
the five or six grains of carbonate of lime prevent the water from dissolving the 
astringent matter contained in the tea without interfering with the extraction of the 
theine and the other desirable constituents of the leaf. 

Magnesia in large quantities is objectionable, as are also lime salts. They are 
liable to cause dyspepsia. It is said that horses acquire a rough coat if supplied 
with water containing a large quantity of sulphate of lime. Goitre and cretinism 
are attributed to these impurities in the water ; at least, the facts observed make 
this reference extremely probable. The goitre appeared in the Durham jail, 
afflicting a large proportion of the convicts. The spring water with which they 
were supplied was analysed, and found to contain seventy-seven grains of lime and 
magnesia salts per gallon. On substituting for this a water containing only eighteen 
grains of these salts it was found that the old cases rapidly improved, while no new 
cases made their appearance. In the limestone districts of England, Switzerland, 
and Central New York, this goitre has been traced over considerable areas. At 
Goruckpoor, in India, where the waters are quite calcareous, ten per cent, of the 
adults are afflicted with goitre, and many of the children are cretins. Even the 
cats and dogs are said to be afflicted with cretinism, which is a kind of idiotic 



WATER. 



943 



insanity. It is a curious fact that in Ireland, on the Waterford side of the Suir 
where sandstones and slates prevail, goitre and cretinism are almost unknown, while 
on the Kilkenny side, where limestones abound, goitre is not uncommon. Perhaps 
the idiotic behaviour of those famous Kilkenny cats is attributable to the calcareous 
impurities of the water with which these unfortunate quadrupeds slaked their 
thirst. 

With regard to the total quantity of impurities admissible in good drinking 
water, the sanitary congress which met at Brussels decided that water containing 
more than thirty-five grains of impurity in one gallon is not wholesome, and that 
there should not be much more than one grain of organic matter. Thirty-five 
grains is a large quantity for city water, though well waters frequently contain 
more. 

More recent investigations have shown that moderate quantities of these com 
pounds are actually desirable, at least this is claimed by some of the most dis- 
tinguished authorities in England, where the subject of water supplies for cities has 
been most carefully studied. Dr. Letheby has carefully examined the connection 
between the quantities of lime and magnesia salts contained in the waters used in 
sixty-five English and Scotch cities and towns in connection with the rates of mor- 
tality. Eor convenience of comparison the waters are rated according to their 
hardness, represented in grains per gallon of carbonate of lime, or its equivalent in 
soap-destroying compounds. 



Table showing Hardness op the Water Supply and the Death Rate. 



Hardness. 


Number of Towns. 


Average Death rate 
per 1,000. 


Average Hardness. 


Over 10° 

10° to 60 Q 

6° to 2° 

2 Q and under .... 


25 

17 

15 

8 


21-9 
24-9 
26-3 

28-5 


16 
8 

3-8 
1-3 



It would certainly appear from these figures that waters containing earthy salts 
in considerable quantities are preferable to very soft waters. Even if this generali- 
sation of Dr. Letheby is not fully sustained, the old theory, which demanded the 
softest water possible, can hardly stand in opposition to these facts. 

2. Organic Matter. — The organic matter of a purely vegetable origin, such as 
occurs to the extent of one, two, or three grains per gallon, in country springs and 
wells, or in ponds and rivers, even when it contributes a tint of yellow to the water, 
is entirely harmless and unobjectionable. The nitrates, nitrites, and ammonia salts 
found in wells in densely peopled towns are themselves harmless, but their presence 
proves the contamination of the water with the products of decomposition of animal 
refuse, and should always be viewed in the light of a warning of the presence of 
impending danger. 

3. Animal Excreta.— The Droducts of the decomposition of animal matter in 



944 



HYGIENE. 



water is, however, by far the most objectionable impurity. Organic matters, pro- 
duced by the decomposition of vegetable substances, are not especially dangerous, 
but the products of decomposing animal substances are highly dangerous, even when 
in minute quantities. These impurities do not make themselves apparent to the 
taste. On the contrary, such waters are frequently considered unusually fine in 
flavour, and persons go a great distance to procure them. Nevertheless, they 
contain an active poison. Many diseases of the most fatal character are now traced 
to the use of water poisoned with the soakage from soils charged with sewage and 
excremental matters. Sudden outbreaks of disease of a dysenteric character are 
often caused by the irruption of sewage into wells, either from a break in the sewer 
or cesspool, or from some peculiarity of the season. Such contamination of the 
water is not indicated by any perceptible change in the appearance of the water. 
The filtered sewage, clear and transparent, carries with it the germs of the disease. 
At a convent in Munich, thirty-one out of one hundred and twenty-one of the 
inmates were affected with typhoid fever. It was found upon investigation that the 
well was polluted by sewage, and the disease disappeared as soon as the proper 
repairs were made. 

At Pittsfield, Mass., the typhoid fever suddenly broke out in a large boarding- 
school for young ladies. The water was found to be contaminated with sewage 
owing to a leak in the cesspool. 

At Edgewater, on Staten Island, in 1866, the inmates of a small block of houses 
were afflicted with typhoid fever, several deaths occurring. On making investiga- 
tion, the health officers found that a neighbour, through whose land the underground 
drain passed, had taken the liberty of closing up the drain, thus sending its contents 
back upon this block of houses, contaminating the well, and thus actually murdering 
the unfortunate victims with sewer poison. 

It is a common saying in villages and towns that " there was health in the old 
houses, while there is death in the new." This is owing to the fact that when 
villages were first settled, the houses were supplied with water from the springs on 
the hill-side, while, as the dwellings multiplied in number, these sources of supply 
proving insufficient or too distant, wells were sunk in the valley, which, of course, 
received the drainage of the locality. Hence diseases, such as typhoid and typhus 
fevers, dyptheria, &c, which were unknown to the early settlers, ultimately became 
prevalent. 

I might multiply illustrations without end of cases in which diseases have been 
directly traced to impure water. I have here a little diagram which illustrates a 
case that occurred in the town of Charmouth, in England, a little village situated 
on the side hill, at the mouth of the Char. The houses are supplied from surface 
wells, sunk in the gravel and marL 

Typhoid fever broke out. My friend, from whom I obtained the facts, was a 
scientific man, and knowing that it was not safe to drink the water from these wells* 
so informed his friends, whom he directed to draw their supplies from the spring 
above the village. My friend had half a dozen children. Two or three of them 
were strong enough to manage the pump, and against his express order they drew 
the water from the well, and drank it. They got the disease as a oonsequence \ but 



WATER. 945 



none of the children who could not use the pump, and none of the neighbours who 
drew water from the springs, were affected. 

This city, during the last century, and before the introduction of sewers or the 
Croton water, was ravaged every few years by deadly epidemics, which are now 
believed to have been favoured and invited by the defilement of the wells then in 
use, by sewage and faecal soakage. No such visitation has occurred since the intro- 
duction of the Croton water, and the completion of the very perfect system of 
■ewers. 

Cholera, though it does not originate from polluted water, is disseminated chiefly 
by the aid of wells, and other impure water supplies. 

At Exeter, England, in 1832, one thousand deaths occurred from cholera. 

A purer supply of water was then introduced from a locality two miles higher 
up the river, above the point at which it received the sewage of the town. When 
the cholera again invaded the city in 1849 only forty-four cases occurred, and in the 
cholera season of 1854 there was hardly a case. 

In London, in 1854, the water supplied by the South wark Company contained 
much sewage, while that supplied by the Lambeth Company was very pure. Both 
companies had pipes in the same streets, supplying water indiscriminately on both 
sides. Among those who used the South wark water, the deaths amounted to 130 
in 10,000, while among those who drank the Lambeth water they amounted to only 
37 in 10,000 ; 2,500 persons were destroyed by the Southwark water in one season. 
On the previous visitation of 1848-49, the case was the reverse. The deaths from 
the Lambeth amounted to 125, while those from the Southwark amounted to 118 
in 10,000. At that time, the Lambeth Company took their water from a point 
lower down the river. 

Another very striking instance occurred in London. The famous Broad Street 
pump supplied water in one of the most fashionable localities of the West End. 
During the visitation of 1848-49 this pump killed 500 persons in a single week by 
disseminating cholera. The wealthy people of the West End went to Brompton, a 
fashionable summer resort, about five miles up the Thames, and soon the cholera 
broke out among them there. 

The health officers soon discovered, on investigation, that these people had been 
in the habit of sending to the Broad Street pump for tea-water, and had brought the 
cholera with it. A curious case was that of an old spinster, who had moved to 
Hampstead, three miles from the pump, but who sent her maid daily for a kettle of 
the highly-prized tea-water. She and her maid were the only persons who suffered 
from cholera at Hampstead. 

A similar story might be told of an outbreak of cholera in a shanty village west 
of Central Park, and another in a shanty village on the heights across the river. In 
both cases it was clearly shown that the cholera germs were distributed among the 
unfortunate squatters by the waters of the single well in each village. There is a 
famous pump in the twelfth ward of Brooklyn, at the corner of Van Brunt Street, 
from which over fifty families obtained their water supply. In 1866 cholera broke 
out m five or six of these families, but the spread of the disease was prevented by 
the prompt action of the health officer, who removed the pump handle. 
60 



946 



HYGIENE. 



From these facts it is seen that water aids in disseminating two of the most 
fatal diseases which affect the human race : the typhoid fever and the deadly 
cholera. During the ten years from 1856 to 1866 there were 21,009 deaths from 
cholera in England and Wales, and 150,000 deaths from typhoid fever. There is 
every reason to believe that at least three-fourths of these deaths might have been 
prevented had proper attention been paid to the purity of the water supply. This 
poisoning by bad water is now fully established, and must awaken communities to 
the vital importance of securing a pure and unfailing supply of this indispensable 
beverage. 

TABLE 

Showing the purity of Croton Water as compared with the Waters of other Cities. 



CITIES 
SUPPLIED. 



New York 



Brooklyn. . 

Boston . . 
Philadelphia. 

Albany . . 

Troy . . . 

Utica . . . 

Syracuse . . 

Cleveland. . 

Chicago . . 

Rochester. . 

Schenectady. 

Newark . . 

Jersey City . 

Hoboken . . 

Hudson City. 

Trenton . . 

London . . 

i» • • 

n • • 

»» • • 

ft . • • 

n • • 

»» • • 

» • • 

Dublin . . 

» . • . 



SOURCE OP^WATES. 



Croton; average for 3 months in 1868 (C. F. Chandler) 
Croton; average for 13 weeks in 1867 „ 

Well west of Central Park (No. 1) „ 

Well west of Central Park (No. 2) „ 

Ridgewood ; average for 3 months in 1868 „ 

Cochituate (E. N. Horsford) 

Fairmount, Schuylkill (E. N. Horsford) 

Delavan (H. Wurtz) 

Hydrant (E. N. Horsford) 

Hydrant (W. Elderhorst) . . 

Hydrant (C. F. Chandler) 

New Reservoir (C. F. Chandler) . 

Lake Erie (J. L. Cassels) 

Lake Michigan (J. V. Z. Blaney) 

Genesee River (O. F. Chandler) 

State street well (C. F. Chandler) 

Passaic River (E. N. Horsford) 

,, >> .•••»•••• 

»» >» 

»» .»» ......... 

Delaware River (H. Wurtz) 

Thames, Grand Junction Co. (Dr. H. Letheby) . . . 

„ West Middlesex Co 

„ Southwark and Vauxhall Co. (Dr. H. Letheby) 

„ Lambeth Co. (Dr. H. Letheby) 

„ Kent Co. (Dr. H. Letheby) 

„ New River Co. (Dr. H. Letheby) 

East London Co. (Dr. H. Letheby) 

Well, Leadenhall street (Dr. H. Letheby) 

Lough Vartry, new supply (Apjohn and others) . . . 
Seine above the city (Bussey ,Wurtz, and Ville) . . • 
Reservoir, Moutmartre (Bussey, Wurtz, and Ville) . . 
Reservoir Passey (Bussey, Wurtz, and Ville) .... 

Maelor Lake (Alex. Miller) 

Hagar Palace (Dr. Bahr) 

Well, Hanwerkeratrasse (Alex. Mueller) 

River Vecht (V. Baumhauer and Van Moorsel . . . 
Deep well at the Kaisersgracht „ ... 

Artesian well at Bikkerseiland „ ... 



o 

a % 


<D 

o-g a 
3 


6-66 


1-97 


6-72 


1-12 


66 80 


780 


6910 


3-40 


4.51 


0-83 


4.12 


1-22 


3-95 


2-06 


4-97 


1-08 


14-52 


3-96 


10-44 


2-30 


943 


1-64 


20-81 


3-0t 


8-13 


2'62 


9-63 


1*81 


20-62 


2-12 


80-38 


4-00 


7-85 


4-90 


7-85 


4-90 


7-85 


4-90 


7.85 


4-90 


5-02 


0-95 


26-67 


1.43 


22-60 


1.21 


25-78 


1-43 


25-36 


1-78 


38-21 


1-07 


23-93 


0.35 


26-71 


0-71 


154-98 


16-44 


3-04 


2-30 


13-43 


1-70 


17-73 


3-50 


19-81 


3-21 


47-00 


7-00 


27-88 


3-26 


389-00 


23-00 


24.78 


3-66 


110-69 


761 


106-89 


2-31 



•P3 



763 

7-84 

74-60 

72-50 

5-34 

5-34 

6-01 

6-05 

18-48 

12-74 

11-07 

23-89 

10-75 

11-44 

22-74 

84-38 

12-75 

12-75 

12-75 

12-75 

5-97 

28-10 

23-81 

27-21 

27-14 

39-28 

24-28 

2742 

171-42 

5-34 

1513 

21-23 

23-01 

54-00 

31-14 

410-00 

28-44 

11810 

100-20 



WATER. 947 



The results of these investigations with regard to the quality of the water supply 
of New York are eminently satisfactory, as the purity of the water is fully estab- 
lished. No one who has examined the district of 352 square miles which supplies 
the Croton river will be surprised at this result. Mountains and hills of azoic 
gneiss receive the rainfall, which is quickly absorbed and filtered by the pure 
siliceous sands and gravels, to gush out in numberless springs, feeding the brooks 
which bear the sparkling waters to the ponds which serve as natural storage 
reservoirs. From these flow the large streams which, by uniting, form the Croton 
river. This is finally expanded by the dam at the head of the aqueduct into a 
broad, deep lake, the Fountain reservoir, in which the quiet waters deposit the 
finer sediments, and thus undergo a final purification before they are admitted to 
the aqueduct. 

Nowhere along the streams can anything be found which can render the waters 
impure. Rugged rocks or bright green pastures generally border them. A few 
factories have been located at points where the water power was available, but a 
careful examination failed to reveal any pollution of the water by them. 

An examination of the Croton water is made weekly by the chemist of the Health's 
department, and the result is communicated to the Sanitary Superintendent, who is 
instructed to report any indications of impurities likely to injure the public health. 

New York has perhaps the best water supply of any modern city. In 1872, 
when the population of the city was about 1,000,000 persons, the water supply 
was estimated at 88,000,000 gallons per diem. Since 1872 the reservoirs for the 
supply of the city have been immensely enlarged, and at present they are capable 
of storing 5,000,000,000 gallons of water. 

The city of Glasgow is perhaps the best supplied city in the United Kingdom, 
and the aqueduct by which the municipal authorities placed Loch Katrine in 
immediate connection with their city is justly looked upon as one of the greatest 
engineering works of modern times. Loch Katrine is capable of storing nearly 
6,000,000,000 gallons of water, and the distributing reservoir at Mugdock, eight 
miles from Glasgow, will hold 548,000,000 gallons. The service pipes deliver 
60,000,000 gallons per diem, which, if we take the population of the city at 700,000, 
is more than 70 gallons per head. 

The city of Vienna is now supplied by an aqueduct fifty-eight miles long, from 
the Kaiserbrunn Spring, situated in the Styrian Alps, 1,146 feet above the level of 
the Danube. The cost of these works (opened in 1873) was about £2,000,000 
sterling. 

Works are now in course of construction for the supply of Paris with potable 
water, since the present sources, although well suited for street cleansing and other 
municipal purposes, are considered too impure for drinking. The new supplies for 
Paris are to be taken from certain tributaries of the Marne, running through chalk 
districts, and also from wells sunk especially in the chalk beds. 

Since the impurity of water seems a matter of such vital importance, it is 
necessarily of equal importance to be able to detect the impurities. Unfortunately 
this is no easy matter. For the detection of even the coarser impurities is a matter 
demanding much skill from the chemist and the microscopist ; and the most 



948 ■YGIKNK. 

dangerous impurities of all, those, for example, which convey cholera and typhoid 
fever, are not to be detected by any known process of the chemist, nor by the 
highest powers of the microscope. When we see their deadly results we infer their 
presence, but all the light of modern science has not removed them from the category 
of pestilences which walk in darkness. 

Wholesome water should be colourless, odourless, and tasteless; but it is 
important to remember that a water may have all these qualities in a high degree 
and yet. be a most dangerous compound ; and it cannot be too widely known that 
waters which are rich in nitrates and nitrites are often brilliant and sparkling, 
A water may be coloured and yet not be unwholesome, as waters tinged by the 
presence of iron or by peat soils bear witness. A water may be muddy from the 
suspension of mineral matter, but any want of clearness in a water must bring 
its purity under suspicion, and the cans® of its muddiness should be carefully 
inquired into. 

We next turn to consider what means are at our disposal for the purification of 
water which has become fouled. The separation of the palpable impurities of water 
is comparatively a simple and easy matter. Mere subsidence will do a great deal, 
and if a muddy water be allowed to stand in a cask or bottle, much of the suspended 
matter, or perhaps all of it, will fall to the bottom, and the clear fluid can then be 
drawn off the sediment either by means of a syphon or by a tap placed near the 
bottom of the vesseL Solid impurities may to a great extent be removed by nitration. 
The simplest filter consists of a piece of cloth or calico, through which the water 
is strained, and in the interstices of which the impurities of the water are left 
entangled. A conical flannel bag will strain off a great proportion of the floating 
particles. The most perfect filter is the one which is used in the chemist's laboratory, 
and which may always be readily extemporised for domestic use. It is made thus, 
Take a square piece of blotting-paper or thick cartridge-paper and fold it twice down 
the centre, across and across. Put the folded paper into a funnel with the closed 
corner downwards. Then separate the upper free edges of the paper, and the most 
efiicient filter known, for the separation of mechanical impurities, is complete, and it 
only remains to place the funnel in a suitable bottle and pour the impure water 
very gently upon the paper. 

Layers of sand and gravel form very efiicient filters, and the water companies 
employ this means of cleansing the water which they serve out to the public. 

Powdered charcoal has long been a favourite material for the purposes of 
mechanical filtration. Charcoal has another property besides that of mechanically 
separating solid impurities. It is a powerful deodoriser, and to a great extent is 
capable of oxidising the organic matters which the water may contain. This it does 
by virtue of the oxygen which the charcoal holds within its pores. This function, 
however, is one which charcoal will not perform indefinitely, so that after a time it 
must be renewed, or, what is the same thing, it must be re-burnt. Animal charcoal, 
or charcoal made from burnt bones, is more powerful as an oxidiser and deodoriser 
than vegetable charcoal. An objection has been raised to animal charcoal because 
the phosphate of lime which it is liable to contain is dissolved by the water filtering 
through it, and encourages the growth of vegetable fungi in the water so filtered. 



It is a very common expedient to filter water through alternate layers of various 
substances, such as gravel, charcoal, and sand. 

Spongy iron has of late become a favourite material for purposes of filtration. It 
is said to possess much of the deodorising and oxidising power of charcoal, and is not 
open to the objections which we have named in connection with that body. 

Filtration may obviously be performed upon any scale, and between the huge 
filtering beds of the water companies and the pocket charcoal syphon niters supplied 
to our troops in the tropics, we have a choice of niters of every size and description. 

The so-called " Poor Man's Filter " is made by plugging the hole in the bottom 
of a common flower-pot with a piece of sponge, and then putting a layer of animal 
charcoal, another of clean sand, and a third of rather coarse graveL 

When small quantities of water for drinking are to be filtered, the best material 
for the filtering vessel is undoubtedly glass, so that its state of cleanliness and of 
repletion or emptiness may be at once evident. It should be put in a place where 
every member of the family may see it and have access to it. It is often a good 
plan to place a filter in the water cistern itself, so that all water drawn from the 
cistern for domestic use must be filtered. 

One of the best filters which has yet been devised is that known as the " tank 
filter," and which we owe to the ingenuity of Major Crease, R.M.A. This filter is 
largely used on board ship, and is equally applicable for domestic use. 

The action of a filter and pure water reser > oir, inside an ordinary house cistern 
may be simply described. The impure water passes through the inlet into chamber 
of filter ; thence upwards through a plate, usually of porous stone, then through 
powdered charcoal into the pure water reservoir, from which it may be drawn ofi 
cold by the pure water tap, or hot and pure from the boiler. 

When the filter is in action the grosser impurities in the impure cistern water 
are stopped by the plate of porous stone, so that only the most minute impurities 
pass into the charcoal, and there they are finally stopped, and being chemically acted 
upon by the charcoal, their character is changed and they are deodorised. Every 
time, therefore, a servant opens the unfiltered tap to procure water for common 
washing-up purposes, the unfiltered water enters the inlet and scours out the whole 
of the impurities in the chamber, carrying them away out of the filter. 

To clean the filter thoroughly once in every six months, or as often as may be 
deemed necessary, one of the household servants lifts a small galvanised chain 
(one end of which is fastened to the top of the cistern), thereby drawing out a 
plug from the upper part of the filter, and drops it into the inlet She then 
turns on the unfiltered water tap for several minutes, thereby causing the cistern 
water to rush through the top opening violently downward through the filter and 
out of the tap, thoroughly driving out from the filter all impurities. 

Although filters are of great and undoubted utility, and although we tTiinV that 
all water used for domestic purposes should be first filtered, we must yet caution the 
reader against placing too much faith in nitration as a means of purification. Dis- 
solved matters of every kind pass through filters of all descriptions, and disease 
germs also do not seem to be stopped by any amount of filtration. The security 
afforded by filtration is limited, and not absolute. 



950 HYGIENE. 



Filters, too, require renewing, and an old, uncleaned filter may become a source of 
danger, instead of a security. 

The boiling of water undoubtedly serves, in some degree at least, to destroy 
organic matter, and probably disease germs also. Boiling serves to soften water, by 
precipitating a great part of the salts of lime dissolved in it, but water which 
has been boiled becomes flat, owing to the expulsion of the carbonic acid 
which gives to water its character of freshness. It is certain also, that many 
organic germs resist a boiling temperature, so that the security afforded by boiling is 
limited, and not absolute. Since boiled water is flat, and probably not very whole- 
some, boiling should only be resorted to during periods of epidemic. 

Thus we see that water once fouled cannot be cleansed again with any degree of 
certainty. 

This fact, together with a knowledge of the misery which fouled water may 
bring with it, will, we hope, prove a practical and useful lesson to the reader. 
There is, we shame to say it, scarcely a village in the United States which has 
not its fouled water-course, used by the lazy and ignorant inhabitants as a receptacle 
for every kind of abomination. It should, we think, be taught as one of the chief 
duties of a Christian to respect the purity of pure things ; and yet, though the 
purity of water is used by Christian teachers as a symbol of all that is highest and 
holiest, this sentiment has so little effect that a man will come straight from his 
church where he has been praising " the Giver of all good gifts," " the Fountain of 
eternal life," and proceed thoughtlessly to pollute that which ought to be to him a 
sacred symbol, thereby showing in one act his want of gratitude to God and his 
disregard for the welfare of his neighbours. 

Rain-water should always be collected and preserved. In country districts it is 
invaluable for washing and for many other domestic purposes. It must neither be 
collected nor stored in leaden pipes or cisterns, since it readily dissolves that metal 



AIR. 

Man is an air-breathing animal. He crawls about at the bottom of a deep ocean 
of air, just as we may suppose some large crustacean crawling at the bottom of the 
sea. Moved ->ut of his natural element into the water, or even into the upper strata 
of the atmosphere, he dies. Air is essential for his existence, and if he be deprived 
of it, but for a minute, death may result. 

In a hundred gallons of air there are seventy-nine of nitrogen and twenty-one 
of oxygen gas. These are the " round numbers," and the ones which are easily 
remembered. They are not strictly correct, however, for in every measure of air 
there is a small quantity of carbonic acid, amounting to *04 measures, in every 
hundred, so that correctly speaking the average composition of the air is M 
under : — 

Oxygen .«•••••••• 20*96 

Nitrogen .••••••••• 7900 

Carbonic acid •••••••• • 0004 

Too^ 



951 



It is a remarkable fact that the air varies very little in composition, and whether 
it be examined on the top of a high mountain or in a deep valley the relative 
proportion of the constituent gases remains, broadly speaking, the same. This is 
owing to the wonderful readiness with which gases mix or diffuse among each other. 
It was at one time thought that air in all situations had absolutely the same compo- 
sition, but this has been proved not to be the case. 

In addition to the gases mentioned, air always contains a large amount of watery 
vapour, and generally a small quantity of ammonia also. The atmosphere has a 
certain depth only, and is supposed to form a covering to the world about 120 miles 
in thickness. Upon us creatures who live at the bottom of it it presses with a 
weight which is calculated as equal to fifteen pounds upon every square inch of 
surface, a weight which is capable of balancing a column of mercury about thirty 
inches in height. If we climb out of the lower strata of the atmosphere into the 
higher, by going up a mountain or ascending in a balloon, the pressure of the 
atmosphere gets gradually less and less. Life can only be sustained in the lower 
strata of the atmosphere, and in the higher the rarefaction of the air, and the 
extreme cold, speedily produce difficulty of breathing and insensibility. 

The greatest height ever attained by human beings was that reached by 
Mr. Glaisher and Mr. Coxwell in their famous balloon ascent made at Wolver- 
hampton, on September 5th, 1862. The following facts with regard to it are culled 
from Mr. Glaisher's report : — 

" The balloon left at lh. 3m. p.m. The temperature of the air was 59°. . At the 
height of one mile it was 41°, and shortly afterwards we entered a cloud 1,100 feet 
in thickness, in which the temperature fell to 36^°. . . . "We reached two miles in 
height at lh. 21m. The temperature had fallen to the freezing point. Three miles 
at 1.28 p.m., temperature 8°. Four miles at 1.39 p.m., temperature 8°. Five miles ac 
1.49. p.m., temperature 2°. Up to this time I had taken observations with comfort. 
I had experienced no difficulty in breathing, whilst Mr. Coxwell, in consequence of 
the necessary exertions he had to make, had breathed with difficulty for some time. 
At 1.51 p.m. the barometer stood at eleven inches, and shortly afterwards it stood 
at 9*75 inches, indicating a height of 29,000 feet Shortly afterwards I laid my 
arm upon the table, possessed of its full vigour, and on being desirous of using it, I 
found it powerless — it must have lost its power momentarily. I tried to move the 
other arm, and found it powerless also. I then tried to shake myself, and succeeded 
in shaking my body. I seemed to have no limbs. I then looked at the barometer, 
and whilst doing so my head fell on my left shoulder. I struggled and shook my 
body again, but could not move my arms. I got my head upright, but for an 
instant only, when it fell on my right shoulder, and then I fell backwards, my back 
resting against the side of the car, and my head on its edge ; in this position my 
eyes were directed towards Mr. Coxwell (who had clambered into the ring of the 
balloon). When I shook my body I seemed to have full power over the muscles of 
the back, and considerable power over those of the neck, but none over either my 
arms or my legs ; in fact I seemed to have none. As in the case of my arms, all 
muscular pcwer was lost in an instant from my back and neck. I dimly saw Mr. 
Coxweii in tne ring, and endeavoured to speak, but could not ; when in an instant 



952 



HYGIENE. 



intense black darkness came ; the optic nerve finally lost power suddenly. I was 
still conscious, with as active a brain as at the present moment whilst writing this. 
I thought I had been seized with asphyxia, and that I should experience no more, 
as death would come unless we speedily descended ; other thoughts were actively 
entering my mind when I suddenly became unconscious, as on going to sleep. I 
cannot tell anything of the sense of hearing ; the perfect stillness and silence of the 
regions six miles from the earth (and by this time we were between six and seven 
miles high) is such that no sound reaches the ear." 

Mr. Coxwell's hands were frost-bitten, and he too began to feel insensibility 
coming on, and had he not with marvellous presence of mind managed to open the 
valves of the balloon with his teeth, and thus caused it to descend, these two 
intrepid aeronauts must have perished. Mr. Glaisher estimates that he wa» 
insensible for seven minutes, and he was able to resume his work of taking 
observations at 2h. 7m., exactly thirteen minutes after the previous one, when 
his powerlessness began to come on. After his descent he felt no ill effects, and was 
able to walk between seven or eight miles. Mr. Coxwell describes Mr. Glaisher's 
countenance as " serene and placid during his insensibility." 

Why is air so necessary for us 1 To support the combustion that is always 
going on in our bodies. Just as a candle or a fire, if not furnished with a good 
supply of air, will "go out," so also is the vital spark extinguished by being deprived 
of its necessary oxygen. In the article on food we had occasion to compare the 
human body to a furnace, for which fuel was furnished in the shape of food, and 
in the combustion of this food in the body there is a great demand for oxygen, 
which is afforded by the air. The products of combustion, carbonic acid and 
watery vapour, must also be got rid of, and these two offices are performed by the 
function of respiration. 

An adult man breathes about fourteen times in a minute, and in each act of 
respiration he draws into his lungs about thirty cubic inches of air, and expels a 
similar amount It is estimated that about four hundred cubic feet of air are passed 
through the lungs in the twenty-four hours. "If a man," says Huxley, "be shut 
up in a close room, having the form of a cube, seven feet in the side, every particle 
of air in that room will have passed through his lungs in the twenty-four hours." 

Seeing that the object of respiration is that the body may appropriate oxygen 
and discharge carbonic acid, it is obvious that the air in the room will have become 
altered in quality, that much oxygen will have been taken from it, and much 
carbonic acid added to it. The exact difference in composition of air before and 
after passing through the lungs is as follows : — 



Oxygen 
Nitrogen 
Carbonic acid 



Befo 



20-96 
79-00 
00-04 

100-00 



Oxygen 
Nitrogen 
Carbonic acid 



AfUr. 



16-30 

79-00 

4-70 

100-00 



In round numbers it may be said that air by being respired once loses five per 
cent, of oxygen, and gains five per cent of carbonic acid. The air which we expire 



air. 953 

has always the same temperature as the body (100° Fahrenheit), and is saturated 
with watery vapour. It is estimated that about half a pint of water is given off 
from the lungs in twenty-four hours. Besides carbonic acid and water, much 
organic matter is given off from the lungs, which is the cause of the close offensive 
gmell of an over-crowded room. 

When the amount of carbonic acid in the air used for breathing reaches the 
amount of 10 per cent., death results, and discomfort is felt when the amount of 
carbonic acid is infinitely below this. 

Dr. Angus Smith, whose work, " Air and Rain," is a most valuable contribution 
to modern science, and whose experiments have been of a most exact nature, asserts 
that air containing more than -07 per cent, of carbonic acid is perceptibly " close " 
to our senses, and that air containing *1 per cent, is odious. Dr. Smith has done 
great service by clearly showing that very small variations of carbonic acid are 
distinctly perceptible, and that we can easily recognise the addition of three or four 
parts in 10,000 of air. 

In populous districts the air is constantly being fouled by respiration, and by 
combustion of other kinds from furnaces, &c, and the amount of carbonic acid is 
found to vary according to the amount of fouling causes which are present. 

Dr. "William A. Hammond, in his " Treatise on Hygiene," says : — " Confined 
air, under all circumstances, is injurious if inhaled into the lungs. Though it may 
not have been vitiated by respiration, by combustion, or by emanations from known 
sources of contamination, the mere fact of its having been stagnant is sufficient 
proof of its unwholesomeness. It is very much with air as with water, it requires 
to be kept in motion to be retained in a condition fit to enter the system. 

" On entering a room which has been kept closed for some time, a peculiar and 
characteristic odour is perceived. This fact of itself is evidence against the 
insalubrity of the air, for it may be laid down as a law admitting of very few 
exceptions, that air which is capable of making an impression on the sense of 
smell is not suitable for the purpose of respiration. 

" Now, what can communicate an odour to air which has been subjected to none 
of the ordinary and recognised causes of vitiation, but which has simply been 
retained in a closed chamber % The matter is a very simple one. The air of such 
a chamber always contains organic substances, animal and vegetable. The emana- 
tions from the last occupant, the fibres from carpets, blankets, curtains, linen, &c, 
the vapours which are given off from the varnish and paint of the furniture and 
other woodwork, and from the wood itself, and the various substances, such as 
spores, starch, <fec, which find entrance into any place not absolutely air-tight, are 
all there and undergoing decomposition. Stagnant air, therefore, presents another 
point of analogy to stagnant water — it contains animal and vegetable bodies which are 
undergoing decomposition. The subject admits of positive experimental illustration. 

"I placed an exhausting apparatus, connected with a set of Liebig's bulbs, 
containing a starch solution of permanganate of potassa, in a room which had 
been immediately before thoroughly aired. The apparatus was set in action, and 
it was found that it required 1,085 cubic inches of air to pass through the solution 
in order to decolourise it. 



954 HYGIENE. 

Now, we have seen that the average amount of carbonic acid in the air is *04 per 
cent., and that when the amount reaches '07 per cent, the air is " close" and dis- 
agreeable. Further, we have seen that air which has been once used for respiration 
contains 4*7 per cent. In order, therefore, that the carbonic acid in the expired air 
shall be diluted until the normal percentage of "04 is approached, it is obvious that 
we require more than 100 volumes cf fresh air. Dr. Parkes thinks that 125 times 
the volume of the expired air ought to be allowed, and if this figure be granted, then 
man's daily want of fresh air amounts to 50,000 cubic feet, or something more than 
2,000 feet per hour. If each man is to be supplied with this large amount of air, it 
is obvious that too many men must not be placed in one room, or else the forcing in 
of the necessary air will necessitate unbearable currents. It is found that for each 
man to get his proper supply of fresh air, a space must be allotted to each of not less 
than 800 cubic feet. 

Thus, suppose we have to construct a dormitory in a barrack for the accommoda- 
tion of 50 soldiers, we must allow a cubic space of 800x50=40,000 cubic feet; 
and if the calculated amount of 2,000 cubic feet of fresh air is to be allowed to 
each man per hour, arrangements must be made for the hourly admission of 100,000 
cubic feet of air. 

Our barrack room, then, should be 125 feet long, 40 feet broad, and at least 
8 feet high. There should be inlets for fresh air, amounting collectively to an area 
of 20 square feet, outlets of the same size, and a current of air must move from one 
to the other at a uniform rate of 18 inches per second. This allowance of 2,000 
cubic feet per hour is considered by many to be excessive, and the Barrack Commis- 
sioners usually only allow 1,200 cubic feet. Under many circumstances 2,000 cubic 
feet is not enough, and when the air is likely to be contaminated by organic 
effluvia, as is often the case in hospitals, as much as 6,000 feet is allowed. 

It must not be forgotten that in a room man is usually not the only thing which 
makes demands upon the fresh air. Fires, and lights, and very often domestic 
animals have to be considered. It is estimated that an ordinary gas-burner burns 
3 cubic feet of gas per hour, and for the combustion of this gas, 5,400 feet of air are 
necessary, so that for every gas-burner the number 5,400 has to be added to the 
hourly admission of fresh air. 

As regards the cubic allowance for each man, it must be borne in mind that 
800 cubic feet is to be regarded as a minimum. In hospitals twice this amount is 
allowed. In building workshops it is always good economy to provide ample space, 
and thorough ventilation, for it is found that the amount of work is, cceteris paribus y 
directly in proportion to the amount of fresh air allowed. 

When air is fouled by respiration and by human exhalation, there is much 
organic matter given off not only from the lungs, but probably from the skin as 
well, which gives the peculiarly offensive odour to a crowded room. Nothing is 
more sickening than the odour given off by a crowd of the " great unwashed." 
Shakespeare has aptly described this feature of a crowd in Julius Ccesar. " The 
rabblement hooted, and clapped their hands, and threw up their sweaty nightcaps, 
and uttered such a deal of stinking breath, because Caesar refused the crown, 
that it had almost choked Caesar, for he swounded and fell down at it ; and foe 



air. 955 

mine own part, I durst not laugh for fear of opening my lips and receiving the 
bad air." 

This organic effluvium deserves almost as much consideration as the carbonic 
acid, for it is certainly most unhealthy, and is very difficult to get rid of. The 
" organic smell " will hang about a room for a long time, and persists often for 
hours, in spite of open windows and thorough draughts. The breath of man is 
often, we know, laden with contagious particles, and it is only reasonable to 
suppose that these contagions lurk in the organic elements which, when they 
reach a certain degree of concentration, we detect readily enough with the nose, 
but which elude detection by the most subtle tests of the chemist. 

. We dwell upon these organic effluvia because they probably constitute the 
difference between air poisoned by the respiration of animals, and air which is 
merely deficient in oxygen or too rich in carbonic acid. We have seen that although 
Mr. Glaisher was rendered insensible and nearly killed during the balloon ascent, 
his recovery was immediate and complete directly the asphvxiating conditions 
were removed ; and it is a matter of every-day experience that those who inhale 
" laughing-gas " for the production of insensibility recover rapidly and completely. 

It is a matter also of every-day experience that to stop in a crowded room — a 
ball-room, a theatre, or a church — entails headache, poorliness, loss of appetite, and a 
general feverishness, which in some persons will persist for twenty -four hours or more. 
To habitually spend one's time in an atmosphere of this kind certainly entails a 
permanent and serious impairment of the health. 

The most notable instance on record of human beings being exposed to the 
poisonous influence of an atmosphere fouled by respiration is afforded in the history 
of the imprisonment of 146 Englishmen in the Black Hole of Calcutta, on June 
26th, 1756. One of the survivors, Mr. Holwell, a surgeon in the employ of 
the East India Company, has given a most graphic account of this terrible episode 
of war, and the following facts with regard to it are taken from his well-known 
letter, written "From on board the Syren sloop, the 28th of September, 1757," and 
addressed to W. Davis, Esq. When the doors of the " Black Hole " were opened 
and the prisoners driven in, Holwell was among the first to enter. He says, " I 
got possession of the window nearest the door, and took Messrs. Coles and Scott into 
the window with me, they being both wounded (the first, I believe, mortally). . . . 
Figure to yourself, my friend, if possible, the situation of 146 wretches, exhausted 
by continual fatigue and action, thus crammed together into a cube of about 
eighteen feet, in a close sultry night in Bengal, shut up to the eastward and 
southward (the only quarter from whence air could reach us) by dead walls, and by 
a wall and door on the north, open only to the westward by two windows, strongly 
barred with iron, from which we could receive scarce the very least circulation of 
fresh air. . . . Various expedients were thought of to give more room and air. To 
obtain the former it moved some to put off their clothes. This was approved as a 
happy notion, and in a few minutes I believe every man was stripped (myself, Mr. 
Court, and the two wounded young gentlemen by me, excepted) ; every hat was put 
it? motion to produce a circulation of air, and Mr. Baillie proposed that every man 
should sit down on his hams. This expedient was several times put in practice, 



956 HYGIENE. 

and at each time many of the poor creatures, whose natural strength was less than 
others, or had been more exhausted, and could not immediately recover their legs as 
others did, when the word was given to rise, fell to rise no more ; for they were 
instantly trod to death or suffocated. When the whole body sat down they were 
obliged to use many efforts before they could put themselves in motion to get up 
again." 

They were immured at 8 p.m., and before 9 everybody's thirst became intoler- 
able. The cry was for water, which was brought by the guards, and handed in 
through the bars in hatfuls, the guards deriving much enjoyment from watching the 
poor wretches fighting for the water, which thus, by rousing their passions and 
excitability, proved a curse instead of a blessing. 

"From about nine to near eleven, I sustained this cruel scene and painful 
situation, still supplying them with water, though my legs were almost broken with 
the weight against them. By this time I myself was very nearly pressed to death, 
and my two companions, with Mr. "William Parker — who had forced himself into 
the window — were really so. ... I came into the prison without coat or waist 
coat ; the season was too hot to bear the former, and the latter tempted the avarice 
of one of the guards, who robbed me of it when we were under the verandah. . . . 
I was observed by one of my miserable companions on the right of me, in the 
expedient of allaying my thirst by sucking my shirt-sleeves ; he took the hint, and 
robbed me from time to time of a considerable part of my store, though after I 
detected him I had ever the address to begin on that sleeve first, when I thought my 
reservoirs were sufficiently replenished, and our mouths and noses often met in the 
contest. This plunderer, I found afterwards, was a worthy young gentleman in the 
service, Mr. Lushington, one of the few who escaped from death, and has since paid 
me the compliment of assuring me he believed he owed his life to the many 
comfortable draughts he had • from my sleeves. I mention this incident, as I think 
nothing can give you a more lively idea of the melancholy state of distress we were 
reduced to. Before I hit upon this happy expedient, I had, in an ungovernable fit 
of thirst, attempted drinking my urine, but it was so intensely bitter there was 
no enduring a second taste, whereas no Bristol water could be more soft or pleasant 
than what arose from perspiration. By half an hour past eleven, the greater part of 
those living were in an outrageous delirium, and the others quite ungovernable, 
few retaining any calmness but the ranks next the windows. . . . Others who 
had yet some strength and vigour left made a last effort for the windows, and 
several succeeded by leaping and scrambling over the backs and heads of those in 
the first ranks, and got hold of the bars, from which there was no removing them. 
Many to the right and left sank with the violent pressure, and were soon suffocated, 
for now a steam arose from the living and the dead which affected us in all its cir- 
cumstances, as if we were forcibly held with our heads over a bowl of strong volatile 
spirit of hartshorn until suffocated ; nor could the effluvia of the one be distinguished 
from the other, and frequently when I was forced by the load upon my head and 
shoulders to hold my face down, I was obliged, near as I was to the window, instantly 
to raise it again to escape suffocation." 

Holwell suffered acutely from others, in their efforts to get to the window 



957 



clambering on his shoulders and there remaining. At last his strength gave way, 
and he left the window in the resolve to die in comparative peace. 

" I was at this time sensible of no pain and little uneasiness. I can give you no 
better idea of my situation than by repeating my simile of the bowl of spirit of 
hartshorn. I found a stupor coming on apace, $&d laid myself down by that gallant 
old man, the Rev. Mr. Jervas Bellamy, who lay dead with his son, the lieutenant, 
hand in hand, near the southernmost wall of the prison." 

Shortly afterwards the narrator became himself insensible. At last, at six m 
the morning, an order came for the release of those who remained still alive. " The 
little strength remaining among the most robust who survived made it a difficult 
task to remove the dead piled up against the door, so that I believe it was more 
than twenty minutes before we obtained a passage out for one at a time." 

There were 123 dead, and 23 alone survived. These 23 survivors all suffered 
from an attack of fever after their liberation, which was accompanied by a copious 
eruption of boils all over the body. Holwell describes himself as suffering from 
"high putrid fever," and as too weak to stand. He also suffered from an out- 
break of boils from head to foot, and on July 7th he was seized with a violent 
attack of "gout" in one foot 

This febrile condition was probably the result of exposure to the organic 
effluvia. 

Happily cases of acute poisoning from foul air, at least on such a scale as 
that just described, are infinitely rare, but cases of slow poisoning from the 
same cause are, we fear, by far too- common, both in the ill-constructed and 
unventilated dwellings of the poor, and in over-crowded workshops, workhouses, 
school-rooms, ball-rooms, churches, and theatres. 

There are few things more astonishing than the poisonous misery to which the 
world of fashion submits, night after night, during our winter season. A fashion- 
able entertainment — a regular "London crush" — almost recalls the piteous story 
told by Mr. Holwell. Five or six hundred people jammed into a room calculated to 
contain perhaps a tenth part of them, and probably as many gas-lights as there are 
guests using up the oxygen, and adding their quota of carbonic acid to the already 
over-charged atmosphera Is it surprising that windows stream with water, and the 
guests drip with perspiration, and in the very height of this misery fly for relief to 
those poisonous compounds called champagne? Is it to be wondered at, also, that 
scented soap3 and perfumes scarcely suffice to mask the odour of organic effluvia; or 
that those who habitually participate in these delusive joys are among the most 
regular of the doctor's patients 1 Why it is that we so persistently turn night into 
day, and prefer to take our pleasure, not only in crowds, but after dark, when the air 
of our rooms is fouled by the combustion of gas and candles, is certainly a most in- 
scrutable thing. " Early to bed and early to rise, make a man healthy and wealthy 
and wise." The reason for this is not far to seek, since he who so acts up to this 
dogma, by seizing on the hours when artificial light is not necessary, avoids the breath- 
ing of the carbonic acid which is given off during the combustion of the midnight oiL 
The needless expenditure of coals and gas which our senseless fashions entail 
must be enormous ; and it would be an interesting inquiry for the statistician to 



95& 



HYGIENE. 



ascertain wliat would be saved in the course of one of our seasons if it were to 
become fashionable to rise at five, and breathe the pure morning air, instead of, as 
is too often the case, retiring to rest at that hour. 

Besides respiration and combustion, air is fouled in other ways, and among these 
we may mention the various gases given off during decomposition, such as ammonia 
and sulphuretted hydrogen. These are the gases which, under the form of " sewer 
gases," escape into our houses, and which are given off from dung-heaps, cess- 
pools, and other similar sources. It is probable that they give rise to headache 
and diarrhoea, if not to more serious forms of ill-health. In certain districts — 
particularly marshy districts and in hot countries — a something called malaria 
is given off into the air which causes ague and intermittent fever in those who 
breathe it This malaria is supposed to be a gas, but its exact nature is not 
known. 

Particles of " dust " are probably carried immense distances by the wind, and 
ships at sea have had their decks covered with the dust of larva emitted by a 
volcano two hundred miles off. 

Yery many microscopic animals and plants have been detected in the dust of 
the air, and it is supposed that the germs of disease may sometimes be carried in 
the same way. 

" ISTo occupation can be chosen in which there is perfect assurance of immunity 
from all the ills to which flesh is heir. Not one can prevent the inevitable issue 
of old age and death at last. These come in every calling. 

" Yet there is much to choose in occupations between the kind and degree of the 
danger. Some occupations are unhealthy from first to last, and for all constitutions; 
others are only exceptionally unhealthy la some the danger is always present, 
no matter what precautions are taken. It is impossible to make some trades 
healthy by any contrivance — such, for instance, as knife-grinding, and diamond- 
cutting, and soap-boiling, and many more in which the peril to vital organs is 
direct and constant. All the statistics of steel factories and laboratories cannot 
prove that it does no harm to the lungs to be constantly inhaling metallic dust or 
poisonous gases. An intelligent chemist knows that he risks his life in many ways 
in working in his laboratory, as much as a locomotive engineer knows that he 
risks his life in driving his engine. A large number of the occupations of civilised 
life, important, indispensable, involve this constant danger, from which there is no 
escape, which belongs to the occupation. Cotton-spinning, flour-grinding, watch- 
making, shoe-making, lace-making, the trade of the painter, of the soldier, of the 
sailor, of the physician — how many trades of the highest need in social life are 
full of hazard to health and safety ! It might almost be said that fully one-half of 
the various callings of civilised man, in the way in which they are of necessity 
carried on, are direct temptation to disease. AYith all that can be done to free 
it from nuisance, every large factory and mill, for almost any product, must 
aid disease. There will be dust in the air, if nothing worse, and probably 
poisonous odours, as deadly as malaria from the swamp and the sewer. The 
most precious treasures, the most delicate ornaments, are wrought in unhealthy 
workshops. 



air. 959 

" It may be -worth while to mention the characteristics of occupations by which 
they are unquestionably bad for health ; the evils in them which none will deny. 
There are some adjuncts of different kinds of labour which are always injurious, 
the harm of which cannot be argued away. Dust first, and on the whole, worst, 
which is the plague of more callings than any other plague, in the field, on the 
road, in the shop, in the house. George Herbert sings that sweeping a room, in 
accordance with the Divine law, is a fine action ; but dust injures the lungs of a 
house servant as much as the lungs of a screaming jockey on the race-course. 
Dust is not healthy in any place or of any kind, whether it be of a potato-patch, 
or a woollen-mill, or a grist-mill, or an iron-miii, or a carriage on the highway, or 
a carpet in the drawing-room, or of books in the study. Any process that raises 
a dust is unwholesome, and is at best a necessary eviL The rule is universal. 
"Wood-dust and coal-dust, lime-dust and saw-dust, shreds and smoke, the dust of 
metals and the dust of animalculse, are all nuisances, to use no stronger word, 
considered from the health point of view. No exception can be made in favour 
of any variety of dust. That kings and cardinals snuff the dust of tobacco does 
not rescue this aromatic powder from the common sentence. Just in proportion 
as any occupation involves dust-making, other things being equal, just in that 
proportion is it unwholesome. The habit of the desert Arabs in washing them- 
selves with sand where they cannot find water is not contradiction to this general 
rule. Their act is only religious and symbolic. All dust is properly unclean and 
makes one unclean — even the dust of diamonds. 

" Dust is the omnipresent nuisance of labour. Filth is less so, but is more 
dangerous in proportion to its quantity. Any labour which is carried on in filthy 
surroundings, no matter how inevitable these are, is unhealthy. Work is not 
good in a pigsty, or on a dunghill, or in the close quarters of a tenement house. 
The cleansing of sewers is not a desirable service, on grounds of health. The 
dredging of harbours is more useful than healthful. All the cordials of the quack 
doctors cannot save from malady the unfortunate women who have to ply their 
stitches in the summer months in the warm streets of New York, where corruption 
festers in the streets, and where rivers of filth run along the pavement. A great 
deal of the work of men, and women, too, nevertheless, is done in squalid surround- 
ings, which are all the worse that they have ceased to offend the senses and to 
excite disgust. The most repulsive of factories often are those which are almost 
ironically called "refineries," refineries of oils and of sugars, in which the finer senses 
are constantly vexed, and the workmen become wonted to foulness. Daniel 
Webster loved to walk among his cattle, and smell their sweet breath, and stroke 
their sleek skins, but he left to his workmen the unsavoury task of cleaning their 
stalls and purifying their beds. Labour which is unclean is necessarily unhealthy 
to that degree, no matter how necessary it may be. It may not degrade one 
who does it from honourable motives, but it exposes him to the risk of pollution 
as much when it is in the care of elephants or of lions as when it is in the care 
of swine or poultry. The stable of a President is no safer than the stable of a dray 
man." — {Influeuce of Occupations upon Health. An Essay by C. H. Brigham, M.D.) 

From what we have said about the impurities of the air, and the evils that they 



960 HYGIENE. 



cause, it will be evident that we should spare no efforts to ensure for ourselves a 
plentiful supply of the purest air that can be obtained. 

This is best got by living as much as possible in the open air ; and in the 
summer months it is a good plan to make use of any verandah or balcony with 
which a house may be supplied, and to take meals and work in it, in preference to 
the rooms, which must be closer and less bountifully supplied with air. The very- 
best rooms, no matter how carefully they may be ventilated, come very far short of 
the open air itself. 

In this country it is nearly always possible to have an open window all the 
year round, especially in rooms which have windows on two sides, since there need 
be no draught from an open window in a wall away from the wind. A window 
open at the top — no matter to how small an extent — has a wonderful effect in 
keeping a room fresh, and no one who has become accustomed to the luxury of a 
constantly open window can tolerate the stuffiness of a close room. 

It is of an evening when the gas is lighted, the windows and shutters closed, 
and the family draw round a blazing fire, that the greatest errors in the matter of 
ventilation are committed. The fire, of course, has a powerful aspirating effect 
Its need for air is great, and as a consequence a powerful draught is drawn through 
every chink — under the door, chilling the feet of those whose cheeks are glowing in 
the blaze ; through the keyhole, which serves as a sort of iEolian harp as the wind 
rushes through it ; and through every cranny in the windows which has been left 
by bad carpentering and failing putty. It is a well-known fact that in a badly- 
constructed room, where no provision has been made for ventilation, the discomforts 
of draught increase in proportion to the size of the fire. 

At an ordinary city " dinner party," when eighteen people are crammed into 
a space not big enough for six, when the lights are increased perhaps four-fold, and 
the servants in a like proportion, the resulting headache is due quite as much to 
the foulness of the air as to any indiscretion in eating or drinking. 

It is a comparatively easy matter, however, to keep a room at least tolerably 
ventilated without a draught. One of the chief things to aim at is, that the 
delivery of the air shall be as vertical as possible — that is, that the air shall be 
directed towards the ceiling of the room. This is done by providing what is known 
as a "louvre-opening" — i.e., an opening communicating with the external air, but 
protected internally by a slanting board which directs the in-coming air in an 
oblique upward direction. 

In some "French" windows this is well provided for. The bottom of the 
window opens like a folding-door while the two top panes are made to open inwards 
from a hinge fixed at their lower border, and thus the louvre-opening is provided 
in the window itself. 

A very good system of vertical delivery is that lately insisted on by Mr. Tobin, 
and which is known as " Tobin's method." It consists in providing a tube running 
through the wall. The vertical part of the tube is about five feet high, so that the 
upper opening is well above the heads of people sitting in the room. As the 
temperature of the air in the room increases, the air from outside rushes in, and 
being delivered vertically, it travels in a compact column towards the ceiling, against 



961 



which it impinges, and being " scattered " as it were by the force of impact, it 
diffuses itself gradually throughout the air in the room. Both ends of the tube 
should be protected by gratings, so that no putrescible matter can be placed in it 
either by design or accident. The tube should also be swept at intervals and 
thoroughly cleansed. 

A very good method for providing a vertical delivery of air into a room, 
provided the room be fitted with sliding sash windows, is to place a piece of wood 
in the lower part of the window-sill, which shall completely fill it up and prevent 
the lower sash from descending to its full extent In this way an open chink is 
left between the upper and lower sashes at the point where they are usually locked 
together, and through this chink, which is nearly an inch in width, a stream of air 
flows compactly towards the ceiling, and is there scattered. 

If air is allowed to flow into a room it must also be allowed to flow out of it, 
and it is as necessary to provide outlets for the air as it is to provide inlets. It is, 
we believe, Mr. Tobin's idea that if provided inlets are made in a room, the air 
may be left to find its own way out This opinion, however, is not held by the 
majority of the authorities on ventilation. A capital outlet for air is usually the 
chimney, and a room provided with vertical inlets and a fireplace is sure to have a 
constant stream of air flowing from one to the other. If there be a fire in the grate 
the current of air is, of course, at a maximum, but with or without a fire the current 
is sure to exist 

The " register " of a stove should never be closed. It is a bad plan to have * 
register at alL If the register be closed, the chief outlet for air is closed, and a 
proper ventilation of the room is impossible. Whenever a room which has been 
used smells fusty and close always look to the "register," and if necessary o} en it. 



EXERCISE. 

Sound health without a due exercise of all the bodily functions is impossible. 
All our organs were made to be used. Some of them are beyond our control, and 
oontinue to do their appointed work in spite of ourselves. The heart and lungs 
cease to work only with the cessation of life, and those who imitate, as it were, 
these involuntary organs, and continue to the last to transact the business of life, be 
it mental or be it physical, provided they do not fall into the error of over-taxing 
their bodies, generally enjoy, not only the longest, but the healthiest of lives also. 
Although in general parlance we limit the term " exercise " to the exercise of the 
muscles, it must, nevertheless, be borne in mind that this restricted use of the word 
is not accurately scientific. Every part of the body needs its due amount of exercise 
and repose, and if either the one or the other be denied it, impairment of constitu- 
tion must result. If mind, muscle, or stomach has work put upon it beyond its 
powers, a failure of those powers, more or less permanent, will result, and a similar 
impairment will infallibly result if we are not careful to allow each its proper 
exercise and function. 

Physical exercise, the exercise that is of the muscles, stands apart from other 
forms of exercise in this, that it entails the exercise of other organs and functions Ml 
61 



962 



HYGIENE. 



well, and it may almost be said that physical exercise entails the exercise of all the 
internal organs, exclusive perhaps of the brain; and although there is certainly no 
antagonism between a proper mental and physical development, still the two bear no 
necessary relation to each other, and athletes have not often been remarkable for 
their intellectual acquirements. 

The effects of muscular exercise are, for the most part, perfectly obvious to the 
most superficial observer. The beats of the pulse increase in number and in force, 
which means that the heart is working harder than when at rest ; the breathing sets 
quicker and deeper, which shows that chemical change has increased in amount, 
causing an increased demand for fresh air and its contained oxygen ; the surface of 
the skin gets red, manifesting an increased fulness of the fine blood-vessels contained 
in it ; and the proper functions of the skin, as evidenced by copious perspiration, 
are very largely increased. Another great evidence of the increased chemical 
change going on in the body is the increase of warmth, and the agreeable sensation 
of heat, even in the extremities. The actual temperature of the body, as measured by 
a thermometer, is not increased during exercise — a fact which is owing to the cooling 
influence of the constant evaporation of perspiration which is taking place at the 
surface. If it were not for this wonderful provision of nature, by which a cooling 
influence is provided to counteract the necessary production of heat involved in 
exercise, exercise would become impossible. The evaporation from the skin causes a 
demand for water in the body, and hence thirst is one of the most immediate results of 
exercise. In a healthy person hunger is almost as marked as thirst, but it is to be 
remarked that hunger is not observable if the body have been over-taxed, and even 
in healthy persons it is very often not acutely felt until after the body has been 
allowed an interval of repose. The final result of exercise is fatigue. Fatigue in 
the muscles is evidenced by loss of power, some pain and " stiffness," and the general 
fatigue of the body by an irresistible inclination to sleep. 

The increase in the respiratory function during exercise is capable of accurate 
measurement, and, thanks to the untiring experiments of Dr. Edward Smith, 
we are able to lay before the reader very exact figures, which may be taken to 
show the rate of chemical change which exercise of various kinds demands. Dr. 
Smith measured the amount of air drawn into the lungs during measured intervals, 
and, taking the amount required by the body during absolute repose as his unit, he 
compiled the following table : — 



Lying position 


• • 


1" 


Sitting „ 


• • 


. 1-18 


Standing „ 


• 


, 1-33 


Singing „ 


« 


, 1-26 


Walking 1 mile 


per hour , 


1-9 


» 2 „ 


»» « 


2-76 


n 3 „ 


» 


3-22 


„ and carrying 34 lb. 


3-5 



Walking and carrying 62 lb. 

„ „ 118 1b. 

„ 4 miles per hour 

„ 6 
Biding and trotting • 

Swimming • • 

Treadmill • • 



3-84 
4-75 

5-00 
7-00 
4-05 
4-33 
6*50 



This greatly increased demand for oxygen in the body during exercise is neces- 
uitated by the change of tissue and rapid oxidation going on in the muscles, and 
one lesson which should be learnt from these figures is this 4 that hard labour is beat 



EXERCISE. 963 

carried on in the open air, and that if the apartments in which work is done be not 
properly ventilated and thoroughly supplied with fresh air, it is impossible for the 
labourer to put forth his maximum amount of energj-, an 1 thus the master is deprived 
of the full working-power of his workmen. 

The exercise of a muscle, if it be not excessive, causes an improved condition of 
the muscle — increase of firmness, bulk, and power. This is a well-known and very 
obvious fact, the leg of the dancer and the arm of the blacksmith being the well- 
recognised examples of this truth. For the production of this improved state of 
nutrition, however, it is important that the muscle be not over-worked, for if this be 
done, wasting and impairment of nutrition will assuredly result. Every period of 
muscular action or contraction must alternate with a period of relaxation, and it 
is supposed that it is during this latter period that the nourishment of the muscle is 
provided for. There must be a due relation between tension and repose, or impair- 
ment of nutrition results. If the period of tension be in excess, the same result is 
brought about as when the excess is on the side of repose. It is a common observa- 
tion that we can do much more work if our muscular action alternate with muscular 
relaxation. Thus the blacksmith will continue to wield his hammer for an hour or 
more, and stroke follows stroke with equal force, and without intermission. If, 
however, the blacksmith were to attempt to hold his hammer at arm's length con- 
tinuously, without allowing for the necessary intervals of muscular repose, he would 
find that intense muscular fatigue would result in a very few minutes, and from this 
fatigue he would be some hours in recovering. 

Now, the heart is an organ which is always at work, and which is, at first sight, 
an apparent exception to the rule necessitating the alternation of intervals of repose 
with intervals of work. This, however, has been shown not to be the case, for 
between every beat or impulse of the heart — i.e., every heart's throb — there is an 
interval of absolute rest, during which the waste caused by action is repaired. This 
interval of rest has been estimated at about one-third of the time occupied by 
the heart in one revolution — that is, from the commencement of one contraction 
to the commencement of the next. In this interval or " pause," as it is technically 
called, the heart is asleep, as it were, and it is a curious fact to notice the relation 
between the sleeping and waking moments of the heart, and the sleeping and 
waking moments of the entire man, for if all the time occupied by the heart in its 
pauses in the twenty-four hours be added together, they amount to something like 
eight hours, which is the time devoted to sleep by the average of the human race. 

This necessity for intervals of relaxation, perhaps, serves to explain why it is that 
man is made bilaterally symmetrical, or double, for by using first one side and then 
the other he is enabled to continue his work for longer periods than otherwise would 
be the case, for while the muscles on one side of the body are contracting, those on 
the other side are getting their necessary repose. To many people, perhaps to all 
people, it is not so fatiguing to walk as it is to stand erect in one position. The reason 
would seem to be that in walking we use each side of our body alternately, while in 
standing we use both sides simultaneously, and the muscles which keep the body 
erect being subjected to a prolonged strain, the sense of fatigue very quickly 
supervenes. 



964 HYGIENE. 

The health of every individual part of the whole body being necessary for the 
perfect health of the whole body, and exercise being undoubtedly necessary for the 
healthy well-being of our muscles, it follows that we should be careful to exercise all 
the muscles of the body. Many a man whose occupation is sedentary keeps himself 
well by walking to and from his office or place of business, and it is obvious that 
this amount of exercise does keep a man fairly healthy. It is equally obvious, how- 
ever, that our sedentary classes are noted for narrow chests and shoulders, and it is 
only reasonable to suppose that if they were as careful to exercise their upper limbs 
as they generally are to exercise their lower, this defect of figure would soon dis- 
appear. The great merit of the English game of cricket lies in the fact that it 
leaves no part of the body unexercised. Arms and legs are equally used, and, in 
batting and fielding alike, every muscle of the trunk is frequently brougnt into play. 
Quickness of vision and of thought, judgment, boldness, brute-strength, and delicacy 
of muscular effort, each receive their share of training, and the best cricketer is 
presumably the man who has these qualities meeting in due proportions in his 
own person. 

The great Duke of Wellington is said to have stated that the battle of Waterloo 
was won in the cricket fields of England ; and it is certain that we are extremely 
fortunate in having such a pastime which, while it requires a vigorous exercise of 
muscle, is by no means deficient in the calls which it makes <m the mental activity 
of its votaries. 

Swimming is one of the best of exercises, because it involves an equal use of the 
arms and legs, and since it is practised in a state of nakedness the limbs have a 
freedom of motion which they seldom attain in other exercises. The fashion, which 
has become pretty general of late, of teaching ladies to swim, is one that should be 
encouraged in every way, and, indeed, we wish it were of the American young 
lady as well as of the English, to be fond of athletic exercises. The introduction of 
u croquet n some years since, a game which encouraged our wives and daughters to 
Bpend their days in the fresh air and gentle exercise, was a decided gain to the 
British nation, and its substitution in later times by " lawn tennis," a game which 
necessitates not only more active movement, but calls upon the upper as well as the 
lower limbs, and entails much of the mental quickness of cricket, was a still greater 
gain. 

For the well-being of our race, it is an absolute necessity that our women should 
be strong and active, and physically perfect as well as the men. Unless this be the 
case, a physically perfect progeny is an obvious impossibility. It is an encouraging 
fact also to note the heredity of athleticism as well as other qualities, and the 
instances of a genius for cricket " running in families," and descending from one 
generation to another, are too common to need particularising. Among games 
necessitating the use of all four limbs we must mention "quoits," "tennis," "base- 
ball," " bowls," and " skittles," and with regard to the latter, we trust that no stupid 
notions of " vulgarity " will allow a really fine, and undoubtedly useful, old English 
pastime to die out. Bicycling has the defect that it leaves the upper limbs com- 
paratively unexercised. " Dancing " is a pastime which by all means should be 
encouraged, as in it we move our limbs in obedience to a sense which otherwise is 



EXERCISE. 



965 



not brought into relation with exercise. The pleasure of the rhythmic movement of 
the dance is one which most of us appreciate, and the fact that the muscular move- 
ment of dancing must be orderly and rhythmical serves to educate the muscles, to a 
certain extent, in precision of movement. Good dancers are seldom clumsy, whicii 
means that they have a good control over their voluntary movement. It is a well- 
known fact, that in the Middle Ages music was employed to cure not only disorders 
of the mind, but also disorders of movement. The disorderly movements which 
followed the bite of the tarantula were only cured by measured movements performed 
to the strains of a particular melody. It is also worthy of note, that an appreciation 
of rhythm is one of the last of the intellectual powers to disappear. In idiot asylums 
there are very few who cannot appreciate the cadences of a simple tune, and it is 
tolerably certain that many of the lower animals — horses for example — move with 
greater gaiety and elasticity to music. The motive power for soldiers on the march 
which is got from a military band is recognised by all military authorities ; and it 
was one of the most remarkable points in the performance of the American pedes- 
trian, Weston, that he was accustomed to make use, as it were, of music to help him 
on his way when he had become jaded by prolonged exertion. This power of music 
is as wonderful as it is undoubted, and the only explanation which the writer would 
offer is this, that a well-timed tune enables us more readily to regulate the periods 
of muscular contraction and muscular relaxation. 

With regard to the exercise of dancing, however, the writer would utter a word 
of caution. It is much to be regretted that dancing in this country is almost 
invariably earned on in rooms in which the atmosphere is stifling, and the benefit 
derived from the exercise is more than counterbalanced by the evil resulting from 
foul air. Those who spend night after night in hot ball-rooms are guilty of an 
almost suicidal act ; and those who spend six and eight hours at a stretch in this 
atmosphere are guilty of a gross intemperance, which surely will do them harm. 
While, therefore, the author recommends dancing as an exercise, he would lay 
stress on the advice that thia exercise should be in moderation and in a pure air. 
As for the fashionable "ball," or soiree, or "dancing party," as at present conducted, 
he can only regard it as an unmitigated nuisance, and an evidence of foolish 
ignorance. 

The Germans are more methodic than we are in the physical training which 
they give their youths ; and gymnasia, in which young men are put through a regular 
course of physical tiaining, are tolerably common. These gymnasia are undoubtedly 
useful institutions, and have an important influence on the physical condition of 
the race. Every man in Germany is compelled also to go through three years of 
military service, and during that time (from eighteen to twenty-one) his physical 
development is very thoroughly attended to ; and there can be no doubt that the 
German military system must have a most beneficial influence upon the physical 
development of the male population. Whether this good is more than counter- 
balanced by certain evils inseparable from the military system it is not for us to 
consider in this place. We trust, however, that gymnasia will become more 
common in this country than at present is the case ; and we hope before long to 
see no school or college without some provision for giving a methodic training fco the 



966 hygiene. 

body as well as the mind. It seems to be of the utmost importance, also, that girls 
should be incited towards exercise as well as boys. In the upper and middle strata 
of society the girls certainly get, if they choose, a fair share of physical amusement, 
but in the lower strata we doubt if this all-important matter is sufficiently attended 
to. The two most beautiful ladies of the writer's acquaintance, who have each of 
them a family of well-formed, beautiful, and healthy children, were both of them 
remarkable in their girlhood for their athleticism, and although by the exercise they 
gave their bodies they have been enabled to transmit like qualities to their children, 
they have not a less share of womanly grace and of feminine accomplishments than 
falls to the lot of the average of womankind. 

A very important question with regard to exercise is the amount which should 
be taken, and to this question we cannot expect to get a perfectly accurate reply. 
The body is always at work, and both during sleeping and waking certain of its 
muscles are never quiet. These are the muscles which are employed in respiration 
— the heart, whose muscular pump never ceases to contract ; and the muscular 
walls of the bowels, which, although not always at work, are very often so, even 
when the body generally is enjoying absolute repose. This exercise, which is 
beyond our own control, and which goes on in spite of us, has been called the 
interned work of the body, while the voluntary work has been called the external work. 
It has been found impossible to discuss the question of the amount of exercise 
without having some standard expression for the amount of work done. The 
unit of work employed in England is the foot-ton, or the labour required to raise 
one ton weight one foot in height. In France and on the Continent generally 
the unit is the kilogramme-metre, or the labour required to lift a kilogramme 
(about 2 lbs.) to the height of a metre (about thirty-nine inches). Most of our exact 
knowledge on this point is due to Professor Haughton, of Dublin, who, being equally 
distinguished as a mathematician . and a physiologist, has been able to reduce this 
subject to something like exactitude * According to this authority the work done by 
the heart alone is equivalent to 122 foot-tons in the twenty-four hours, while the work 
done during respiration is equal to eleven foot-tons more. Other authorities place the 
internal work higher, and Dr. Parkes is inclined to regard the whole internal work 
of the body as equivalent to 260 foot-tons. The following estimates have been made 
by Haughton of the actual work involved in a day's labour (eight hours) of various 
kinds : — 

Pile-driving 312 foot-tons. 

Porter carrying goods and returning unladen , , . 325 „ 

Turning a winch • • . 374 „ 

Pedlars always loaded • • • 303 „ 

Paviours at work •••• 352 „ 

Shot drill (three hours) 160*7 „ 

Walking one mile on the level, the weight of the man being 150 lhs. 17*67 „ 

Walking ten miles 176*7 „ 

Walking one mile and carrying 60 lhs . 24*75 „ 

Walking ten miles „ „ . 247*5 „ 

Using these standards and practically comparing the work of one man with the 
work of another, and observing not only what was stated to be hard, but also what 



EXERCISE. 967 

appeared to be so to the observer, the conclusion has been arrived at that an 
average day's work is 300 foot-tons ; that 400 foot-tons is a fairly hard day's work, 
and 500 foot-tons excessively hard (Parkes). 

Parkes further says, " Looking at all these results, and considering that the 
most healthy life is that of a man engaged in manual labour in the free air, and 
that the daily work will probably average from 250 to 350 tons lifted one foot, we 
can perhaps say as an approximation that every healthy man ought, if possible, to 
take a daily amount of exercise in some way which shall not be less than 150 tons 
lifted one foot. This amount is equivalent to a walk of about nine miles ; but then, 
as there is much exertion taken in the ordinary business of life, this amount may 
be, in many cases, reduced. It is not possible to lay down rules to meet all cases, 
but probably every man with the above facts before him could fix the amount 
necessary for himself with tolerable accuracy." 

Not only has the amount of work to be considered, but the rate of work also, 
and great care must be taken that, in the desire of getting enough exercise in the 
twenty-four hours, it be not taken too quickly. To take exercise too quickly 
is like bolting one's food, and in both cases the end and aim of exercise and nutriment 
is defeated. It is far better to distribute one's exercise over the day, if such a 
course be possible, and an hour in the morning and another in the afternoon is 
better than attempting to concentrate one's exercise into two hours of excessive 
work. We may perhaps, with advantage, make a few remarks on the question of 
clothing and feeding during exercise. 

It is of great importance that the lungs and heart, which are called upon for very 
much extra work, should be allowed as much room as possible for free play, and 
therefore anything at all tight round the chest or waist must be absolutely prohibited. 
All restraint on the limbs must be, as far as possible, removed ; and such garments 
as are worn must be as loose as possible. Flannel is the best material, since it absorbs 
the increased amount of perspiration, and prevents chills. It is very important to 
remember to put on warm clothing directly the exercise ceases, and if the clothes be 
damp from exertion to change them, and rub the body dry. If these simple and 
obvious precautions were attended to, dangerous chills after exercise would be 
avoided. 

Diet is an important question in relation to exercise, and there can be no doubt 
that many grave errors have been committed by trainers in the diet which they have 
allowed to athletes under their care. The mistake has been in restricting the diet 
too exclusively to nitrogenous matter, under the mistaken notion that the chief end 
of food was to repair waste. Undoubtedly nitrogenous matter in liberal quantities 
is necessary for a man in training, since the call upon his nitrogenous tissues is very 
great. Force producers are equally necessary, however ; and no greater mistake can 
be made than in denying fats and star dies. Provided that the food be of a whole- 
some and simple kind, and not excessive in quantity, the man's appetite and in- 
clination is the best guide in the selection of a diet. Good roast or boiled meat, 
bread, potatoes, green vegetables, and farinaceous puddings made with milk, together 
with stewed fruits, may all be given with advantage. If green vegetables and 
fruits be denied, constipation and " training boils " are veiy apt to interfere with work. 



968 HYGIEN*. 

No man should eat too soon after exercise, or when the body is fatigued. Under 
these circumstances, there is often not sufficient force to properly digest the food, 
and the troubles of indigestion will probably cause loss of sleeping power, if no more 
serious derangement. 

CLEANLINESS AND CLOTHING. 

Cleanliness is one of the chief means of securing and retaining health, and where 
cleanliness does not exist, perfect health is almost impossibla Unless the skin be 
kept clean, its functions are not properly performed ; and the functions of the skin 
are as important as the functions of any other organ of the body. The most perfect 
way, probably, of cleansing the skin is to cause perspiration by exercise, and thus, 
as it were, flush out the innumerable pores with which it is studded, and then wash 
off the perspiration by immersion in water, accompanied by the movement of swim- 
ming. There can be no proper cleansing of the skin without an occasional tolerably 
copious perspiration, and this is one of the most cogent arguments in favour of brisk 
exercise. 

Sweat is composed chiefly of water— i.e., water constitutes 9,956 parts out of 
every 10,000. The remaining 44 parts are composed of 25 parts of salts, 18*8 parts 
of organic matter (scales from the skin, <fcc), and the remaining parts of urea (a 
nitrogenous body found in the urine) and fat. 

Sweat readily decomposes, and very soon becomes offensive ; and clothing 
saturated with sweat, if not washed, becomes unwholesome for the wearer, and 
offensive to others. 

There are many skin diseases which are directly attributable to want of 
cleanliness, and there is no disease of the skin which is not aggravated by it. 

It is particularly necessary to cleanse carefully the skins of young children. 
The perspiration is very apt to accumulate and decompose in the folds of the skin 
of a fat baby, and irritating the skin, causes the disease known as intertrigo or 
chafing. 

The invention of soap was a great boon (no one can say how great) to the 
human race. By its aid we are enabled to obtain comparative cleanliness without 
an extravagant use of water. Soap acts chiefly by its solvent action on the 
superficial scales of the skin, which it dissolves, removing at the same time the 
adherent dirt. 

There can be no doubt that among people who are scrupulously clean there is 
far less risk of the conveyance of contagious diseases. 

It has been shown that house painters and plumbers very much diminish their 
risk of contracting lead colic if they are careful to wash their hands before eating 
their meals, a precaution which they too often neglect, and thus the salts of lead 
in the paint, adhering to the food, are taken into the system. 

Ophthalmia, or inflammation of the eyes, is another disease which is caused by 
want of cleanliness. In young children it is said to have been produced by the 
rubbing of the eyes of the child against the dirty breast of the mother. Ophthalmia 
is certainly conveyed from one to the other by the common use of towels, which 
get far too little washing, and by allowing the pillows and bed-clothes, which hav« 



CLEANLINESS AND CLOTHING* 969 



been, perhaps, fouled by the discharges from the eyes of a patient with ophthalmia, 
to be used, without previous wasliing, by another person. 

The plan is very general in this country to bathe the whole of the body every 
day with cold water, and to follow this complete ablution with friction of the surface 
with rough towels. This plan is a most excellent one, and cannot be too strongly 
recommended. It is not, however, to be pushed too far, and is not to be persisted 
in when the weather is severely cold. The best test is to be found in the person's 
own sensations, and the readiness with which the reaction, or glowing of the skin, 
follows the application of the cold. If a cold bath be not taken daily a warm bath 
should be taken at intervals, but the practice of bathing in warm water must not 
be indulged in too often — not oftener than once a week. 

The hair should always be kept scrupulously clean. The hair of children should 
be cut short, and should be washed with soap and water three or four times a week. 
If the hair be short this can be done without trouble, and since it is easily dried there 
is no risk of the child catching cold. The hair must also be carefully combed and 
thoroughly brushed. If this be not done, lice and vegetable fungi soon begin to 
breed and multiply in it 

Long hair is a luxury, and those who indulge in it ought to be prepared to give 
the necessary attention to it. The hair itself demands patient brushing and 
combing, and the skin of the head must be carefully cleaned with some oily or 
spirituous application. Soap and water is the best of all applications, even for 
a lady's hair, provided it be thoroughly rinsed in pure soft water afterwards. 

The mouth and teeth ought to be kept scrupulously clean. The teeth should bfe 
thoroughly brushed night and morning. If this be not done, food collects in the 
interstices between the teeth, and, rapidly decomposing in the warm mouth, causes 
the breath to smell offensively. The presence of decomposing matter in the cavity 
through which the greater part of the air is drawn for the supply of the lungs cannot 
but be highly prejudicial to health. The mouth should always be rinsed out after 
eating, and a little Tilden's fluid may advantageously be added to the water which is 
used for this purpose. If the teeth are imperfect, so that food readily lodges in them, 
they should be brushed after every meal. An observance of this plan would prevent 
many an attack of toothache. The frequent washing of the mouth prevents the accu- 
mulation of tartar on the teeth. The mouths of babies and young children should be 
washed with the most scrupulous care, in order to prevent ulceration and thrush. 

We now pass on to make a few observations on the subject of clothing. We 
have classed clothing and cleanliness together, because a great cause of the dirtiness 
of the body is the dirtiness of the clothing. Among the poorer classes in this 
country the underclothing is seldom changed sufficiently often, and among hospital 
out-patients the body linen is generally visibly black and smells offensively. If 
we should ever come to have a compulsory military service in this country, we 
should gain, among other advantages, that a large proportion of the male popula- 
tion would acquire the habit of keeping their persons and their clothing scrupulously 
clean. It is much to be regretted that the habit is not general among the working 
classes here, as it is among the ouvriers of France and Belgium, of wearing a readily- 
washable blouse and pair of trousers in which to do their work. These blouses 



970 HYGiEm 



may not be picturesque, but, at least, they are usually clean. The custom of some 
of our lower class workmen is to buy a coat, a hat, trousers, waistcoat, and boots 
at some grimy second-hand depot. These garments he wears, or rather inhabits, till 
they almost drop off him. He works in them, eats and drinks in them, and not 
unfrequently debauches and sleeps in them. They are never brushed, washed, or 
cleaned in any way, and only those who are brought in contact with them can form 
any adequate conception of their foulness. It certainly would be better if the 
blue cotton blouse were to become a little more general. The saving of money 
would be great, the gain in health would be great also. 

The object of clothing is to protect the body from extremes of heat and cold, and 
to retain the animal heat, and prevent its radiating too rapidly. 

The colour of clothing should certainly be of some light shade during the summer, 
since it is well known that the sun's rays are absorbed far more readily by dark 
than light colours. Excepting during the extreme heat of summer, the colour is not 
important. The covering for the head should be of a light weight, so as not to press and 
cause discomfort on the forehead. It should be high in the crown so as to enclose a 
good layer of air between the crown of the head and the crown of the hat. This ensures 
both warmth and coolness. It should be ventilated so as to allow a free circulation 
of air in its interior. The eyes should be shaded by a peak in front, or a brim of 
some breadth, and in hot weather when there is danger of sun-stroke the nape of 
the neck should be protected either by a peak, or one of those falling veils called 
puggerees. 

The head-dresses for men in the present day are tolerably sensible, and a great 
deal maybe said even in favour of the much-abused "stove-pipe hat." Its great 
fault is, that it presents too large a surface to the wind, and is not so durable 
as it ought to be considering its cost. It is inferior to the " deer-stalking" hat 
in not having a rounded crown, off which the wind readily glances. The " deer- 
stalker" is probably quite as strong, and as capable of resisting blows. It 
should be made tolerably high in the crown. As regards ladies' hats, when 
these are required for use rather than ornament (!) the same considerations 
should hold good. 

Underclothing should be of woollen material. These materials absorb the 
perspiration far more readily than cotton or linen. They absorb less heat, and 
allow less heat to pass through them from the body than either cotton or linen. 
Both for hot and cold climates they are to be preferred. In hot countries the 
woollen garments must be of fine texture, such as merino. The body should be 
completely covered with woollen under-vests, drawers, and socks. The white linen 
shirts which are very general are certainly a protection in a limited degree, but 
they must be looked upon mainly as decorative clothing. Clothing should allow of 
absolute freedom of movement to every part of the body. It must never be tight 
round the neck or the armholes, nor must it constrict the chest A man or woman 
should always be able to draw the fullest breath possible without feeling any restraint 
imposed either across the chest or in the waist. 

The habit of wearing stays or tight waistbelts, except in cases of disease, ought 
to be discontinued. It should be a legitimate inference that any woman requiring 



CLEANLINESS AND CLOTHING. 971 

these supports is not healthy. If she is healthy she cannot continue so for long if 
she persists in restraining the movements of her chest and abdomen with an 
apparatus of stout jean and steel. 

Coats should never be tight across the chest. The best form of coat for a man 
is the open jacket of boyhood, and next to this the so-called " evening coat " which 
permits great freedom of movement. A few years ago this garment was generally 
worn in the day-time, and in this respect the present writer is inclined to be 
laudator temporis acti. 

The neckcloth should always be loose. The collar should allow absolute freedom 
to the neck. The throat should never be coddled and over-protected. The more it 
is wrapped up the more it requires to be wrapped, and the greater is its liability to 
be affected by cold. 

Boots must be easy and allow absolute freedom to the foot. The measure for a 
boot should be taken when the weight of the body is resting on the foot — i.e., in the 
upright position, and not, as is too often the case, when the intending wearer is 
sitting down. The ankle boot now so generally worn is perhaps the best model. 
It is not too hot, and has not the fault of the shoe, of allowing the dust to get in 
over the "uppers." All boots should be stout enough to resist a moderate amount 
of wet. It is better to wear a stout boot than to trust to waterproof overshoes, 
which keep the feet very cold. The heel of a boot should not be too high, lest the 
weight of the body be thus thrown on the toes. We feel it is needless to point out 
the senseless absurdity of the fashionable ladies' boot, with its high heel and general 
want of room and all serviceable qualities. Without a projyerly-constructed boot there 
can be no proper exercise, and without exercise there cannot be health. 

It would be far better if the children of the poor, whether at home or in the 
various asylums and schools where they are congregated, were accustomed to go 
without shoes or stockings. This habit is easily acquired, and would certainly be 
better for them than cramming their tender feet into ill-made, clumsy boots, of such 
weight and construction that any active exercise is impossible in them. Chilblains are 
very troublesome to all children in pauper schools. This is because of the sluggish 
circulation through the feet, due to depressed general health and inability to take 
active exercise. Let the boots be discarded, and one cause of chilblains will disappear. 

Our remarks on clothing have been dictated solely from scientific considerations. 
As for " fashion," we can only say with Borachio, that he is " a deformed thief." The 
clothing of men has not undergone any great changes of late years, and the general 
tendency of " fashion " is towards increased simplicity. This we take to be the 
result of culture and mental training. As for the clothing of women, it is not two 
days alike, and the various changes are dictated neither by considerations of science, 
art, nor utility. When we see a fashionable lady limping along in high-heeled boots, 
with a hat of no possible service of any kind, with her dress trigged up behind in 
imitation of the anatomy of the Hottentot, and her train sweeping the horse-dung 
from the pavements, we feel that arguments addressed to her would be entirely 
useless. Let us hope that the " higher education " of which we hear so much may 
in time do something. Does any woman ever appear to greater advantage than in 
the simple riding-habit ? Verbum sap. 



972 



HYGIENE. 



BATHS AND MINERAL WATERS. 

A human body which weighs 154 lbs. is composed of 66 lbs. of solid ingredients 
and 88 lbs. of water. It is evident, therefore, that water plays a most important 
part in the animal economy ; and it is not surprising that man should have sought, 
by the use of waters of various descriptions, both internally and externally, to in- 
fluence the nutritive changes which are constantly going forward in the body. Water 
in its pure state consists merely of oxygen and hydrogen ; but in this pure state it is 
only met with in the laboratory of the chemist. It is the most powerful solvent 
known, and owing to tkis power, it is continually enriching itself. Even rain-water 
dissolves the carbonic acid and ammonia in the air ; and although rain-water, 
especially after a continuance of wet weather, is the purest water known, it is always 
very far from absolute purity. Water falling on the earth and percolating through 
it, or draining into rivers and water-courses, dissolves whatever soluble particles it 
may come across. Most spring waters contain saline ingredients, of which the most 
common are chalk, common salt, sulphate of lime, and sulphate and carbonate of 
magnesia. Thus spring waters are all of them weak mineral waters ; but the term 
mineral water is generally reserved for those waters containing mineral ingredients 
in quantity sufficient to impart a distinguishing taste, or to water containing some 
rare salt in solution. The richest of all mineral waters is sea-water, which contains 
in solution a great variety of saline matter. The following is the analysis of watsff 
from the British Channel : — 



Water . . 


• • • 


963-74372 


Chloride of Sodium (common salt) < 


> • • • « 


28-05948 


„ Potassium . 


» • • » < 


76552 


„ Magnesium » , 


► • • • 


, 3.66658 


Bromide of Magnesium , , 


» • • • • 


0-02929 


Sulphate of Magnesia. • < 


i • • • 


2-29578 


„ Lime • • , 


» • • # 


1-40662 


Carbonate of Lima » , , 


i • * * 


003301 


Iodine "1 

Ammonia J * * * 


i • • * 


, Traces. 




100000000 



Specific gravity, 1027*4. 

Besides salts, mineral waters contain gases, the most common of which are car- 
bonic acid (which we see bubbling up in seltzer water and many other mineral 
waters) and sulphuretted hydrogen, the gas which gives the peculiarly disagreeable 
odour and taste to the waters of Harrogate, in England. 

Mineral waters vary in temperature. Some of them are cold, others are very 
near the boiling point. These hot springs, of which there are very many through- 
out America, appear in the neighbourhood of volcanoes or spring from great depths 
in the rocks of earliest geological periods. Thus we have to consider these various 
waters which we find in nature as the vehicles of saline matters, gases, and heat, and 
sometimes we use a water for the sake of one property, and sometimes for another. 

We may now proceed to a consideration of the different kinds of baths. 



1ATHS AND MINERAL WATERS. 973 

The cold bath acts as a general stimulant. Its first effect is to chill and to cause 
slight depression, but reaction quickly follows, and the body glows with pleasant 
warmth, the absorption of oxygen by the lungs is increased, the appetite is augmented, 
and tissue change and nutrition are quickened. If a cold bath be continued for 
too long a time, or if the water be too cold, the period of reaction passes off and 
leaves the bather more or less permanently depressed. A bather should be exceed- 
ingly careful not to remain too long in the water. The time which it is safe to 
remain cannot be exactly stated, but must depend upon the strength of the bather 
and the temperature of the water. If cold baths be taken before breakfast they 
must be of short duration. They should not be taken too soon after a meal, or 
digestion may be arrested. 

It must be remembered, that in bathing, the skin absorbs neither the water nor 
any saline ingredient which may be dissolved in it. It is not possible to get iron, or 
any other medicinal agent, into the system by means of the bath. 

Sea-baths, owing to the salt dissolved in the sea, are more stimulating than 
simple cold baths. The sea is of a more equable temperature than river-water, and 
is generally warmer. The bather in the sea gets the benefit also of the sea-air. 
Whether a cold bath be taken in fresh or salt water, it is always advisable to swim 
in it, and add the effects of exercise to the other benefits. 

The sponge-bath and the shower-bath are both methods of applying cold water, of 
which the former may be considered mild and the latter severe. In the shower- 
bath we get the extra depression and stimulation caused by the force of impact. It 
should only be used by those strong persons who take a natural pleasure in heroic 
and, to others, uncomfortable measures. By its means we certainly get a severe 
shock in a short time, and that is probably its chief merit. 

By means of the cold douche we may apply cold water locally, as to a limb or a joint, 
and this is often useful. Cold packing in the wet sheet is a mode of applying cold 
greatly in vogue in hydropathic establishments. Cold bathing and cold packing 
have been much used of late years in the treatment of fevers, and both these 
methods have been found very efficacious in lowering the temperature. 

Tepid baths from 85° to 95° feel neither hot nor cold. They have no appreciable 
depressing nor stimulating effect 

Warm baths from 96° to 104° cause reaction and an increased frequency of the 
pulse and redness of the skin. 

Hot baths from 102° to 110° cause great frequency of pulse and respiration, great 
redness of the skin, and profuse perspiration 

While cold baths stimulate to tissue change, warm baths may be said to favour it by 
their heat. 

A vapour bath produces profuse perspiration, and is a most effectual cleanser of 
the skin. 

A hot air bath causes most profuse perspiration, so great, in fact, that a man may 
lose as much as 3 lbs. of weight during a single bath. They cause, also, great 
quickening of the pulse and respiration, redness of the skin, and elevation of the 
temperature. 

A warm bath draws blood to the surface, while a cold bath favours internal 



974 



HYGIENE. 



congestions. Warm baths must not be indulged in to excess, since they cause 
considerable depression of animal power. They cause drowsiness and lethargy. 

Mineral baths are much used on the Continent, but since the mineral ingredients 
are in no case absorbed, they act only by their effect on the nerves of the skin. If 
we wish to increase the stimulating effect of water it is a common thing to add a 
little salt to it Many of the mineral baths in great repute contain ingredients 
similar to those found in sea- water. Some of the mineral waters contain so little 
mineral matter that they are spoken of as "indifferent baths." The following is a 
list (taken from Braun's work on baths and mineral waters) of some of the more 
important : — 

Table op Indifferent Baths, showing the usual Tempebatubb and the Elevation op the 

Situation above Sea-level. 



Plombieres . , 






66° to 143° . 


. 1,310 Feet. 


Leukerbad . « 






102 „ 122 . 


. 4,670 „ 


Teplitz 






99 „ 103 . 


. 648 „ 


Warmbrunn t 






104 — . 


■ • 1,100 „ 


Wiesbaden . , 






93 „ 104 . 


. . 323 „ 


Gastein . , 






90 „ 104 . 


3,315 „ 


Tuffer 






95 „ 102 . 


► • 712 „ 


Romerbad • « 






,100 — . 


. . 755 , 


Pfaffer 






.100 — . 


> . 2,115 „ 


Ragatz • 






.100 — . 


. • 1,510 „ 


Wildbad . 






. 95 — * 


. . 1,323 „ 


Neuhaus . , 






. 95 — . 


. . 1,200 „ 


Schlangenbad 






. 86 „ 90 . 


900 „ 


Bertrich 






, 90 — . 


■ . 500 „ 


Badenweiler 






. 86 „ 90 • 


. . 1,425 „ 


Landeck 






. 87 „ 90 . 


. 1,398 „ 


Liebenzek . 






,77 — . 


. . M13 n 


In England. 




Bath 117 —-'••'< 


> . 100 „ 


Buxton • • « • 82 — • , 


, . 1,000 m 


Clifton • , 


< 


\ 


.74 — . 


1 • — 



When the amount of saline matter is in larger proportion, they are called salt 
baths and sool baths. The most common " salt bath " employed in this country is 
naturally the sea, and it is probable that any good effects which are obtainable from 
inland salt waters are also to be got by sea-bathing. Many salt baths are situated 
in the neighbourhood of salt works, and are called brine baths, from the very large 
quantity of salt which they contain, a quantity which in some cases is so great that 
dilution of the water is necessary before it can be employed for bathing purposes. The 
strongest brine baths in this country are situated at Droitwich, Worcestershire. For 
the alleged advantages which flow from the use of these waters we must refer the 
reader to special treatises. The following table will show the exact constitution of some 
of the most characteristic of the salt waters which are used for bathing, and, to a less 
degree, for drinking also. For this table we are also indebted to Braun's work on 
" The Curative Effects of Baths and Waters," translated by Dr. Hermann Weber : — 



BATHS AND MINERAL WATERS. 



975 



Gaseous 


Thermal Salt Waters. 












Nanheim. 


Kiss inge h. 


HOMBUKS. 


Keetjb. 

NACH. 


Guars or 16 On. 




j 6 i 


A 
to 


CD 

60 










CD 




° a 

145 

Ja 


a 

I 
m 

•a 

"3 

03 


OS 

=3 
ED 


I 


S 

a 


cd 

N 


be 

■a 
a 

i-9 


9 
a" 

1 

s 


Chloride of Sodium 


109-923 


58-413 


141-822 


74-363 


44-713 


42-399 


79-154 


84-461 


72-883 


„ Potassium , 


4-047 


2-024 


5-479 


2-739 


2-203 


1-835 





2-198 


0-624 


„ Calcium 


8-215 


4-234 


10-714 


5-492 




— 


7-765 


9-506 


13389 


„ Magnesium . 


2-155 


1-173 


2*102 


1-146 


2-333 


1-625 


7*767 


6-001 


4-071 


Bromide of Sodium 














0-064 


0-054 









„ Magnesium . 


0-295 


0-148 


0-400 


0-200 











__ 


0-278 


Sulphate of Soda . 





— 














0-380 








„ Magnesia 


— 


— 


— 


— 


4-508 


— 











„ Lime . 


0-740 


0-548 


0775 


0-565 


2-990 


4-590 





0-225 





Bicarbonate of Lime 


11-558 


. 7-540 


11-904 


7-713 


8-148 


7-793 


10-982 


9-796 


1-693 


„ Protoxide of Iron 
» „ Man- j 

ganese . . , .J 


0-199 


0-269 


0199 


0-269 


0-242 


0-202 


0-460 


0-390 


0-199 


0-027 


0-014 


0-061 


0-030 


— 


— 


— 


— 


0-009 


Carbonate of Magnesia . 


. 


0-149 


_ 


0-940 


_ 





2-011 


0046 


1-351 


Chloride of Lithia . 





— 








0-153 


0-129 






0-613 


Silica ... 


0115 


0-119 


0163 


0-137 


0-099 


0131 


0-315 


0-125 


0129 


Nitrate of Soda 


— 


— 




— 


0-071 


0-027 







— 


Total. 


137-271 


74-702 


173.609 92-848 


65-702 60-289 


108-828 


112-752 


94-023 


Temperature, Fahr. . 


72° 1 59° 


72-5°60-12° 


51-12 c 51-12° 


60° 


50-67° 


54 5* 


Carbonic Acid 


14-26712-319 


17-267J13-816 


17-5 j 20-2 


21-48 


18-42 


— 



1,997 grs. 


to 16 ozs 


1,736 


n 


ii 


1,970 


» 


ii 


1,811 


i> 


ii 


116 


i> 


» 


77 to 122 


it 


ii 


100 


ii 


N 


95 


ii 


II 


45 to 137 


ii 


II 


45 to 58 




II 



Table of Salt Baths showing thb Amount of Chlorides in 16 Ounces of Water. 

SaLzungen 

Eeichenhall 

Taxtfeld 

Arnstadt 

Soden (Taunus) 

Kreuznach 

Hall (Austria) 

Homburg 

Kissingen 

Wiesbaden 

A bath of medium strength should contain from 100 to 300 grains to the lb., so 
that concentration or dilution of some of the above may become necessary, and is 
practised. 

These natural salt baths are stimulating in proportion to the salt which they 
contain. The carbonic acid gas, too, which adheres in bubbles to the surface of the 
bather's skin, is said to be very exciting and stimulating. The water of these baths 
should never be boiled, for in that way the contained gas is expelled, and the bather 
is deprived of its beneficial effect. The water should be (and is in the best bathing 
establishments) carefully heated to the required temperature by steam-pipes under 
the bottom of the bath. The temperature to be used in any particular case, the 



976 



HYGIENE. 



frequency of the baths, and the duration of each bath, are points which can only be 
determined by a physician who has a practical acquaintance with disease, and with 
the effects of the water of which the bath is composed. These salt baths are used 
chiefly for retarded convalescence after a serious illness, for conditions accompanied 
by poorness of blood, and for affections of a gouty and rheumatic nature, as well as 
for plethora and liver diseases. 

Sulphur water 8 owe their peculiar qualities to the sulphuret of sodium, and sul- 
phuretted hydrogen which they contain. One of the best known sulphur waters in 
the world is that at Harrogate. The following analysis by Dr. Sheridan Muspratt 
shows the composition of 



The Harrogate Old Well. Strong Sulphur Watml 






Grains in the impl. gaL 


Carbonate of Lime (Chalk) 


. 


10-545 


„ Magnesia . 


. 


2-864 


Chloride of Sodium (Common 


Salt) , 


. 862-412 


„ Potassium . 


. , 


69-897 


„ Magnesium . 


• t 


61-769 


„ Calcium . 


• \ 


79-878 


„ Barium 


• 4 


4-998 


„ Strontium 1 
,, Lithium ) 


• i 


, . traces 


Sulphide of Sodium 


Total 


16-418 




. 1108-781 


Carbonic Acid in the gallon 


. 


25-55 cubic mchm 


Sulphuretted Hydrogen. 


• 


701 



If this analysis be reduced to the standard of grains in the pound of 16 ozs., it is 
only necessary to move the decimal point backwards, and we thus get the solid 
contents in the pound, equal to 110-8781 grains. 

The following is the analysis of the celebrated Kaiserquelle at Aix-la-Chapelle :— 



AlX-LA-C'fAPELLE, 634 FEET ABOVE SEA. 

Kaiserquelle, in 16 oza. Grains. 

Chloride of Sodium . . 20*271 

Bromide „ 0-028 

Iodide „ 0-004 

Sulphuret „ 0-073 

Carbonate of Soda 4-995 

Sulphate of Soda 2-171 

Sulphate of Potash 1*186 

Carbonate of Lime .••••-•• 1*217 

„ Magnesia ........ 0*395 

„ Strontia 0*002 

n Lithia . . '. . 0*002 

„ Protoxide of Iron . . . . . . 0*073 

„ Silica 0*508 

Organic Matter 0*577 

11*502 



BATH8 AND MINERAL WATERS. 



977 







jiNoooca • ■■*•© oo © -* oo-^-^<» 
-^0-<CC«i ^ooo« © © £ £ © 1 
E^wo©ab©£©,l<<^o © ©©£.£© 


© 9 ' 

•si] 


00 

© 

© 


Cub. in. 

39 
(1870.) 


! 


aK • Q e ir r -q H 

•UO^TXUIfTi 


llllln 1 i|i 1 1 1 i|i 1 1 1 1 

<-i « 




© 

CO 

© 

WO 


.© 

r 






«wO C* ?* WO © *5 O* «0© 

r-»*o« 00 © © © 


CO 

•* 
© 


d 

.oco 

s 





'era * TSa rrr *i s 


Grains. 
0-625 
3-667 
0-375 
6166 

20852 

0-268 

0-683 
0196 

0-029 


CO 


GO 
CO 


**!© 

J2C* 

6 




•3uudg poa. 


»*—<»'*■© too -?«? * 

!!si£liiiiMi]|Mii?i 


ig 1 


OO 
© 
© 


i> 






Grains. 
1 097 
4-686 
0110 

10-796 
0124 

trace. 
0-010 
1-212 

49-795 
0-675 

trace. 

0015 
0071 

trace. 

trace. 

trace. 


,si\ 


© 
9 

CD 

© 

co 

oo 

wo 


Cub. in. Cub. in. 

57 i 60 
(1870.)! 


00 




ai»cc^s3ic-305^-.«o©©» • — ' -o • • • 
Sr-^cco^r^-ot-oS , , 9 ,«n??S 


- 9 

'II 


^(coo^ooowo 5 ' * © © £ ~ .3 


<1 




1 -m ao »© -<f — . . • r~- © © • t 51 ■ ■ r- 

•S99r°P9sir^9 £ ??m? 

^o4cs©t-©£J3©<c© .£ © © £ £ © 


0* 9 

i » i 

© ^ 


© 

CO 


't 


g 

o 

QD 




-; vO © »C -*• © — ' xJ« 00 -<t« ~» CO to • • e* 
SOCKOKOOOONCO .© © © © © — 

■;*«ocwccon © l © -7 £5 s © 
CbibooDbbo^^ ' © © © _~ £ © 


© 9 

'si 


© 
co 

CO 


-. © 

^co 


•J9IPUT3TK) A *J 0i d 

■noiriABj 


_; r~ © co c^ -*» . ooccj t — co . • — 

UOvb©©©^©©^© © ©©«-£© 
•-» «■© *-»+■" 


© £ 


W3 

© 





'ai '913018 H T 
•umqurtiioo 


,/ CO r-1 OO O O © 

rj CO © C5 © . i *^ , 1 1 1 1 C* 1 1 , , 1 

I9T99 II I 1 « 1 I 1 1 |£ 1 1 I 1 1 

_£ — < CO © 00 CO O 


CO 

IS 1 


© 

9 
*^ 


f 


l-l 
<3 


•jrorptnnin •£ '0 -jam 


„JC^iM©©CO-aO©aC© CO —•«0^^'^ 

•|r--.OWO*-£©fcooO © © CT £ £ O 

s-©co©©©«^©©ro© © ©©_£>-© 
*^ © -*->+■> 


,2 8 




Cub. in. 

43 
(1872.) 




•i9rpin?qo -j "o *joaj 
•uaoq^fl 


Grains. 

0-372 
13-072 

0101 
14-816 

trace. 

0-178 

1-199 

63746 

trace. 

o-ooi 

025 
0192 
trace. 

0016 


,28 


00 
en 
© 


i 

a- 




•eeexSuoQ 


G mi us. 
0934 
9019 
0031 

12-449 
0-374 

truce. 
0-095 
1-006 

60055 
0111 

0002 

0-017 
1-069 

trace. 

trace. 

trace. 


,2S 


© 


Cub. in. 

49 
(1871.) 




•^oog q^!H 


Grains. 
3024 
4-069 
0135 

11-443 
01 54 

trace. 
0050 
1-122 

48-766 
0-201 

trace. 

0011 
0091 

trace. 

trace. 
153 




© 
•O 
© 
© 


ril 




1 

i 

§ 

Q 


•S a a .« 




-3 

1 


Ga*. 
Carbonic acid • . . 

L. ... . . 




Solids. 
Carbonate of soda . 
Carbonate of magnef 
Carbonate of iron . 
Carbonate of lime . 
Carbonate of lithia. 
Carbonate of stront 
Carbonate of baryt* 
Chloride of potassiu 
Chloride of sodium 
Sulphate of potassa 
Sulphate of soda 
Sulphate of ma^nes 
Phosphato of soda 
Phosphate of lime 
Iodide of sodium 
Bromide of sodium 
Fluoride of calcium 
Biborate of soda 
Alumina . . . 
Silicate of potassa 


Silicate of soda . 
Silica .... 
Organic matter . , 



62 



978 



HYGIENE, 



These waters of Ballston Springs, N.Y., present the same properties as those of 
Saratoga. They are richer, however, in mineral constituents, that of the Lithia 
well having the exceedingly large quantity of one hundred and thirty-four grains 
of solid matter to the pint. 

IN CANADA. ST. CATHERINE'S WELLS. 
Analysis. 



One pint contains — 



Stephenson-House 

WelL 

Prof. Croft. 



Merritt's or Wel- 

land House Well. 

Prof. Croft. 



Solids. 
Carbonate of iron .... 
Carbonate of lime . • 

Chloride of potassium . . • 
Chloride of sodium 
Chloride of magnesium . 
Chloride of calcium 
Chloride of ammonium and silicic acid 
Sulphate of lime .... 
Iodide of sodium .... 
Iodide of magnesium ... 
Bromide of sodium . • • 
Bromide of magnesium . • 



Grains. 



2-687 

217-234 

24-760 

108-271 

0056 

15-981 

0030 

0045 



Grains. 

•380 

•060 

2060 

275-868 

29-644 

127202 

14-429 
0-010 

trace. 



Total 



368-964 



449-653 



Temperature 60° Fair. 

6. Sulphur Waters. — The prominent characteristic of these waters is the presence 
of sulphuretted hydrogen, hence the peculiar odour. Excepting the uniform presence 
of this gas, sulphur waters vary exceedingly in composition. Some contain a large 
proportion of calcic carbonates, and hence may be termed calcic-sulphur waters; 
others, containing chloride of sodium in excess of other constituents, may be termed 
saline-sulphur waters; and, according to the proportion of these salts, will their 
action be modified. Those containing a considerable quantity of carbonate of lime 
and sulphate of lime will usually prove constipating, while those characterised by 
the presence of much chloride of sodium, or sulphate of soda or magnesia, will be 
cathartic. Still another element enters into the action of these waters in many 
instances : organic matters, known by the names of baregine and glairine, undoubtedly 
differing in composition in different springs, and producing various results. How- 
ever, as a rule, the action of these substances seems to be sedative; as an illustration, 
see the Red Sulphur Springs of Virginia. Some sulphur waters are exciting, others 
depressing, depending on the quantity of sulphuretted hydrogen, the salts, and tem- 
perature. Many of these waters are thermal. They all act as diaphoretics and 
alteratives. As a rule they are decidedly diaphoretic, a result due to the sulphur- 
etted hydrogen contained. Persons who take considerable quantities of sulphur- 
water are sometimes surprised to find articles of silver carried in the pockets 
decidedly blackened. This is due to the elimination of sulphuretted hydrogen in 
the perspiration, sulphuret of silver being formed. 

The Upper Blue Lick Springs, Nicholas County, Kentucky, are located on the 
margin of the Licking River. The water has been deservedly popular with the 
people of the West ever since the early settlement of the country, and bottled and 
barrelled water is sold largely. 



BATHS AND MINERAL WATERS. 



979 



RICHFIELD SPRINGS, OTSEGO COUNTY, N. Y. 




Analysis. 




One pint contains (Prof. Reid) : 




Solids. 


Grains. 


Carbonate of magnesia • « . . 


. 1-480 


Carbonate of lime • • • • • 


. 0-870 


Chlorides of sodium and magnesium •••••• 


. 0-187 


Sulphate of magnesia • • 


. 3-750 


Sulphate of lime ......•••«• 


. 2-500 


Hydrosulphate of magnesia and lime ..•••• 


. 0-250 


Undetermined ......•••• 


. 19-187 


Total 


. 28-224 


Gas. 


Cubic in. 


Sulphuretted hydrogen 


. .3-3 



These waters act as stimulants to the skin, and are chiefly used in chronic skin 
diseases. 

In selecting a locality either for drinking or bathing in mineral waters, many 
other circumstances besides the quantity of mineral matter — purgative, alkaline, 
saline, or nauseous — contained in the water have to be considered. It must be 
confessed that the German bathing resorts are managed far more adroitly than those 
in this country, and patients visiting the German baths find themselves in many 
instances bound, or rather compelled, to follow a certain strict regimen. At 
Carlsbad, for example, the invalid finds it impossible to procure many of those 
articles of diet which are known to be hard of digestion or which interfere with 
health.^ Thus mustard and pepper, as well as salad, have to be dispensed with by 
all sojourners in Carlsbad. At some German watering-places butter and cheese are 
not permitted to the guests. There is no doubt a great advantage in sending a 
patient to a locality where, will he, nill he, he cannot get that which does him harm. 
Some of our favourite watering-places would do well to follow the example set them 
in Germany. 

The position of the health resort is all-important, and the climatic peculiarities 
of the place have to be taken into account. The height above sea-level, the 
character of the soil, the amount and nature of the prevailing vegetation, the 
average temperature, and the rainfall, are all matters which require attention before 
selecting a locality for an invalid. 

Of scarcely less importance is the sanitary condition of the town in which the 
spring may be, for it is manifestly absurd to send an invalid to be poisoned by 
sewer gas in some filthy ill-kept place. The amount of amusement, and the induce- 
ments to spend the day in the open air, are also of great importance. In all cases 
of illness it is necessary to provide recreation for the mind as well as medicine for 
the body. The following account (taken from the Lancet, Sept 23, 1876) will give 
the reader an accurate notion of the kind of life which is led by visitors to one of 
the more quiet of the German watering-places : — 

"The Kniebis baths are known to few even of the members of the medical profes- 
sion, but are destined, if I mistake not, to fill a prominent position among fashionable 
health resorts ere the lapse of very many years. This group of watering-places is named 



980 HYGIENS. 

from its situation in the Black Forest, close to the range of hills called the Kniebis, 
whose summit forms the boundary between Baden and Wurtemberg. The main 
reason for prophesying a speedy renown beyond their own district (by the dwellers 
in which, for a century or so, these health resorts have been greatly frequented) lies 
in the fact that increased railway accommodation has rendered the locality more 
accessible. From Appenweier and from Offenburg, on the Baden railway, run two 
branch lines into the interior of the Black Forest, and either from Oppenau, which 
is the termination of the first branch, or from Hausach, a station on the second 
branch, can the Kniebis baths be reached. In the first instance we come to the 
most north-westerly point, and in the second to the most south-easterly. There can 
be few pleasanter excursions than from Oppenau to Hausach, taking the baths 
en rottie. The group consists of five baths — viz., Antogast, Freiersbach, Petersthal, 
Griesbach, Bippoldsau, and I have enumerated them in what may be supposed to be 
the inverse order of their popularity. Of Antogast I know nothing, but propose to 
give a slight sketch of the other four. 

" At each of these baths there are, as is usual at such places, three or four 
different springs, and it is probable that in the Kniebis district there may be thirty 
or forty, or even more, healing fountains ; for it may be said, with some truth, of 
mineral waters that 'it never rains but it pours.' The truth of this would 
certainly be admitted in the Nassau district, and as certainly in this district of the 
Black Forest. The wells here are all very similar in composition, the chief 
ingredients being bicarbonates of lime and magnesia (the former in considerable 
quantity), sulphate of soda, potash, and magnesia (in not very large quantity), 
carbonate of iron sufficient to give a very decided chalybeate taste, and a large 
amount of free carbonic acid. They are indicated for all cases requiring iron, but 
especially for those cases of anaemia and chlorosis with a tendency to constipation, a 
tendency which the contained Glauber's salt is sufficient to counteract. 

" The elevation above the sea-level varies from 1,000 to 2,000 feet, Bippoldsau 
being the most elevated. The prevailing tree is the black pine, and, in fact, on the 
higher elevations there is nothing else, but in the lower valleys a great variety of 
trees is to be found — oak, limes, plane-trees, mountain-ash, chestnuts, &c. For those 
who require a pure forest air, and wish to inhale the fresh mountain breezes, re- 
dolent of the sweet odour of the pines, there can be no more desirable locality than 
these mountain baths. On the very summit of the Kniebis hill, more than 3,000 
feet above sea-level, at the very comfortable although homely ' Gasthaus zum Lamm,' 
1 encountered a consumptive gentleman who had been sent here to breathe the 
mountain air, according to the present ' fashion ' (and fashion one must call it until 
we have more definite knowledge on the point) of treating consumption. His life 
certainly was a happy and a comfortable one here, and, although seriously ill, he 
seemed able to enjoy it. The air was keen and exhilarating, and the depths of the 
forest afforded a protection against the terrible fierceness of the sun, as well as 
against the violence of the wind ; and here, in a hammock slung from two pine 
trees, inhaling the pine-laden air, lazily dozing, reading, or writing, this patient 
spent his days most happily, and indeed I could hardly conceive anything more cal- 
culated to eke out advantageously the vitality which remained to him. I remained 



BATHS AKD MINEBAL WATKBg. 981 



myself at this secluded spot for the best part of three days, and when the hour of 
departure came I left it with a most unusual regret, as one would leave a place 
which combined a beautiful and wholesome situation, tranquillity, simplicity of life, 
culture, good food, and a landlord at once obliging, talented, and amusing. 

" But of the baths themselves, and of the life at them, what shall I say 1 No 
greater change can be conceived than to come, as I did, from Homburg to the 
Kniebis. They form as it were the very poles of bath life, and to my mind the 
escape from the fashionable crush and cosmopolitan society of Homburg to the 
simple life in these almost purely German resorts was a great relief. The Germans 
make the most of their baths ; their sea-resorts being entirely on the north coast, 
and hardly suitable for pleasant autumn residences, they are compelled to come 
inland for change of ir, and in a large majority of cases I believe that the mineral 
water serves merely as the excuse for going somewhere. In England, when pater- 
familias wants a change from his city work, he discovers that ' the children require 
sea-air,' and so it is, I believe, in Germany ; and the anaemia of one serves as an 
excuse for the whole family to go to the Kniebis, Schwalbach, or elsewhere for 
their regular summer holiday. The German baths, with their enormous bath- 
houses, and their array of paraphernalia necessary for hotels and hospitals, are apt 
to astonish the traveller who regards them too rigidly from the point of view of 
actual sickness ; but he who looks upon them as recreation-grounds, and resorts for 
prophylaxis as well as therapeutics, will soon cease wondering. 

" Bippoldsau, Freiersbach, and Petersthal, all stand by the roadside. The high- 
road runs through the very centre of all of them, and the traveller on the diligence 
who may stay for ten minutes is admitted for the time being into the very arcana of 
bath life. The bath establishments at each of these villages are in the hands of one 
proprietor, such proprietor being, in fact, an hotel-keeper in a very large way of 
business. An arch, forming a communication between two wings of the building, 
stretches probably across the road, and instead of the sign of the Red Lion or the 
Kaiser, the words ' Bad Bippoldsau/ announce to the traveller that here is to be 
found healing in addition to board and lodging. These bath establishments remind 
one of the great old-fashioned inns which are found flanking the post-roads in some 
parts of England, and, indeed, my first glimpse of the house at Bippoldsau recalled to 
me the famous Montem Hotel near Windsor. In place, however, of the mail coach 
with four bays, stopping all steaming at the door, with the guard in scarlet livery 
rousing the echoes with " three feet of tin," one must be content with a lumbering 
diligence crawling at snail's pace, with Hans, the postboy, in shining hat and corded 
uniform, discoursing discord on a penny trumpet, and the postmeister with spectacled 
and official countenance taking his survey from his seat in the coupe\ The accom- 
modation at Bippoldsau is good, and although there is room enough probably for 
1,000 guests or more, the demand this year has been in excess of the supply. This 
is due to increased facilities of access, and also, no doubt, to the fact that the Queen 
of Sweden has been making a lengthy sojourn here ; for where Sovereigns go, there 
all other classes assuredly will follow. Mr. Cook, too, of tourist notoriety, has lately 
been paying his attentions to the Black Forest, so that for the future it will probably 
be as difficult here as it is elsewhere to get, for ever so short a space, ' far from the 



982 HYGIENE. 



madding crowd.' The six or eight enormous hofs, or mansions, which constitute 
Bad Rippoldsau are situated in a valley, the natural beauties of which would strike 
the most blase of travellers. Richly-wooded hills ; meadows, even during the 
scorching weather of the past August, literally green as emeralds ; a babbling water- 
course making sweet music as it tumbles Rhine ward down the valley ; a variety of 
foliage difficult to surpass ; a profusion of the gayest flowers ; peasants, both male 
and female, decked in the smartest of costumes ; houses remarkable for their neat- 
ness and picturesque homeliness ; these, together with the lights and sounds which 
are characteristic of rural existence, go to make up a picture which cannot but l»e 
pleasing to the lover of nature, and doubly so to one who has been working amidst 
the murkiness and the noise of some manufacturing or money-making BabeL 

"The daily routine is that common to baths. Up by times, and then to 
drink at the wells to the sound of music. And, as for the music, the least said the 
better. The bands at the Kniebis are literally ' German bands,' and nothing is 
to be done save to put one's fingers in the ears. Such tootling, such braying in 
cornets, such hectoring, booming bass — such variations, in fact, of that melody 
which killed the cow, it has seldom been my lot to hear. Then breakfast beneath 
the trees, followed by a bath, a novel, a leisurely walk or a drive, till dinner-time. 
The baths are of all kinds, simple water or mineral water, and of any temperature ; 
but the bath par excellence of the Black Forest is the bath to which extract of 
pine-tops is added, which is pleasant in the highest degree, and is certainly a 
sensuous luxury with or without therapeutic value — a question I feel unable to 
discuss, since I can find no data on which to ground a discussion. At one o'clock 
a bell summons the guests to dinner, which is served at an enormous table d'hote, 
and after dinner comes the dolce far niente. Seated out of doors, with the sunlight 
flickering through the thick curtain of leaves, the men smoke, drink coffee, read 
newspapers, and discuss politics or Wagner (a great topic just now), or play with 
the children; while the ladies crochet, knit, prattle, read, and finally dose, as do 
also the men, until the heat has sufficiently abated to permit of the evening 
constitutional, which is taken in the lovely and well-kept paths which are cut in 
all directions in the forest No one who has not been through the Black Forest 
can form any idea of what high-roads and public foot-paths can become if sufficient 
labour be spent upon them. I have seen nothing like them in England, except in 
the private parks of the very wealthy; and it is needless to say that these 
magnificent roads, well watered as they are, and almost without dust, are a great 
comfort, especially to invalids. At seven o'clock supper is taken — a great meal 
throughout Germany, and certainly very preferable to our eight o'clock dinners. 
At nine or ten all are in bed, and then at six in the morning da capo. 

" Finally, we would say that in one respect these Kniebis baths are ahead of 
other similar establishments, and it is in this simple little matter, that they provide 
exercise for the upper limbs as well as the lower. In all baths there are to be 
found walks which encourage one to use the legs, but it is the especial glory of the 
Kniebis that it provides skittle and bowling-alleys for its guests; and at Rippoldsau 
there is, in addition, an excellent swimming-bath. Croquet, too, is becoming 
fashionable. These are trivial details, but by no means unimportant ones. life is 



SEWAGE AND DRAINAGE 983 



made up of details, and a knowledge of these details is necessary for those whose 
duty it is to advise people ' Where to go.* n 



SEWAGE AND DRAINAGE. 

There is no more important question in the whole range of sanitary science than 
that of dealing with, and the best method of disposing of, our sewage. This question 
gets more and more pressing as populations go on increasing in density, and 
in this country at the present time it requires to be inquired into calmly and 
judicially. 

Now all this matter which we call "sewage" is putrescible, and, as is well 
known, very soon becomes intolerably offensive. This putrid matter gives out gases 
into the air, which it renders unwholesome, if not poisonous ; and soaking into the 
ground filters into sources of water-supply, and thus proves highly dangerous in 
another manner. It has only one use, and that is as manure, and put upon the 
ground fertilises it, as we all know. The Chinese and Japanese, of all nations, have 
the keenest appreciation of the use of sewage, and it is their custom to collect it 
and apply it as manure -with as little delay as possible. If manure be left to putrefy 
in heaps, its fertilising value is diminished, for instead of giving its store of nitrogen 
to the earth, and so to the plants which grow in it, it gives it to the air in the form 
of ammonia, where it is an offence to our senses and of no use to anybody. Many 
gaseous bodies besides ammonia are given off from decomposing sewage, and the 
gases themselves probably vary with the material of which the sewage is 
composed. 

Sewer gas varies in composition. It is composed of a mixture of variable 
amounts of carbonic acid, sulphuretted hydrogen, carburetted hydrogen, ammonia, 
and organic particles, these last being often its most noxious ingredients. The 
poisonous qualities of sewer-gas vary immensely, depending partly upon its degree 
of dilution, and partly also on the special ingredients which it is liable to 
contain. 

If the atmosphere breathed by a population becomes contaminated by sewer-gas 
the health of that population suffers. Headache, sickness, diarrhoea, general malaise, 
and great depression of health, with anaemia, are liable to be produced. 

It has been a matter of dispute whether or no typhoid fever can be conveyed by 
sewer-gas. There are many pros and cons in this question which we need not con- 
sider, but since there is much doubt on the point it will be safer to consider that its 
conveyance in this way is possible. There seems to be little doubt that the effluvia 
from typhoid evacuations are capable of producing the disease. 

Moses seems to have had very definite notions of the evils which may result 
from decomposing sewage, and his law on this matter is surprisingly explicit, as the 
following quotation from Deuteronomy xxiii 12, 13, will show : — 

"Thou shalt have a place also without the camp, whither thou shalt go forth 
abroad. 

"And thou shalt have a paddle upon thy weapon; and it shall be, when thou 



984 



HYGIENE. 



wilt ease thyself abroad, thou shalt dig therewith, and shalt turn back and cover 
that which cometh from thee." 

Thus it will be seen that the method of treating sewage by means of " earth " is 
no modem idea, but was definitely set forth by Moses 3,000 years ago. 

In this way excrement is at onee restored to the great purifier and deodoriser, 
the earth, which, in its turn, it helps to fatten. 

Such a primitive method of getting rid of the excrement is clearly out of the 
question when masses are congregated in towns and cities. 

No fact is better established than that the thorough drainage of grounds which 
produce the malarial poison removes the conditions on which the generation of this 
poison depends. Districts most uninhabitable, from the periodical appearance of 
malarial fevers, have thus been rendered comparatively healthy, under circumstances 
apparently most unfavourable to general salubrity. And, in general, it may be 
stated that all marshy lands may be reclaimed, not only to the purposes of agri- 
culture, but for habitation, if the drainage secures a dry soil. 

We quote from the last report of the engineer in charge of sewers such facts aa 
relate to subsoil drainage : — 

" The Old System. — There are now laid down within the limits of the city 
(exclusive of the Twenty-third and Twenty-fourth wards, the improvements in 
which are under the control of the Department of Parks) 370 miles of sewers ; 
205 miles of these pertain to the old system, and 165 miles are embraced in the 
new system. 

" Of the former, many miles are sewers only in name, having been laid down 
before the introduction of Croton water ; most of them being simple drains, open at 
the bottom, while the sides are built of dry stone, without mortar or cement, and 
were made for the purpose merely of carrying off the waste water from the houses, 
at that time derived from wells and cisterns, while refuse and excrementitious 
matter were deposited in vaults and periodically removed. After the water supply 
was introduced these drains were, many of them, suffered to be used as sewers, to 
the great and manifest injury of health; and from that time up to the adoption, in 
1865, of a general system under the 'Sewerage Act,' were simply added to or 
extended by the Croton Aqueduct Department, as ordered by the Common Council, 
at random, and were built on haphazard plans, as they were called for by individuals 
from time to time; not a few of them being built by the individual owners of 
property to suit their own views and convenience. 

" The consequence of this fatal stupidity and negligence cannot be exaggerated, 
the city in its older sections having been honeycombed with an incongruous variety 
of badly-constructed, irregularly-shaped conduits, inadequate to the public wants, 
and which, in consequence of the inferior quality of the materials used, are fast 
falling into decay, to the great injury of the public health, and involving a large 
outlay to keep them in working order. This vicious system grew with the growth 
of the city, and has been extended in all its defects over a very large area. 

" The sizes of most of these old sewers are found to be out of all proportion with 
the service they have to perform. Some are several times larger than can be kept 
clean with the limited amount of sewage flowing through them ; for instance, a 



SEWAGE AND DRAINAGE. 985 



sewer will be found five feet in diameter, with scarcely sufficient flow through it to 
keep one of as many inches free from deposits, while others are found nearly as 
much too small, which latter overflow during a heavy storm, while the limited flow 
spread over the broad bottom of the larger sewer, loses much of the power necessary 
to carry off the solid matter, the result being to reduce the velocity so low as to 
make the flow hardly sufficient to prevent stagnation. 

" In the construction of these sewers there seems to have been a total disregard of 
the principle of hydraulics, that the velocity of flow is in proportion to the hydraulic 
depth or radius. 

" Alterations made to relieve or improve one sewer, without considering the effect 
on the sewers in the district below, have resulted in transferring trouble from one 
neighbourhood to another, without doing any permanent good. 

" As the area of the city was extended and built upon, the sewers already built 
were added to or lengthened out, without regard to the effect the additional drainage 
thrown into them would have on the sewers below, which, being often taxed much 
beyond their capacity, are continually flooding cellars and damaging property; 
while, on the other hand, many of the old sewers, originally built too large, have 
been greatly benefited by having the storm water carried to them in greater quantity 
from the increased areas of surface covered by the many new buildings, some of 
them of vast proportions, and more recently from the smoother surface of the large 
amount of new pavements that has replaced the dilapidated and irregular cobble 
stone pavements. Little or no precaution was formerly taken to secure a firm 
foundation for sewers built on made ground, especially along the river front, where, 
for a considerable distance back from their discharging point, the sewers have sunk 
several feet below low water, while the part of the sewer built through the solid 
bulkhead remains at the original level it was built on, cutting off the discharge of 
the solid portion of the sewage, and all possible escape of gases, which, when confined 
by storm water or a rising tide, is forced back and, with the aid of improper 
plumbing, is disseminated through the dwellings." 

Some towns of considerable size are drained almost entirely into cesspools. The 
manure is then removed at regular intervals in vans, and put upon the land. 

When we trust to water as the means for washing the sewage out of our house, 
this necessitates an elaborate system of subterranean sewers. Every house is in 
direct communication with these channels, in which enormous quantities of gas are 
necessarily generated as the sewage decomposes. It is very convenient to be able 
to flush the sewage of the house at once into the sewer, and if all the mechanism 
for effecting this be perfect no harm results. It is obvious, however, that any 
imperfection in the trapping by the house-drain may admit sewer-gas into the house, 
and it is xlso evident that if there be any " tension " of the gas in the sewer, it may 
force its way back into the house. 

There are many forms of house-traps, but they all consist, in principle, of the 
same thing — the interposition of a body of water between the sewer and the house. 
The so-called " S trap," from its likeness to the letter after which it is named, is in 
very common use. The bend of the S (which is placed horizontally) always remains 
full of water, and thus acts as a barrier against the gas in the sewer. 



986 HYGIENE. 



All traps, however, are only a very limited protection. The water in them soon 
absorbs the gas in the sewer, and gives it off into, the house quite irrespective of any 
pressure. If the water in a trap be not constantly renewed it soon gets foul. 

An anonymous writer in the Times of October 14, 1874, gives an admirable 
summary of the way in which sewer gas gets into a house. He says — " Sewer gas 
finds its way into a house by one or more of five distinct kinds of channels : — 

"1. Sewer gas very frequently enters a house through the pipes which carry off 
the refuse water — for example, housemaids' sinks* butlers' pantry sinks, baths. 

"As a rule, the pipes from these places are carried directly into the house 
drain. . . . It is easy to prevent the entrance into a house of sewer gas through 
these pipes. The pipes which carry off refuse water should terminate, not in a 
drain, but in the open air. In London houses they may pour the water directly 
into the area. 

" 2. Sewer gas may enter the house through the overflow pipes of the cisterns. 

" Every cistern has a pipe to convey away the water, which, if the ball-cock of 
the cistern were out of order, would flood the house as often as the water came into 
the cistern. 

" This overflow pipe of the cistern is frequently made to open into the soil-pipe 
of the nearest water-closet — i.e., into a pipe filled with sewer gas. 

" The overflow pipe of all cisterns should terminate in the open air. 

" 3. In towns the water-closets are at the back of the house, and the main sewer 
runs down the centre of the street in front of the house. The consequence is that 
a drain has to be made under the house from front to back. < 

" Injury to the walls of this drain may result from accumulated sewer gas, and 
the escape of sewer gas from the drain will be in proportion to the pressure of the 
sewer gas on the walls of the drain. To prevent this pressure the drain should be 
ventilated — i.e., a pipe should be carried from the drain up the back of the house to 
a little below the level of the chimney-pots. 

"4. A common practice is to make one pipe serve the double purpose of 
ventilating the sewer and of carrying off the rain-water from the roof. The pipe 
serving this double purpose is frequently a channel for the conveyance of sewer gas 
into a house. For every cubic foot of water that enters the pipe a cubic foot of 
sewer gas is forced out, and if, as is commonly the case, the top windows are near 
to the aperture of this pipe, sewer gas finds a ready entrance into the house. 

" The pipe which conveys the rain-water from the roof should open into the area, 
and never into the drain. 

" 5. The soil-pipe of a water-closet, like the house drain, should always be ven- 
tilated — i.e., an open pipe should pass* from the soil-pipe to a little below the level 
of the chimneys, to an elevated spot, that is to say, at some distance from all openings 
leading into the house. If the soil-pipe of the water-closet be not ventilated, then, 
whenever the closet is used, should there be the least defect from wear, or accident 
in the trap, a certain amount of sewer gas will be forced upwards into the house from 
the soil-pipe." 

It would be beyond our scope to deal with the method of constructing sewers, so 
that we pass by this question altogether and in conclusion make a few remarks on 



INFECTION AND DISINFECTION. 98? 

tlie ultimate disposal of sewage. Opinions can hardly be said to be divided on the 
point now. Almost all are agreed that the only proper destination for sewage is the 
soil. In this way, it is not only rendered harmless, bat profitable as well. 

A cesspool must be emptied at frequent intervals. It must also be ventilated 
by means of a grating, or else the gas generated in it will be forced back into the 
drain coming from the house. A cesspool is always a dangerous thing, and should 
receive constant and intelligent attention. 

The introduction into the sewers of matter foreign to their use, the improper 
arrangement of sewer connections, the neglect to give an intelligent supervision 
to the use of these connections by careless and ignorant employes, all contribute 
to the permanent injury to this great system, the care and preservation of 
which is of the most vital necessity to the community at large, and to every 
individual 



INFECTION AND DISINFECTION 

The ideas of the public on these two important subjects are, it is to bo feared, 

very vague, and it must be confessed that the knowledge possessed, even by the most 
learned, is incomplete, and not always satisfactory. In the first place what do we 
know about the process of infection] Now we are in the habit of inoculating 
ourselves with the cow-pox, in order that we may escape the small-pox, and we know 
the limits of infection in respect of this cow-pox, most accurately. It is not con- 
veyed by the air or by the clothing, nor by discharges from the body, and no case is 
on record of one person having " caught " cow-pox of another person. It is always 
necessary to take cow-pox matter from an infected person and actually insert it into 
the body of another person, before the disease can be conveyed. This cow-pox 
matter (vaccine lymph as it is called) can be kept for considerable lengths of time, and 
it is so kept, either in a liquid state, in tubes hermetically sealed ; or, in a dry state, 
upon ivory points. Now here we have a disease capable, as far as we know, of only 
one method of infection. Can the infective power of the vaccine limph, either in a 
liquid or dry state, be destroyed, or, as we are accustomed to say, can the liquid be 
disinfected ? Dr. Baxter has, by careful experiment, answered this question with 
tolerable accuracy. 

With dry lymph he found — 

1. That its infective power was destroyed by exposure for thirty minutes to a 
temperature exceeding 194° Fahr. 

2. By exposure for ten minutes to the vapour of sulphurous acid (the suffocating 
gas given off when sulphur is burnt, the odour of which is known to all who have 
used 3ulphur matches) 

3. By exposure for thirty minutes to the vapour of pwre carbolic acid. 

4. By exposure for thirty minutes to the vapour of chlorine gas. 

With moist lymph Dr. Baxter found that the infective power was destroyed — 
1. By admixture with half per cent, of potassic permanganate (the salt contained 
in Cond/s fluid). 



988 % HYGIENE. 

2. By admixture with two per cent, of carbolic acid. 

Now it is considered highly probable that one reason at least why the cow-pox 
is never, practically speaking, conveyed except by direct inoculation, is the fact of the 
small amount of vaccine lymph which the person inoculated forms. If by inocu- 
lating with vaccine lymph we caused the person inoculated to be covered on his skin 
and on his lungs and intestines with myriads of pustules, as is the case in small-pox, 
the disease would probably become far less manageable, and it is at least possible 
that persons might be infected by inhaling or swallowing the matter given off by an 
infected person. Small-pox differs from cow-pox in the quantity of infective matter 
formed. This is certain. It is also almost certain that they differ in the virulence 
of the infective matter, but it is at the same time highly probable that there is some 
family resemblance, as it were, between the infective materials. It is exceedingly 
likely that small-pox poison is more difficult to destroy than cow-pox poison, but at 
the same time the infection-destroying agent found most useful in the one case is 
probably the most useful in the other. 

Small-pox is a highly infective disease. It is highly dangerous, as has been shown 
over and over again, to go into a room or to ride in a cab which has been occupied 
by a patient with small-pox. That which is discharged from the skin of a small-pox 
patient is highly infectious, and it probably proves infectious by entering either the 
lungs or the stomach. The breath of a small-pox patient is infectious, and probably 
all the discharges from his body also. It is evident, therefore, that the rooms, the 
bedding, the clothing, and the discharges of a small-pox patient must all be subjected 
to disinfecting processes, before those who inhabit the same house with him can be 
considered safe. The discharges from the body are best disinfected by mixing with 
carbolic acid, the room and bedding by fumigation with sulphur, and the clothing 
by subjecting it to a great heat. 

Scarlet fever is very infectious. All the discharges from the patient's body carry 
the infection, and especially the scales which peel off the skin. These scales remain 
infectious during the patient's convalescence, and they will convey the disease by 
letter or by being retained in clothing or bedding. Every means must be taken, by 
anointing with carbolic acid ointment, &c, to prevent the scales flying off the 
patient's body, and heat, and sulphur, and carbolic acid must be used for the dis- 
charges, the clothing, and the room. 

Scarlet fever may be conveyed in milk, and probably, also, in other articles of food. 
This, probably, is brought about by people whose duty it is to prepare these articles 
of diet doing so before they have completely recovered, and unconsciously mixing 
infected scales with the food. 

Typhoid fever, which is more properly called enteric fever, or fever of the intes- 
tines, is not conveyed" at all, or is only in a very slight degree, by the air. This 
fever is admitted into all the hospitals of London, and, practically speaking, it never 
spreads. It is only infectious in one way, and that is by the discharge from the 
bowels. These discharges are terribly infectious, and if they find their way into a 
well or water-course, they may scatter the disease far and wide. The stools of a 
typhoid patient should be instantly disinfected by being mixed with strong carbolic 
acid, and then should be thrown down the sewer, or else deeply buried in some spot 



INFECTION AND DISINFECTION. 989 

remote from any source of water-supply. Simple washing of the clothes and bedding 
is sufficient. 

Cholera is infectious in the same way as typhoid, and the stools and other dis- 
charges from a cholera patient must be instantly disinfected and then thrown away. 
Cholera is conveyed almost entirely by water. If it is ever conveyed by air, it is 
exceptional. 

Typhus fever, otherwise known as famine fever, or gaol fever, is infectious through 
the air, and if patients with this fever be congregated together, the air becomes 
terribly pestilential Typhus patients must be separated as much as possible, and 
enormous quantities of fresh air must be allowed. The clothes, rooms, and bedding 
must be disinfected by heat and sulphur, and the discharges by carbolic acid. 

Whooping-cough and Measles are conveyed by the air, and are exceedingly infec- 
tious. It is not possible so to apply disinfectants as to influence the spread of 
these diseases. 

Dr. Parkes gives the following directions for the Purification of rooms after 
infectious diseases : — " In addition to thorough cleansing of all wood-work by soft 
soap and water, to which a little carbolic acid has been added (one pint of the com- 
mon liquid to three or four gallons of water), and to removal and washing of all 
fabrics which can be removed, and brushing of the walls, the room should be fumi- 
gated for three hours by either sulphurous or nitrous acids. Both of these are believed 
to be superior to chlorine, especially in small-pox. All doors and windows and the 
chimney being closed, and curtains taken down, sulphur is put in a metallic dish, a 
little spirit of wine is poured on it, and it is lighted. The proportion should be one 
pound of sulphur to every 1,000 cubic feet of space, and in a long room it is best to 
have the sulphur in two or three places. After three hours the doors and windows 
should be opened and kept open for twenty-four hours." 

Nitrous acid, which has great disinfectant power, is evolved by putting a piece of 
copper in a vessel filled with nitric acid. 

Chlorine is generally evolved from pans of chloride of lime, which are moistened 
with water and exposed. It may be got in greater quantity by pouring four parts by 
weight of strong hydrochloric acid on one part of powdered binoxide of manganese. 

Bromo-Chloralum is a powerful deodoriser. It may be exposed in a room in 
pan ') and seems to have the power of destroying some of the " close " smells. 

Dr. Baxter says, " Aerial disinfection, as commonly practised in the eisk-room, 
is either useless or positively objectionable, owing to the false sense of security it is 
calculated to produce. To make the air of a room smell strongly of carbolic acid 
by scattering carbolic powder about the floor, or of chlorine by placing a tray of 
chloride of lime in a comer, is, so far as the destruction of specific contagia is con- 
cerned, an utterly futile proceeding." 

Dry heat is one of the most powerful of all disinfectants, and if a temperature of 
250° Fahr. can be obtained, it is doubtful if any infective particles can withstand it. 
Various forms of disinfecting chambers have been devised. In cases of emergency 
an ordinary baker's oven may be employed. 



/' 



SKIN DISEASES. 

It is not proposed in the following pages to give the reader anything like an 
exhaustive treatise on skin diseases, but only to refer to those which by the- 
possession of a little general knowledge may either be prevented or else readily 
cured. To make the subject more intelligible, it is desirable to devote a few 
words to considering what the skin is, and what it does. The skin, as every 
one knows, forms the outer covering of the body, adapting itself to all the 
inequalities of the surface, and whilst attached to the underlying tissues with 
varying degrees of looseness, readily permits the many movements which the 
muscles perform. The primary object of such a structure, then, will be to serve 
as a protection to the internal organs of the trunk and head and limbs. In 
man this purpose is not so effectively carried out as it is in many of the lower 
animals, where the skin is provided with such substances as scales, horny or bony 
plates. Another purpose served by the skin is to confine, to a certain extent, the 
heat of the body. During life we are continuously producing heat, and although 
much of it is as continuously being lost by evaporation and radiation from the surface, 
still, the skin does regulate and limit this loss. These deficiencies, if we may sc call 
them, which our skin manifests are compensated for by clothes, which serve alike as 
a protection and as a further regulator of our temperature, this latter office being 
carried out in many of the lower animals by hairs, wool, feathers, &c. In the per- 
formance of the many and varied acts which are characteristic of living beings, and 
in the production of the heat of our bodies, we use up a certain amount of material- 
and give rise, in consequence, to a corresponding amount of waste, and just as a 
steam engine will not do its work without a due supply of fuel and water, so are we 
dependent on food and air, and equally as the engine produces a quantity of ashes 
and smoke, which must be removed lest the fire be choked up and the action of 
the machine interfered with, so must the ashes and the smoke resulting from the 
combustion of the food in animal bodies be got rid of. This work the skin aids in 
doing, and is therefore one of the important excretory organs of the body. In order 
that these various uses of the skin should be effectively attained, it must have the 
following properties and structure : — To allow of its adaptability to the surface and 
to movements, it must be soft, flexible, and elastic. That it may be protective it 
should be less sensitive than the structures which it covers ; and to eliminate the 
waste materials it is provided with numerous glands which extract from the blood the 
constituents of the perspiration. The skin is usually described as being composed of 
two layers. The outer superficial layer, called the scarf skin, or cuticle, or epidermis, 
varies much in thickness in different situations, being usually thickest in the parts 
exposed to pressure, as the palms and soles. It is of itself, to all intents and purposes, 
a dead material, being without sensibility, and may be cut without bleeding. It is 
oontinually being thrown off on the surface as scurf, and as constantly being formed 



992 SKIN DISEASES. 



in the deeper parts where it covers the true skin. The nails and hairs are modifica- 
tions of the cuticle. The deep or true skin is, on the contrary, both sensitive and 
vascular, and it is from it that the blood escapes when the skin is wounded, and it 
is in virtue of the nerves ending in it that the skin possesses the general sense of 
touch. When the cuticle is removed, as may be done by a blister, the surface of the 
true skin which is left is exquisitely tender, and it is in protecting this delicate 
structure that one of the chief uses of the epidermis consists. In the thickness of 
the true skin (which is mainly composed of bundles of tough, flexible fibres felted 
together in all directions) are the sweat glands, which open on the surface of the 
cuticle by minute openings or pores. 

It is obvious that the skin, from the very extent of it, no less than its position 
and structure, is liable to become diseased from many causes to which the other 
organs of the body are not exposed. Putting aside all those morbid conditions to 
which the skin is subject as the result of constitutional states, and in which the 
skin suffers only in common with other tissues, there remains a large class of affections, 
many of which are eminently preventible. The eruptions which are associated 
with gout, scrofula, the eruptive fevers, scurvy, <kc, demand for their recognition 
and treatment a trained intelligence, and are beyond the scope of these remarks, 
whilst many of the purely local skin diseases are the result of sheer ignorance of 
simplest principles, and not only ignorance but careless inattention and disregard of 
what is writ very large in nature. Foremost among the causes of skin disease is 
dirt — dirt in every shape and form, often too . obvious, sometimes less apparent on 
the surface, and requiring looking for, still, nevertheless, " matter in the wrong 
place." There would, however, seem to be some difference in the kind of dirt, for 
we are not aware that sweeps, miners, blacksmiths, &c, in whom a dirty skin is 
more or less inseparable from their calling, are more prone to skin diseases than 
other people. The dirt that appears to be most harmful is the unremoved scurf and 
cutaneous secretions. Under ordinary circumstances the former falls off or is 
rubbed away by the friction of the clothes, and most of the perspiration escapes by 
evaporation. Washing — especially with soap, which from its alkaline nature softens 
the horny cuticle — materially aids in the removal of the secretion, and, further, keeps 
the pores of the skin open. Those garments, whether linen or flannel, which are 
worn next the skin are apt to become saturated with these waste matters, and if 
worn too long, to become sources of irritation. Besides the ill effects which directly 
follow want of clean linen, there are other evils which are very liable to ensue. A 
dirty skin offers a most favourable situation for the development of the numerous 
parasites, both animal and vegetable, that are so prone to infest our bodies. It is 
only in an indirect sense that dirt can be said to breed them. The spores or eggs 
must come from somewhere, but when once they do arrive their chances of develop- 
ment are in proportion to the dirty state of the surface. Many of the brown stains 
which are met with, especially between the shoulders and on the back, are due to a 
form of vegetable fungus which grows among the scales of the epidermis, and is very 
soon removed by soap and water. There are several other varieties of a similar 
parasite met with, one of them, the so-called " ringworm," being among the com- 
monest. This often very obstinate affection has nothing tc do with any worm, but 



PARASITES — SHINGLES. 993 



is a microscopic form of fungus which tends to spread in a circular manner identical 
with the plan pursued by many of the larger forms. Those bald spots so often seen 
on the head are in many cases due to similar growths, which attacking the hairs 
also render them brittle and easily broken short off, leaving a surface at first covered 
with dry scurf and short hairs, afterwards often becoming smooth. 

There are several forms of animal parasites which live and breed at our expense, 
and which often manifest a distinct choice of locality. The body lice which may be 
found on the surface generally differ from that species which is found among the 
hairs of the head, and these again both differ from the itch insect, which burrows 
into the thickness of the epidermis and deposits its eggs, especially on the 
hands and feet, whilst the nits or ova of the lice are fixed to the hairs. The intense 
itching which these pests give rise to induces scratching, and the skin becomes covered 
with numerous bleeding points, the blood drying and forming small hard crusts. 
Countless are the forms of irritation to which the skin may be exposed besides 
dirt. Extremes of temperature may produce disease short of actual destruction 
of the surface, as burns, scalds, and frost-bites. Erysipelas, or inflammation of 
the skin, not unfrequently follows exposure to heat, especially to that of the 
sun's rays, to which cause the less important bronzing of the cuticle is due, 
whether it be uniform or in spots (freckles). The materials used in various 
manufactures, sugar, dyes from socks and gloves, even flannel, silk, &c, are all 
liable to irritate the skin, and set up one form or another of disease, and the 
cause often requires a good deal of looking for. Even soap itself may produce 
in skins sufficiently sensitive an unhealthy state, and this is dependent on the 
amount of alkali that it contains, the common soaps being the worst in this 
respect. It is possible for there to be too much soap and water, and this is 
especially the case with the feet, which may be kept by it in a tender state, 
and not allowed to sufficiently harden to resist the friction of the boot. 

Skin diseases present among themselves a considerable diversity of appearance. 
Some appear as patches of redness or brown discoloration, which may or may not be 
slightly raised ; sometimes the redness is limited to small elevations termed pimples, 
and may so remain a considerable time. Certain eruptions commencing as pimples 
undergo a change, and appear after a time with small watery heads. An example of 
this group is shingles, which so curiously attacks only half the circumference of 
the body or limb. A very similar affection is frequently seen about the lips and 
ears. In other cases the pimples are surmounted with small heads of " matter ; " 
such an eruption is said to be pustular. There is a distinction, too, of no small 
practical value, between those rashes that, extending over considerable areas of 
surface, present a dry and scaly appearance, owing to excessive formation and 
peeling off of the cuticle, and those which continually exude a thin, acrid dis- 
charge, sufficient of itself to extend the disease by the irritation it produces in 
the skin it flows over. Psoriasis is a type of the former group, and eczema of 
the latter, but numerous modifications of this general statement are met with, 
and not unfrequently it is a matter of the greatest difficulty to apply a name to 
an affection which may none the less readily yield to treatment. Some singular 
alterations in the skin secretions are occasionally found. In some people the 
63 



994 SKIN DISEASES. 



perspiration may be unduly excessive, in others it may be scanty, and occasionally 
limited to one-half of the body or face, the corresponding half never sweating, 
or it may shift from place to place. Rarely are seen alterations in the odour 
and colour of the secretion.- Another material thrown off by the skin is known 
as the sebaceous matter, and is produced by small glands connected with the 
hair roots. Sometimes the orifices of these glands may be blocked up, and the 
secretion not being able to escape may continue to accumulate and form large 
rounded tumours — often several together on the scalp — known as " wens." 

Among the means at the disposal of the suffering public for the relief of skin 
diseases, without applying to the doctor, the most important are those at the 
same time both preventive and curative or palliative, foremost among them being 
habits of cleanliness in every way, in clothes no less than in the skin itself. 
The value of this has been sufficiently insisted on. The popular preference for 
soft rather than hard water is a reasonable one ; but as regards soap, it is not 
always easy to make a selection among the many, each with its numerous vaunted 
virtues. Soap may often be made the vehicle for the application of drugs, such 
as sulphur, carbolic acid, belladonna, &c. We have seen that some parasites are 
killed by soap and water; but for most of these certain special applications are 
needed. 

The most effective remedy for itch or scabies is certainly sulphur, but a good 
deal depends on the method of its application. It is essential that the remedy should 
come in contact with the animal, and, owing to the parasites being embedded in the skin, 
which is usually more or less encrusted with scabs and dirt, this often requires some 
trouble. The most effective plan to pursue is as follows : — The patient should have a 
hot bath, as hot as can be borne, and be thoroughly well soaped all over; when dry, the 
ordinary sulphur ointment — to be obtained at any chemist's — is to be well rubbed 
into the skin, especially between the fingers and toes, the most frequent seat of the 
disease. Thick gloves should be put on, and the patient should be sent to bed, the 
ointment not being removed. This should be repeated night and morning for two or 
three days, by which time the cure is almost always effected. It is undesirable to 
Continue the application for a longer time, since the sulphur itself may prodiv.p 
irritation. It must not be forgotten that the animals attach themselves to the clothes 
as well as to the skin, and in this way the patient may reinfect himself as fast as he 
is cured. It is absolutely necessary, therefore, that the body linen should be boiled 
to destroy any of the insects that may remain, and it is as well that the linen or 
flannel worn during the day should be thoroughly saturated with the ointment — in 
fact, the same garments may be worn day and night throughout the treatment. 
The ointment of iodide of potassium may be used in a similar way, but sulphur 
inunction rarely fails. 

Lice may be got rid of by adopting a similar treatment to that just described 
for itch, substituting the white precipitate ointment for the sulphur. Since 
these parasites live on the surface, they are more easily attacked, but great care 
is necessary to ensure destroying the eggs or nits, which, being attached to the hairs, 
are apt to escape observation. If the lice be very numerous in the head, and 
particularly if they have existed for some time, it is really the quickest in the end to 



miNGWORM — FRECKLES — ACITB. 995 

out the hair off either entirely or in part (such hair should be straightway burned) ; 
this effects the double object of removing many of the nits, and allowing what are 
left to be the easier reached. The white precipitate ointment as sold by the chemist 
is a violent poison, and should be mixed with twice or three times as much fresh lard 
before being used, especially if the skin be broken from scratching. 

Among the vegetable parasitic skin diseases, ringworm is the commonest and 
most important. The affection differs a good deal in appearance, according to whether 
it be seated in the scalp or on the surface of the body, but it is produced by the same 
fungus, whatever its locality. The scalp is rarely attacked in the adult. Sometimes 
it occurs in both situations on the same child. It is extremely contagious, and it is 
on this fact that much of the difficulty of cure depends. The more recent the 
case, the easier is the cure, but whatever means be adopted great care should 
be taken to bring the drug used in contact with the fungus. If the scalp be 
the seat of the disease, the hair should be cut off over the patch, and for 
about half an inch round about it. Since the parasite grows in and on the 
hairs, as well as in the skin, the hair removed should be carefully burned, 
otherwise it may serve to spread the disease. The bared surface should be then 
painted over with tincture of iodine, or tincture of iron — ink, which is a prepa- 
ration of iron, is often as effectual as it is a popular remedy, especially in 
ringworm of the body ; or a lotion consisting of a drachm of carbolic acid dissolved 
in an ounce of glycerine. These remedies applied night and morning for a 
couple of days are usually effective, or a single application of blistering fluid 
may be tried. Where the disease has lasted a long time, it is necessary to do 
more than merely shave the surface, the hairs must be bodily pulled out, each 
one singly with a pair of tweezers. The hair being loosened at the roots by the 
fungus the procedure is not so painful as it seems, but it is often a tedious 
process, from the extremely brittle state of the hairs. The applications above 
mentioned must be continued for a longer time, and it is as well to keep the 
surface generally moist with a lotion consisting of an ounce of the sulphurous acid 
of the Pharmacopoeia, mixed with an equal quantity of glycerine, and six ounces of 
water. Patients, especially children, suffering from these affections, are usually in a 
low state of health, and for the cure of skin diseases it is necessary to attend to 
this, ordering tonics such as cod-liver oil and iron, and frequently sea air is 
imperative. The poorer the state of health, the more suitable a soil there is for 
the parasite to flourish in. 

Freckles are said to be removed by touching them with crystals of saltpetre 
moistened with water, and many of the brown discolorations of the surface may be 
removed by electricity. Acne is frequently a very intractable disease, and being so 
frequently associated with dyspepsia and anaemia, it requires more than merely local 
treatment. This, however, is not to be neglected, and consists in keeping the surface 
clean with frequent washings with warm water and oatmeal or glycerine soap, and a 
tea-spoonful of carbonate of soda added to the water is frequently of advantage. 
When the spots contain matter the contents should be evacuated by pricking them 
with the point of a needle and gently squeezing them on the surface, and may be 
dabbed over with a lotion consisting of a couple of tea-spoonfuls of carbonate of soda 



996 KCIK DISEASES. 



and borax dissolved in half a pint of rose water, to which a table-spoonful of glycerin© 
has been added For the general treatment, see Dyspepsia and Anaemia. 

Shingles is another disease demanding internal treatment, and for that 
purpose quinine in one or two-grain doses, according to age, and given at meal-times, 
is the best (Pr. 9). The rash, which is often acutely painful, should be kept covered 
with a piece of lint smeared over with zinc ointment, and should be kept dusted 
with a powder composed of equal parts of oxide of zinc and starch powder (Pr. 80). 

Local applications only will rarely effect a cure in psoriasis ; dependent as it often 
is on constitutional states, attention to them is imperative. Arsenic (given in the 
form of three drops of Fowler's solution in a table-spoonful of water immediately after 
each meal) acts almost as a charm in some cases, whilst in others it appears to do 
but little good. Five-grain doses of iodide of potassium in an ounce of water (Pr. 32), 
three times a day, is successful in other cases. The local applications that have been 
recommended may be counted by dozens. Keeping the surface moist with cod-liver 
oil is sometimes effective, or inunction with tar ointment. It is very liable to recur, 
especially at certain seasons of the year. Eczema, a term applied to most skin 
diseases accompanied by a discharge, is really a form of inflammation, and offers a 
good many differences in appearance due to the situation of its occurrence, and its 
duration. One point in regard to its treatment demands the greatest attention, viz., 
that the dry crust formed by the discharge must be entirely removed by careful 
washing and poulticing before the local remedies are used, and should be repeated 
previously to each subsequent application. At the same time, every effort should be 
made to prevent the spread of the discharge over the healthy skin. Like psoriasis, 
it is frequently associated with some state of ill-health, which must be attended to 
at the same time the local treatment is pursued. 

Tonics, such as quinine (Pr. 9), and iron (Prs. 1, 2, 3, 4, and 7), are frequently 
required, or the appropriate remedies for the dyspepsia (Prs. 14 and 15), gout 
(Pr. 33), (fee., which may exist. The raw surface, when cleaned, should be dusted 
with zinc and starch powder, and smeared over with zinc ointment ; it should never 
be allowed to get dry, for the applications put on over the hard scabs are useless. 

By attention to the above-mentioned suggestions for treatment, most of the 
diseases referred to may be cured ; should they fail, recourse must be had to medical 
advice. 



BONE SETTEES AND "BOOT SETTING." 

Not a few of the means adopted for the relief of suffering humanity by medical 
men are derived from sources that are anything but orthodox. Most of the drugs 
enumerated in the British Pharmacopoeia — that authorised cookery book of doctors — 
owe their position there to a popular opinion of their efficacy. The herb whose 
medicinal virtues has been long recognised by the old wives and herbalists of a 
country side gradually comes under the notice of the qualified disciple of ^Esculapius, 
and spreads from him to his fellows, finally to be incorporated in the armoury of 
the craft. Many are the nostrums of marvellous reputed power which are swallowed 
by our trusting fellow-creatures on the faith of tradition, and as yet are not found 
on the shelves of chemists. Nettle tea is a sample of this class. The advancing 
knowledge of the present day has introduced to us drugs the effects of which on the 
living body are accurately known by experiment ; drugs which may be relied on to 
produce certain definite results, such as increasing or diminishing the rapidity of the 
pulse, dilating or contracting the pupil, inducing or checking perspiration, <fec. It is 
obvious that these are most valuable tools in the hands of the doctor who is endea- 
vouring to set in order our diseased bodies. And although many are the medica- 
ments employed the exact modus operandi of which is but imperfectly understood, 
there are still some whose value has been ascertained as the result of scientific 
investigation, and the why and wherefore of whose actions is pretty completely 
accepted. 

Among the methods of treatment which have pure empiricism for their origin, 
" bone setting," so called, occupies a prominent place. Without robbing the bone 
setters of all the credit they jostly deserve in effecting many undoubted cures in 
cases which have been given up by the surgeons, they nevertheless are distinctly 
quacks, though having introduced a method of relief and cure which is gradually 
becoming accepted to a very considerable extent by the legitimate practiser of the 
healing art. No one attempts to deny that many a crippled limb pronounced to be 
incurable has been restored to a condition of perfect health by the treatment of bone 
setters; the cases are too numerous and too well attested to be doubted for a moment. 
But when the individuals who have effected these cures are confessedly ignorant of 
the structure of the limbs they are treating, who persistently designate every case 
they are called to as " a joint out," when such is rarely, if ever, the case, and who are 
really absolutely unaware of what it is they have done, even in their most successful 
cases, they are worthy of no other title than that we have applied to them. For many 
a day there has scarcely been a district that has not had a " bone setter " who not 
unfrequently has combined this profession with some other calling, such as a blacksmith, 
and marvellous are the tales of their powers when all other means have been tried in 
vain. The fact that they frequently fail, as fail they do, and that, too, in cases 
which ; did they possess real knowledge, they would see to be hopeless, should not 



998 BONE SETTERS 



deter us from appreciating what is valuable in their system, and appropriating it. 
There are few methods, however wrong, from which some useful hint may not be 
obtained, for the wrong in many a method lies in the too absolute pursuit of it. 
For the proper application of a system which has its origin grounded in empiricism, 
an educated intelligence is required to avoid such mistakes as might overshadow the 
good that the system really possesses. 

It is possible from one point of view that the very ignorance of the practisers of 
bone setting has been one means of contributing to the success it undoubtedly has 
gained. Wholly unaware of what they were really doing, they, blindly rushing in 
where the more knowing would have feared to tread, have succeeded, by the applica- 
tion of the powerful means which were necessary, but which the more cautious 
would have hesitated to employ, and so would have failed. 

It is true, however, that such practitioners as the late Mr. Hutton had some 
knowledge to proceed upon, and some system upon which they acted; but knowledge 
and system alike were merely the outcome of having seen a vast number of cases, 
and having carefully noticed the result in each — an excellent plan when based upon 
a definite acquaintance with anatomy. This experience led them to decline cases 
which they felt to be unfavourable, though not knowing why, and gradually reduced 
their method of action within the limits of rules. 

The term "bone setting" in itself is distinctly a misnomer. Scarcely ever 
have broken limbs come under this method of treatment, and when they have 
the results have been disastrous. A bone is said to be set when it is placed in 
such a position as to allow the fractured ends to unite. Bones that are ill set 
are sometimes purposely broken by the surgeon and re-set more favourably ; such 
cases, however, the bone setter does not meddle with. What they really do is to 
restore the power of mobility in joints which have become stiff from accident or 
disease. 

Not only is the expression " bone setting " incorrect, but their view of the con- 
dition they are called upon to treat is wrong. Nothing will persuade one of these 
bone setters but that the "joint is out," and that what he does is to return it to its 
place. The remonstrances of the patient and his friends are alike unheeded, and 
the success that follows his treatment justifies — at least to his own mind — the view 
he has propounded. Now a broken bone is one thing, and a dislocated joint is 
another, and it is neither to set the one, nor reduce the other — to use the language 
of surgeons — that the bone setter is really ever called in. 

In order to make clear to the reader what so-called " bone setting " is, we must 
explain the nature and structure of a joint. The rigid, unyielding bones, or the 
levers to which the muscles supplying the motive power of the limbs are attached, 
are enabled to move upon one another by certain arrangements, which are termed 
joints, similar to the hinges by which a door moves upon its post. Thus the fore- 
arm can be bent upon the arm at the elbow joint, the leg upon the thigh at 
the knee, the thigh upon the trunk at the hip, or the fist can be doubled by the 
folding of the different segments of the hand at the finger joints. The ends of the 
bones, where they come in contact at the joints, are covered by thin cushions of a 
firm yet very smooth substance, known as gristle or cartilage. Different joints are 



AND "BONE SETTING.* 999 



of different shapes, but in all the bones which enter into the joints fit into one 
another to a certain extent, the inequalities at the end of one bone corresponding to 
prominences and depressions on the other. Sometimes the bones interlock very 
completely, in other cases the adjacent surfaces are nearly flat The former Tariety, 
of which the elbow may be taken as an example, will obviously allow of more limited 
movement than the latter, as may be seen by contrasting the extensive range of 
motion possible at the shoulder joint with that at the elbow. It is further necessary 
to keep these ends of the bones in contact by some material which shall be suffi- 
ciently flexible to permit of the movement of the bones on each other, and at the same 
time shall not be elastic and allow the ends to be separated from one another. Such 
a material are the tendons constructed of, and they bear very much the same rela- 
tion to the ends of the bones, surrounding them more or less completely, as the 
leather hinges do to a box and its lid. Round about the joint are the muscles and 
their tendons or leaders, by which they are attached to the bones. The tissue of 
which the tendons are formed is identical with that which forms the ligaments. 
Lastly, an arrangement exists in the joint for maintaining the surfaces of the carti- 
lage lubricated by a viscid fluid, which acts like oil in a hinge. Such is the essential 
structure of a joint, however much they may vary in shape and size. In some few 
there are ligaments inside the joint, passing across from one bone to another ; this 
is particularly the case in the knee. It should be understood that injuries to the 
joints, especially such as those leading to the escape of the lubricating fluid, are very 
liable to be attended with serious consequences. 

Every one knows how easily and readily the healthy limbs move, and it will not 
be difficult to understand that anything which diminishes the flexibility of the 
tendons and ligaments, or causes the opposed surfaces of the cartilage to adhere 
together, will diminish the freedom of movement. Now it is exactly such conditions 
as these that accident or disease may lead to. We most of us, at some time or 
other of our lives, have unfortunately experienced a blow on a joint, or a sprain; 
the knee may have been struck with a cricket-ball, or the ankle may have been 
" twisted " by a fall. In the majority of such cases no harm follows, there is probably 
a good deal of pain, the joint is swollen and cannot be moved, and an enforced rest 
adds to the general discomfort. In a few days, however, the limb has returned to 
its normal state, and no harm has been done. Supposing, however, that the injury 
had been more severe, or that proper rest and other remedies had not been adopted, 
or that the individual's constitution had been such as to predispose him against 
recovery, the joint would then have become inflamed, and the ultimate result of such 
a condition would very probably be the formation of a certain material wldch 
would cause the surfaces of the cartilage to become adherent, and would render 
the ordinarily flexible ligaments firm and rigid, a state of things that we have 
seeA interferes with the mobility of the joint. Rest, whether simply by keeping 
tne limb quiet, or, as it is more completely obtained, by bandaging the limb in a 
splint, is a necessity for the treatment of the case ; but this very rest, if unduly 
prolonged, is apt to favour the development of the " adhesions," as they are called, 
that have resulted from the inflammation, and allow of them becoming tough fibrous 
bands, which, if once formed, are rarely, if ever, to be got rid o£ It is clear, however, 



1000 BONE SETTER* 



if these bands are broken across, or if the rigid ligaments which impede the 
movements of the bone be bent and made pliable, that a considerable, or perhaps 
complete, improvement may be effected. It would seem that the actual significance 
of a stiff joint has not hitherto received quite all the attention ii has deserved, 
and that possibly the notion of resting a limb has been pushed too far. Be this 
as it may, what the bone setter does is forcibly to flex the affected joint, and in so 
doing rupture the adhesions and bend the ligaments, leaving the ends of the bone 
free to move upon one another. "With the knowledge of how serious joint affections 
may be the surgeon may have hesitated to apply sufficient force to affect his object, 
and only succeeds in causing pain, whilst the more ignorant " bone setter " who 
follows him, heedless of what may be since he knows it not, puts the whole strength 
of his arm into his work, and breaking through all obstacles, not unfrequently brings 
about a perfect cure at once, and points to the cracking that is heard as the 
restraining bands give as the proof of his assertion that the "joint was out," 
and has now "gone back to its place." 

It would not be quite fair, however, to the bone setters to attribute their success 
simply to ill-considered efforts of brute force. The more successful among them — 
and notably Mr. Hutton, before mentioned — had reduced the method of procedure to 
rules, the results of extensive experience. When once a case is undertaken — and it 
is by no means every one that presents itself that is accepted — a definite mode of 
action is determined on, and either put in practice then and there, or after a slight 
preliminary delay, during which the affected part is usually ordered to be poulticed 
and rubbed with oil, ostensibly for the purpose of softening and rendering more 
pliant the structures round about the joint. When the operation itself is performed, 
there is no more done than is actually necessary. The limb is bent and straightened 
by a few effective movements, not one beyond what is needful. According to the 
joint which is to be manipulated, and the supposed direction in which the " bone 
is out," so are the movements made; but considerable importance is attached to 
making them in the direction in which the most pain is produced, and at the same 
time it is regarded as essential that a painful spot, which is almost always to be 
found somewhere over these joints, should be firmly pressed upon by the thumb of' 
one hand of the operator. One great advantage is the absence of apparatus and 
instruments, often so terrifying to patients. The limb is held firmly on the side of 
the joint next to the trunk, and the required movements are made by bending and 
twisting in definite directions the segment of the limb beyond the seat of the mischief. 
Advantage is often very cleverly taken of the natural leverage afforded by the bones 
and the weight of the trunk, and this without any real knowledge on the part of the 
manipulator of the actual arrangement of the bones and muscles, but simply as the 
result of experience. 

Whilst it is plain that in cases such as we have described a plan of treatment 
like this appears to be rational, and is, as we know, often successful, it is equally 
obvious that there might be many diseases of the joints which would be made very 
much worse by such a course. For instance, the cartilaginous ends of the bone not 
unfrequently become destroyed as the result of disease ; or matter may form in 
the joints, and break through to the surface. This is especially liable to co-exist 



AUD "BONE SETTING." 1001 



with the death of a portion of the bone. In all such cases the bone setter, if he 
touched them at all, would assuredly aggravate the disease, and death has been 
known to follow their interference. And it is at this point that the skilled surgeon 
has the advantage over his empiric rival. The knowledge of anatomy and of the 
true condition of the parts, together with a general acquaintance with the signs and 
symptoms of disease, would lead the former to recognise at once the suitable from 
the unsuitable, and to know when he might with propriety act. With the other it 
is often but little more than guessing, and sometimes he guesses wrongly. Enough 
will have been said to show the real value of so-called " bone setting," and that 
whatever may have been its results in the hands of its practisers, it is destined to 
become in the hands of the intelligent surgeon a valuable addition to his means of 
combating disease. Accepting from the quack the general principles of his art, it is 
amplified and corrected by the light of knowledge, and the how to act is improved 
as the when to act is accurately ascertained. There should be no need to caution 
the public at large against attempting the process themselves. 

In connection with the subject of " bone setting," a word or two may be said on 
the treatment of deformities. Of late years orthopaedic surgery, as it is technically 
called, has assumed such gigantic proportions that it has become a special study in 
itself, and there are at the present time in most of our large towns surgeons who 
devote their time and attention almost exclusively to this branch of their profession. 
Roughly speaking, orthopaedic surgery may be said to comprise the treatment of 
deformities of the trunk, neck, and limbs — such, for example, as club-foot, contrac- 
tions of the arms and legs, curvature of the spine, wry neck, distortions resulting 
from rickets and from scars of burns, stiff joints, badly-set bones, &c. The adaptation 
of artificial substitutes for lost limbs sometimes falls to the province of the orthopaedic 
surgeon, but is more commonly relegated to the instrument maker. 

In the majority of the above-mentioned cases, domestic medicine is obviously 
powerless. The wisest course is to lay the matter before your ordinary medical 
attendant, and to take his advice about consulting a specialist or expert. In 
deformities of the limbs resulting from rickets much, however, may be done 
without resorting to mechanical appliances or instrumental aid. It is a great 
mistake to be in a hurry to put children into irons. Many people have a mania for 
these horrors. Often enough, it is true, the legs become straight when these 
instruments of torture are worn ; but, in the majority of cases, they would get all 
right just as quickly without them. We are often told that a child " gives way at 
the ankles." This simply means that the bones are not yet sufficiently strong to 
support the weight of the body, and the rational treatment is obviously to keep the 
child off its legs till they grow stronger. A little persuasion will, as a rule, be 
found more efficacious than a bar of iron. Let the child crawl, by all means ; but 
keep him from standing or walking. The only kind of splint that is likely to do 
any good is a long, wooden, padded splint, placed on the outer side of the limb, 
reaching from above the knee to well below the foot, and this acts simply by 
preventing the child from using its feet. The same result may often be attained by 
tying the legs together just above the knees. Attention to the general health will 
in these cases do more good than anything. The child should be placed in as 



1002 BONE SETTERS AND "BONE SETTING.* 

favourable hygienic conditions as possible, special attention being paid to the purity 
of the air, warmth of clothing, &c. It should, if possible, sleep alone, and care 
should be taken to keep the bed and bed-clothes fresh and sweet Milk should 
enter largely into the composition of the diet, two or three pints, either pure or 
diluted with water — or, better still, lime-water — being taken in the course of the 
day. Steel wine is a useful adjunct, and the same may be said of Parrish's chemical 
food, and the syrup of phosphate of iron. Cod-liver oil, given immediately after 
meals in a little orange wine, often proves remarkably beneficial. The phosphate 
tif lime powders (Pr. 77) will do much to give the requisite firmness to the bones. 



TABLE OF DOSES. 



In this table only medicines in common use are given. The doses are those 
ordinarily employed : in some cases it may be necessary to depart from the rule. 
Prescriptions for many of these drugs have already been given (see Prescriptions). 
The doses are, in most cases, those suitable for adults. The proportionate dose to 
be used for children and young people is indicated below : — 

Under 1 year old give ^ of the adult dose. 



» 2 


N 


i 




M 


» 3 


»» 


1 




99 


» * 


99 


i 




99 


» 7 


M 


t 




99 


* H 


» 


i 




99 


„ 20 


n 


t 




W 


Above 21 


»» 


full dose. 




„ 65 


M 


the 


inverse gradation of the above. 



It should be borne in mind that certain drugs, especially opium and its prepara- 
tions, must be given with great care to children. 



Alum as an astringent, fifteen grain*. 
Antimony Wine : 

As an emetic, a table-spoonfuL 

In fevers, five drops. 
Barley water, ad libitum. 
Baume de vie, two table-spoonfuls. 
Black draught, two table-spoonfuls or more. 
Brimstone and treacle, a tea-spoonful. 
Bromide of potassium, fifteen grains. 
Cajeput oil, three drops. 
Calomel as a purgative, three grains. 
Camphor julep, two table- spoonfuls. 
Carbonate of magnesia, half a drachm. 
Carbonate of potash, fifteen grains. 
Carbonate of soda, fifteen grains. 
Castor oil, a tea-spoonful to a table-spoonfuL 
Chalk mixture, two table-spoonfuls. 
Chamomile tea, a wine-glassful. 
Charcoal, a tea-spoonful. 
Chloral, ten to fifteen grains. 
Chloric ether, fifteen drop*. 
Chlorodyne, ten drops. 

Cod-liver oil, a tea-spoonful to a table-spoonful. 
Colchicum wine, fifteen drops. , 
Confection of senna, a tea-spoonfuL 
Confection of sulphur, a tea-spoonful. 
Decoction of aloes, two table-spoonf ule. 



Decoction of bark, two table-spoonfuls. 
Decoction of broom-tops, two table-spoonfuls or 

more. 
Decoction of dandelion, two table-spoonfuls or 

more. 
Decoction of sarsaparilla, two table-spoonfuls 

or more. 
Dover's powder, ten grains. 
Dill water for children, a tea-spoonful. 
Epsom salts, half a tea-spoonful. 
Ergot, liquid extract of, fifteen drops. 
Essence of anise, fifteen drops. 
Essence of camphor, ten drops. 
Essence of ginger, fifteen drops. 
Essence of peppermint, fifteen drops. 
Friar's balsam, half a tea-spoonful. 
Gallic acid, fifteen grains. 
Gregory' 8 powder, for children, ten grains. 
Grey powder, five grains. 
Infusion of calumba, two table-spoonfuls or 



more. 
Infusion 

more. 
Infusion 



of cascarilla, two table-spoonfuls or 



of gentian (compound), two table- 
fuls or more. 
Infusion of quassia, two table-spoonfuls or 
more. 



1004 



TABLE OF DOSES, 



Infusion of orange-peel, two table-spoonfuls or 

more. 
Iodide of potassium, fire grains. 
Ipecacuanha wine : 

As an emetic, a table-spoonful 

For cough, ten drops. 
Lavender, compound tincture of, a tea-spoonful. 
Lime water, two table-spoonfuls, or more. 
Liquorice powder (compound), 30 to 60 grains. 
Mustard, as an emetic, a table-spoonf oL 
Paregoric elixir, half a tea-spoonful. 
Parrish's chemical food, a tea-spoonfuL 
Peppermint water, two table-spoonfuls, 
Pepsine, three to fire grains. 
Quinine wine, two table-spoonfuls. 
Sal volatile, twenty to thirty drops. 
Sarsaparilla, decoction of, two tabls-ipoonfuls, 

or more. 
Senna tea, half a supful. 



Spirits of camphor, twenty drops. 

Spirits of chloroform, fifteen drops. 

Spirits of horseradish, thirty drops. 

Spirits of juniper, a tea-spoonful. 

Steel wine, for children a tea-spoonful. 

Sweet spirits of nitre, half a tea-spoonful to a 
tea-spoonfuL 

Syrup of chloral, a tea-spoonfuL 

Syrup of poppies, for children half a tea- 
spoonful. 

Syrup of senna, for children a tea-spoonfuL 

Tannic acid, fifteen grains. 

Tar water, two table-spoonfuls or 

Tincture of bark, a tea-spoonful. 

Tincture of oalumba, a tea-spoonfuL 

Tincture of ginger, twenty drops. 

Tincture of nux vomica, ten drops. 

Tincture of quinine, a tea-spoonfuL 

Tincture of steel, fifteen drops. 



POISONS AKD ANTIDOTES. 

Read the following lines in connection with special directions under the different poisons: 

When poisons have been taken into the stomach, it must be quickly freed by 
emetics, or a stomach-pump, for the issues of life and death in many cases hang on a 
few minutes. A stomach-pump in the hands of a person who understands its use will 
perform the work most satisfactorily, and in cases where the power of swallowing is 
lost, nothing else will succeed. The best practice in extreme conditions is to inject, by 
means of the pump, warm milk, warm water, or the antidote in solution, into the 
stomach to dilute and neutralize the contents, and then withdraw the liquid. Cold 
water will do if the others are not convenient — do not lose time by waiting. 

Vomiting may be induced by filling the stomach full of warm water or milk, and 
using the finger or a feather down the throat, by giving a glass of water with a table- 
spoonful of mustard stirred in it, by ipecac, sulphate of zinc, or alum in thirty-grain 
doses. Salt and water can also be used. 

Sulphate of zinc as an emetic is speedy in its action, usually emptying the stomach 
in a single evacuation, a point of considerable importance where a short delay may 
make a difference between life and death. The dose is from thirty to sixty grains, but 
in an emergency a teaspoonful may be taken in warm water. Large draughts of warm 
water, by distending the stomach, promote vomiting. (Pr. 27) consists chiefly of sul- 
phate of zinc. This emetic is the best in narcotic poisoning. 

In fainting and insensibility from poisoning, where ammonia and sal volatile are 
used, employ them cautiously, or serious and fatal results may ensue. Gauge the 
proper distance by holding to your own nose. 

Give milk copiously, the whites of five or six eggs, and oil in half-pint doses, when 
respectively ordered. 

When small doses of opium are ordered, give from ten to fifteen drops of laudanum 
so as to get only the stimulating effects. 

Flaxseed tea, slippery elm tea, gum arabic in solution, Irish moss tea, and gelatine 
are useful after the stomach is freed from irritant poisons. 

The irritant poisons — arsenic, antimony, mercury, iodine, chlorine, ammonia, 
cantharides, alkalies, and strong acids — cause intense burning pains in the throat and 
stomach, and after the stomach is evacuated oil or the whites of eggs must be given. 
The narcotic poisons — opium, chloral, alcohol, belladonna, aconite, prussic acid, 
strychnia, carbolic acid, hemlock, and hyoscyamus — produce deep sleep and insensibil- 
ity, which must be combated by shocks to the nervous system by means of dashing 
cold water on the spine and breast, together with the administration of strong coffee, 
and stimulants in most cases. 

Send for a doctor always, to relieve yourself as quickly as possible from a responsi- 
bility that you could not lightly assume without a great deal of experience in emergen- 
cies. Generally, results flow from poisonings which need the greatest care of a skillful 
physician. 

Aconite, or Monk's-hood. 
1005 



1006 POISONS AND ANTIDOTES. 



Symptoms are, burning and numbness of the lips, mouth, and throat, soon extend- 
ing to the stomach ; violent and constant vomiting, coldness of limbs, dilatation of 
pupils, swimming in the head, and trembling. Give the emetic draught (Pr. 27), or a 
tablespoonful of mustard in a little hot water — induce vomiting by all means. Use 
stomach-pump if at hand. Give stimulants, such as brandy, coffee, and alcohol. A 
physician will use inhalations of oxygen, galvanic battery, strychnia, or digitalis. 
Keep the head low. See page 744. 

Alcohol ; lack of muscular power, and insensibility. Empty stomach by mustard 
emetic, administered by stomach-pump if necessary; dash cold water on breast and 
spine ; keep awake ; apply ammonia to nostrils carefully. 

Ammonia; great distress is felt in the stomach, accompanied by spasms. Give 
mild acids, such as diluted vinegar and lemon-juice. 

Aquafortis, or Nitric Acid, which see. 

Arsenic ; faintness and depression, sickness, tightness and heat in throat, burning 
pain in stomach and bowels, violent vomiting and purging, intense and agonizing 
thirst which nothing will relieve, skin sometimes hot and at other times cold and 
clammy, severe cramps in calves of legs and oppressed breathing, bloody stools and 
urine, insensibility and death. If the patient has not vomited, shake up a teaspoonful 
of sulphate of zinc in hot water and give it in two doses, or cause vomiting by draughts 
of warm water, warm mustard water, salt and water, or by emetic draught (Pr. 27). 
Stir up whites of eggs, flour, or lime-water with the emetic draughts. If unsuccessful, 
use stomach-pump. Then administer moist hydrated sesquioxide of iron, or hydrated 
sulphate of iron in large quantities. Counteract the extreme prostration by hot bricks 
and bottles, applied to the limbs and back, and by the careful use of alcoholic stimu- 
lants. A physician would inject opiates. See page 750. See on page 806 how to 
make moist peroxide of iron. 

Belladonna, or Deadly Nightshade ; tightness in the throat, nausea, dilated pupils, 
delirium, anaesthesia, staggering, and bladder paralyzed. If there has been no vomit- 
ing, give an emetic of a teaspoonful of wine of ipecac, or five grains of sulphate of zinc 
every few minutes until the desired result is obtained, or salt and water, or mustard and 
water, or the emetic draught (Pr. 27). Give stimulants — hot brandy and water, sal 
volatile, etc., and dash cold water on the breast and spine. See page 761. 

Blue Vitriol, or SulphaCe of Copper, which see. 

Calabar Bean, or Physostigma, which see. 

Camphor; burning pain in stomach, giddiness and dimness of sight. After emetics 
give alcohol in small and repeated doses. 

Cantharides, or Spanish Fly; burniug in the throat, stomach and bowels, sickness, 
vomiting, griping, bloody stools and bloody urine. When vomiting exists, it should be 
promoted by linseed tea or strong gum and water, but if absent, emetics and castor oil 
should be given. Olive oil should not be given. Milk and water and ipecac emetics 
are the best. A stomach-pump may be used. Use warm baths and warm poultices on 
stomach. Injections of opium will be given by a physician. See page 771. 

Carbolic Acid ; burning pain in throat and stomach, tongue swollen, pupils dilated 
if death occurs soon, and contracted if not, inability to move, face pale, and insensi- 
bility. . Breath betrays the odor of the poison. Give a milk and water emetic, or 
better, inject and withdraw the fluid by the stomach-pump ; then administer oils or 
whites of eggs. Meet extreme prostration with stimulants and dry heat to back and 



limbs. 



POISONS AND ANTIDOTES. 1007 



Carbonic Acid Gas, or Choke Damp ; giddiness, slow breathing, purple face, dilated 
pupils, and tightness in chest. Keep up artificial respiration by blowing air into the 
throat or nostrils with a bellows. A physician would use a galvanic battery for this 
purpose. Inject strong coffee, dash cold water on the back and breast, and administer 
oxygen gas if it can be obtained. 

Chloral ; faintness, paralysis, legs and arms cold, fluttering heart. Give a tablespoon- 
ful of mustard in a glass of warm water, and promote vomiting by all means in your 
power. (Pr. 27) may be used for this purpose. Give strong coffee and small repeated 
doses of alcohol ; keep the patient moving about, or use friction, hot cloths, bricks, or 
bottles, to spine, heart, and extremities. See page 777. 

Chlorine Water ; irritant with usual symptoms. Evacuate stomach with milk, and 
warm water emetic, then give flour and water, white of eggs, milk, or veal broth. 

Chloroform by inhalation. When suffocation occurs, artificial respiration; when 
fainting, place the head low. When chloroform is. taken into the stomach; convul- 
sions, insensibility, dilated pupils, and stertorous breathing. Empty the stomach by 
emetics, and use remedies for irritant poisons. 

Choke Damp, or Carbonic Acid, which see. 

Chloride of Antimony is an irritant poison. Give chalk, magnesia, demulcent 
drinks, and tannic acid, then evacuate the stomach by emetics. 

Cobalt is also an irritant poison. Administer emetics first, then give oil, milk, and 
whites of eggs. 

Conium or Hemlock ; fullness in head, giddiness, and loss of muscular power, com- 
mencing with hands and feet. Empty the stomach by an emetic, then give alcoholic 
stimulants and apply bottles of hot water and hot bricks to back and limbs. 

Corrosive Sublimate; burning and tightness in the throat and stomach, retching, 
vomiting blood and bile, bloody stools, and painful abdomen. Give the whites of five 
or six eggs, or flour stirred in water. Evacuate the stomach by the milk and water or 
ipecac emetics. See page 827. 

Creosote ; severe pain in stomach and bloody stools. Treat the same as for Carbolic 
Acid poisoning. 

Croton Oil ; great pain in stomach and prostration. Give olive oil, or mucilage, or 
gelatine, and to combat prostration, alcoholic liquids, small doses of opium, and apply 
heat to back and limbs. 

Deadly Nightshade, or Belladonna, which see. 

Digitalis, or Foxglove ; dizziness, vomiting green matter, faintness, and prostration. 
Give ipecac or mustard and water, to free the stomach if vomiting has not occurred. 
Keep the patient lying on his back, and administer alcoholic stimulants, coffee, and tan- 
nic acid. See page 784. 

Gelsemium ; vision double, pupils dilated, face red, and great prostration. Stimu- 
lants are to be given ; keep up artificial respiration. Physicians inject morphia hypo- 
dermically. See page 791. 

Hellebore; vomiting and purging, prostration, and convulsions. A mustard and 
water emetic must be given, and then strong coffee and stimulants. 

Hyoscyamus, or Henbane; skin cool, face pale, delirium, pupils enlarged. Emetics 
of mustard and water, ipecac, or sulphate of zinc in a fifteen-grain dose to be given, 
then stimulants and coffee. Physician would inject small and repeated doses of mor- 
phia hypodermically. Apply heat to extremities and keep the head cold. 

Iodine ; tightness in throat, nausea, pain in stomach. Give starch or flour in warm 



1008 POISONS AND ANTIDOTES. 

water, milk, and white of eggs, and emetics as long as the vomited matter turns starch 
blue. Opiates are to be given, and a mustard plaster applied to the abdomen. 
Laudanum, see Opium. 

Lime ; pain in throat and stomach and vomiting. Give mild acids and mucilage, 
flaxseed tea, or slippery elm tea. 

Monk's-hood, or Aconite, which see. 

Morphia, see Opium. 

Muriatic Acid ; corrosive, causing burning in throat and stomach. Chalk, lime- 
water, soap, or bicarbonate of soda, milk, and whites of eggs are to be given, and the 
stomach emptied afterwards by emetics. 

Nitrite of Potash, or Saltpetre; faintness, vomiting, pain, bloody stools, and pros- 
tration. Mucilaginous drinks, emetics, and stimulants are to be given. 

Nitrate of Silver; great pain in stomach, convulsions, exhaustion, vomiting, and 
purging. Throw a tablespoonful of salt in water and give it immediately; then give 
emetics, milk, and stimulants. 

Nux Vomica ; see Strychnine for treatment. 

Oil of Vitriol, or Sulphuric Acid, which see. 

Opium ; great giddiness, sleepiness, insensibility, pupils contracted, muscles relaxed, 
and stertorous breathing. The emetic draught (Pr. 27), a teaspoonful of sulphate of 
zinc dissolved in hot water and given half at a time, or large draughts of warm water, 
warm mustard and water, or salt and water must be given to excite vomiting. Keep 
him awake and give strong coffee or tea. Read full directions on page 845. 

Oxalic Acid ; vomiting, burning pain and tightness in throat and stomach. Give 
powdered chalk stirred in water, slaked lime, lime-water, or whiting, and mucilaginous 
drinks, or oil. This poison is often mistaken for Epsom salts. 

Paris Green ; see Arsenic for treatment. 

Paregoric ; see Opium for treatment. 

Phosphorus; vomiting, burning pain in stomach, nervous excitement, giddiness, 
fainting, delirium, spasms, and convulsions. Albuminous and oily substances must not 
be given. Evacuate the stomach, and give from twenty to thirty drops of oil of tur- 
pentine every half hour for several hours. Oxygen may be inhaled. Lime-water can 
be taken. 

Physostigma, or Calabar Bean; pupils contracted, paralysis, stertorous breath. Give 
strong coffee, alcoholic stimulants, and keep up artificial respiration. 

Prussic Acid; difficult breathing, giddiness, spasms, dilated pupils, insensibility, 
and vomiting. If seen before the symptoms come on, give two teaspoonfuls of blue 
vitriol, and a teaspoonful of tincture of iron in a tumbler of water; if after, dash a 
pitch erful of water over the head and face and spine ; hold ammonia, hartshorn, sal 
volatile, or smelling salts, or some chloride of lime to which vinegar has been added, 
under the nose ; keep up artificial breathing, as in drowning, and be quick in all you 
do. See page 860, 

Saltpetre ; see Nitrate of Potash for treatment. 

Spanish Fly, or Cantharides, which see. 

Sugar of Lead ; dry, burning sensation in throat, thirst, vomiting, colic, great pros- 
tration, and cramps in the limbs. Promote vomiting by a teaspoonful of sulphate of 
zinc and frequent draughts of cold water, or by any other means. Give a tablespoon- 
ful of Epsom salts or Glauber's salts. In slow lead poisoning, give two tablespoonfuls of 
(Pr. 34) every four hours until the bowels are well opened : then take two tablespoon- 



POISONS AND ANTIDOTES. 1009 



fuls of iodide of potassium mixture (Pr. 32) three times a day. For paralysis result- 
ing therefrom, friction and galvanism must be used. See pages 811 and 814. 

Sulphate of Zinc ; vouiiting, colic, and coldness of extremities. Whites of five or 
six egcs to be given, or flour and milk, then an emetic, then two cups of strong tea or 

coffee. 

Sulphate of Copper ; metallic taste, vomiting, purging, cramps in limbs. Give an 
emetic, then the whites of five or six eggs, or flour aud water, then strong tea or coffee. 

Sulphuric Acid, or Oil of Vitriol ; burning pain in throat and stomach, vomiting of 
a dark fluid. Antidotes are chalk, carbonate of magnesia, or any alkaline carbonate, 
whiting, lime-water, or plaster from the wall. Give an emetic after the antidote. 

Stramonium; dizziness, delirium, convulsions, vomiting, faintness, and enlarged 
pupils. Give an emetic, then a purge, and lastly a small dose of laudanum every three 
or four hours. 

Strychnine ; violent convulsions and shooting pains. Give an emetic, then purge 
with castor oil. Half a pint of sweet oil, or milk in large quantities must be given. 
Physicians may use chloroform, bromide of potassium, chloral, camphor, or tobacco. 
After vomiting, twenty-five grains of chloral may be given in severe cases while the 
doctor is on his way. See page 838. 

Tartar Emetic ; cramps in chest, severe nausea, colic, watery stools, pain in stomach, 
dryness of throat, and salivation. Evacuate stomach by an emetic and give strong 
green tea, tannic acid, strong coffee, wine, alcohol, or small doses of laudanum. 

Toadstools; sickness, vomiting, fainting, cold extremities. Free the stomach by 
an emetic, purge with castor oil, and give alcoholic stimulants. 

Tobacco ; vomiting, dizziness, pain in head, and convulsions. Give an emetic and 
a purge, then alcoholic stimulants. 

Verdigris ; for treatment, see Sulphate of Copper. 



EDITOR'S PREFACE 



Wokks on branches of science other than medicine flow from the 
printing presses in a continually increasing stream. Books on subjects such 
as Biology, Chemistry, Astronomy, or Political Economy, are widely read 
and freely discussed. Why should medicine alone be monopolized by its 
professors, and denied to the public ? 

There is no other special knowledge which admits of greater usefulness. 
What an incalculable amount of suffering might be prevented, and how 
many lives might be lengthened, did a more general acquaintance with the 
nature of diseases and the mode of preventing them exist. 

The reader must not imagine, nowever, that possessed of this or some 
similar book he can dispense with the physician. A medical work can no 
more make a doctor than a Webster's unabridged can make an English 
scholar, or a Blackstone can make a lawyer. 

The object of this book is to give the physician intelligent help, not to 
be a substitute for his knowledge. It aims to be useful, and it is republished 
and edited with the hope that it will secure in this country a continuance of 
the favor which it has enjoyed in England. 

G. DURANT HOOD. 



ACCIDENTS AND EMERGENCIES. 



INDEX FOR QUICK REFERENCE. 



Angina Pectoris, or " Suffocative Breast 

Pang" 99 

Apoplexy, Treatment of 110 

Asthma Ill 

Bleeding from arteries 694 

" bowels 136 

" " lungs 142 

" nose 700 

" stomach 137 

Burns 707 

Bruises. 700 

Catalepsy . _. 172 

Cholera, Treatment of - 179 

Choking 715 

Colic, Treatment of 186 

Colic, Biliary, Treatment of 285 

Contusions 700 

Convulsions 9 

Croup, Treatment of 14 

Delirium Tremens, Treatment oi, , . . . . 212 

Dislocations 705 

Drowning 709 

Ear, Foreign bodies in 248 

Epilepsy, Treatment of 268 

1011 



Eye, Foreign bodies in , „ . . . 714 

Fainting, Treatment of 278 

Falling of bowels 23 

Foul Gases 711 

I Gallstones, Treatment of 285 

I Giddiness...., 287 

Gunpowder Accidents 713 

! Gunshot Injuries 713 

Hanging 711 

I Hydrophobia, Treatment of 323 

| Hysterics, Treatment of 339 

i Intoxication 712 

: Night Terrors 30 

! Paralysis 436 

\ Ruptures 727 

; Scalds 707 

| Sprains 701 

i Stomach, Foreign bodies in 716 

Suffocation from foul gases 711 

j Sunstroke, Treatment of 505 

I Vomiting, Treatment of 560 

Vomiting of blood 138 

Windpipe, Foreign bodies in 715 

Wounds, Poisoned 699 



Copyright 1901 
£KB HOOD MEDICAL BOOK CO, 



LOVE AND MARRIAGE. 



Among the gifts which nature has bestowed upon man alone, to the exclusion of 
all other living creatures, is the power to love. And no one who has ever experienced 
that passion, even in its mildest form, will deny that it is the most powerful influence 
of all the most potent agencies by which our life in this phase of existence is 
governed. 

All hopes, all passions, all delights, 
Whatever stirs this mortal frame, 
Are but the ministers of love, 
And feed his sacred flame. 

Even the prosaic Lord Bacon, whose mind rarely occupied itself with any sub- 
ject less engrossing than philosophy, has remarked that "no cord or cable can draw 
so forcibly, or bind so fast, as love can do with only a single thread." 

The gentle poet laureate of England and author of In Memoriam, regards a life 
as absolutely lost in which love has formed no share, for, he asserts that 

" 'Tis better to have loved and lost 
Than never to have loved at all," 

and Thackeray only repeats the same thought when he says: "It is best to love 
wisely, no doubt, but to love foolishly is better than not to be able to love at all." 

The prodigious power of love as a factor in human affairs being proved, by the 
evidence of the ages, it behooves us to inquire into the nature of this passion, over 
which death itself is stated to have no power. Moralists and poets notwithstanding, 
it must emphatically be asserted that love, or at all events the love of the sexes, is 
first, and before all things an animal passion. It is in fact, at its foundation, 
nothing le§s than the desire of every perfect animal to continue itself "after its 
kind," which we share in a modified form with all living creatures that move — or do 
not move — upon the face of the earth. So far, we and the rest of nature are one* 

But human love consists of two parts, the desire for procreation which we share 
with the world beneath us, and that blending of two natures into a perfect whole 
which constitutes the love that is distinctly human, and utterly unknown to the 
lower animals. Both are necessary to constitute a perfect human love. Without 
the procreating instinct, or the maternal principle, love is mere affection, and does 
not rise to the loftiness or importance of a passion. 

Dealing first with the procreative instinct, we learn from biology that falling in 
love is really nothing more than the latest, highest and most involved exemplifica- 
tion in the human race of that almost universal selective process, which Mr. Darwin 
has enabled us to recognize throughout the whole long series of the animal king- 
dom. The butterfly that circles and eddies in his serial dance around his observant 
mate is endeavoring to charm her by the delicacy of his coloring and to overcome 
her coyness by the display of his vivacity. The peacock that struts about in imperial 
pride under the eyes of his admiring hens, is really contributing to the future 
strength and beauty of his race by collecting to himself a harem through whom he 
hands down to posterity the valuable qualities that were a source of fascination in 
his own person. Just so is it with man. We cannot fall in love with everybody. 

1013 



1014 LOVE AND MAKRIAGE, 



Some of us will admire one person, some another. As Grant Allen has pointed out 
in an able article; " This instinctive and deep seated differential feeling 1 of prefer- 
ence for some one person of the other sex, above all others, we may regard as the 
outcome of complementary features, mental, moral and physical in the two persons 
concerned; and experience shows us that in nine cases out of ten it is a reciprocal 
affection. 

Spencer declares that 

"Such is the power of that sweet passion 
That it all sordid baseness doth expell." 

By love's influence all baser passions are subdued, the attacks of ill humor are 
resisted, bad habits are corrected and vice torn from its throne. By love's power 
the bitter cup of affliction is softened, all the miseries of life are alleviated and 
the sweetest flowers are plentifully strewn along- the thorny ways of the world. 

Man is alone in his consecration to one being- of the opposite sex, and in devot- 
ing his life-efforts to the rearing of one family. Birds mate afresh year by year and 
many varieties are polygamous. ' All quadrupeds, in their wild state, choose a fresh 
mate for each impulse of procreation, and the offspring of all are turned out to 
shift for themselves as soon as they are able. 

Among the choicest gifts we receive from nature is the capacity for enjoyment, 
the enjoyment of himself and of herself. Many kind attributes she bestows on men, 
but if we had not also this, the others would be a barren heritage. What value 
were there in meat or drink, in sunshine or repose unless the physical man had his 
regular cravings for them? Why do we shrink from discordant sounds, or ugly sights 
or smells, except that nature has implanted in us a relish for her own matchless 
harmonies, her graces and her fragrance? In every faculty, bodily and mental, if 
we do not ourselves impair them, she has done her full part to make life worth 
living. And it will accordingly be seen that, as the supreme privilege of existence 
is to continue itself , to propagate the species "after its kind," she has made the 
exercise of this privilege, in all its stages, the supreme delight and comfort of the 
mental and physical being. Taking it as the first step to this temple of enjoy- 
ment, love must be regarded, notwithstanding its huge blunders and frequent tyr- 
annies, as probably the most welcome and beneficient guest that knocks at the door 
of the human heart. Of course it may be used amiss, like every other gift from 
nature, but when it enters into pure hearts, unstained by any base purpose, we may 
accept the poet's verdict that 

41 There's nothing half so sweet in life 
As Move's young dream." 

In order to taste the full sweetness, however, it is essential that it be used in the 
right spirit. What, then, are the qualifications or attributes necessary to its full 
enjoyment? Love comes to all, or with so few exceptions that it may fairly be de- 
scribed as universal. The very small minority who escape its clutches do not rise 
to the full dignity of human beings at all, they are not even perfect animals. They 
are a sort of material full stop, love and life of humanity, so far as they are con- 
cerned, end in themselves. 

Love, then, comes to the majority of the human race, and, as a rule, it comes 
in youth — 

" When the springs of life are fullest." 

The young man or woman has gone along in the full enjoyment of life, when 
suddenly a huge coiled spring is loosened in his or her breast. The whole of the intel- 



COURTSHIP. 1015 



lectual forces center on the attainment of one object. All other aims in life sink 
into insignificance beside this. 

Is it any wonder in this condition of mind, mistakes in choice are often made? 
The period of courtship, if entered in the spirit of true seekers for self-improvement, 
will give opportunity for correcting discrepancies in the natures of those who have 
decided to marry. 

COURTSHIP. 

It is a most delightful period, this time when lovers are about deciding life, will 
not be worth much unless the other shares it. It is an important period as well, 
for all inharmonies in thought and character must be made to blend. 

In the choosing of a life companion, all feelings aside from the intellectual 
should be kept dormant for the time being, and the necessary requisites for a per- 
fect union looked for. For instance, a woman who aspires to purity and goodness 
should not be linked to a man in whom a love for purity and goodness is deficient. 
A man with social faculties largely developed should marry a woman who also cares 
for society. A man or woman having a desire for wealth or position should mate 
with one of similar taste. Otherwise discord would result. 

In physical make-up the law of opposites should rule. The tall and the short, 
the fair and the dark, the plump and the slender should marry. Every young man 
and woman, or every uninformed person should take a course of reading on Phre- 
nology. 

Man and woman, in the plan of nature are complements, 

" ' As unto the bow the cord is, 
So unto the man is woman. 
Though she bends him, she obeys him. 
Though she draws him, yet she follows. 
Useless each without the other!' 
Thus the youthful Hiawatha said within himself." 

The modern woman has had the word "obey" stricken from the marriage cere- 
mony, having outgrown the idea of submission shared alike by Hiawatha and others 
equally primitive. 

Having, however, consulted the law of mental and physical adaptation and 
selected a companion of suitable years, our young people begin courtship. What is 
it? A few evenings out of each week spent together intermingling the magnetic ele- 
ments which make the very being together, a dear delight. Amusements are enjoyed 
the more because enjoyed together. The hand clasp, the lover kisses, all tend to 
convince one that 

"There is nothing half so sweet in life 
As love's young dream — " 

The precarious economic outlook which at present confronts young people is, a 
serious stumbling block. The young man whose salary is just enough to meet his 
own expenses will ponder long as to how he can make it answer for two. He may 
not have been prudent in the use of funds up to this time, but he has had no incen- 
tive to do so till now. He cannot save very much in the city, out of six, eight or ten 
dollars a week, but perseverance will enable him to accumulate enough to furnish a 
home-nest in time; a place that will be a haven of refuge and rest from the storms 
of the active business world. 

If the young woman also be earning a livelihood, perhaps she will hesitate before 
deciding to give up an independent career to begin home-making. Home-making 
will, in the end, win most women; women are dominated to such a great extent by 



1016 COURTSHIP. 



their affecti ms and emotions. Having- decided to unite her life with a worthy 
young 1 man she can add to the fund for making 1 a common home, by little self- 
denials. A prominent writer says " successful love takes a load off our hearts and 
puts it upon our shoulders." In the courtship days the load will not rest heavy 
while the heart is light in expectation of the culmination of their cherished hopes. 
Who should be happier than the young- pair with a fair life opening- before them 
like 

'•A rose with all its sweetest leaves yet folded" 
and all the glorious possibilities of mutual confidence and helpfulness and mutual 
love. 

Too much stress cannot be laid upon the idea that information regarding the 
marriage relation is a necessity before marriage. To their great discredit be it said 
that most parents allow their children to grow up untrained in matters relating to 
sex, or give whatever information in such a way as to make that part of the body 
seem indecent. A morbid curiosity is aroused, just as would be regarding any other 
part of the body, if the true knowledge of its functions were smuggled away. Until 
purity of thought and knowledge on this question is engendered in youth, we can 
not hope for men and women to be much cleaner spiritually. 

Nothing can make up for a lack of education in youth, but a help that will 
greatly assist is books. Young people should glean all possible information between 
the time they decide to marry and the date of marriage, selecting with care their 
reading. All books will not do, because all authors do not treat of marriage, except 
in its physiological sense, and there is so much more in true wedlock than the mere 
physiologic. 

Another point for the consideration of lovers: The tide of passion will some- 
times run high in these days of close association. All familiarities which would tend 
toward over-stepping the bounds of prudence and propriety should be avoided. The 
consequences of transgression are such that no young person wishes to assume the 
load. 

Be honest and sincere one with another. Truth should be the foundation of all 
dealings. Especially in money matters. Food and clothes are more intimately con- 
nected with happiness than most lovers are inclined to think. A whole after life of 
uprightness may not be able to expunge the effect of a single misrepresentation be- 
fore marriage. It would be foolish to jeopardize the happiness of future years for 
a little effect in the present. 

It is safe to say ninety-nine young men out of every hundred will choose for a wife 
one whose character is without a spot or blemish, and not consider the justice or 
the need of having the same personal test applied to their own, as regards health, 
chastity and morality. 

A young man may have been thrown into the filthy stream of impure social life 
by circumstances or ignorance; he may have gone on with the current without being 
befouled thereby, but that is hardly probable. Some men go on for life, destroying 
the beauty and usefulness of both body and soul. 

Assuming, however, that he swims ashore having seen the folly of his other 
course, is he a fit associate for any pure young woman until he has lived in a state 
of mental quarantine for some time, in order to be sure he has escaped finally 
from the thraldom of sensuality? 

Dr. Dio Lewis has a plan for eradicating sensual thoughts which is worth the 
experiment. He says: "While striving to help young men into the habit of clean 
thinking, I have tried many expedients. With intelligent persons what I call the 
'card plan' has often proved successful. That is, to write on a card a number of 



MARRIAGE. 1017 

words, each suggesting" a subject of interest or a familiar train of thought. When 
an impure notion obtrudes itself, the idea of danger which has been associated with 
it will arrest attention; the card is taken out, and a glance at it will help to shift 
the switch at once." A patient who had profited by this prescription of the doctor's 
said: "I can not tell you how clean and manly I feel. I would not go back for a 
mine of gold. I believe that this expedient might help the worst victim of sexual 
filth into purity and manliness, if he would only try it with a good, strong will." 

One idea further for this period of courtship: The young man must make up 
his mind to try to preserve the depth and sweetness and delicacy of the attraction 
that brought them together, by treating his wife with the same consideration he 
gives his sweetheart. Many a young husband supposes that the nuptual ceremony 
gives him the fullest power over the person of his wife. Nothing more disastrous 
to their future happiness from every possible point of view can be imagined. The 
most innocent and affectionate young wife will feel that she has been abused 
through the holiest impulses of her nature if she yields to excessive sexual demands 
on the part of her spouse. This is not an intentional wrong on the part of hus- 
baods — only lack of correct information, and that is the reason for bringing up the 
subject for consideration during courtship. Knowledge as to the way to live a pure 
married life is worth more before mistakes are made. "An ounce of prevention is 
worth a pound of cure." 

Persons, who would not be persuaded to enter a business career without a pre- 
paratory course, enter the matrimonial career blindfolded, having no guide but pas- 
sion. The shipwrecks of so many barks of health and happiness can testify to the 
mistaken idea that ignorance is purity. 

MARRIAGE. 

Ralph Waldo Emerson says: "We are not very much to blame for our bad mar- 
riages; we live amid hallucinations, and this especial trap is laid to trip up our feet 
with, and all are tripped up first or last. But the mighty mother Nature who had 
been so sly with us as if she felt she owed us some indemnity, insinuates into the 
Pandora box of marriage some deep and serious benefits and some great joys." 

Every one will agree that there is a vast difference between marriage as it is 
and marriage as it should be. A marriage properly entered into by chaste partners, 
understanding the natural laws which should govern the conjugal relation, is prob- 
ably the happiest condition upon earth. 

But the divorce record which almost keeps pace with the weddings is a testimo- 
nial that few reach the ideal state. The ideal can never be reached so long as we 
are dominated by passion, or while the gratification of passion or the results attend- 
ing gratification is the aim of the institution of marriage. Marriage is of the 
mental and spiritual as well as the physical, a blending of all three elements, for 
the uplifting of man and woman. It is called a lottery because reason and judg- 
ment are so seldom exercised in connection with sex attraction; hence the responsi- 
bilities should not be assumed in haste, lest never-ending unhappiness be brought 
upon two individuals. 

Matrimony gives the opportunity and the occasion for the higher faculties of the 
mind to unfold, while a single life offers self as the chief object of consideration. 
The Buddhist says there can be no such things as happiness until self is lost 
sight of. 

There are many arguments used to prove marriage is a failure by those who 
either have made mistakes in ohoice, or who, by a violation of natural laws in the 



1018 MARRIAGE. 

conjugal relation, have not tasted happiness. The fact still remains unshaken that 
it is the doorway through which the real life with all its blessings is attained. No 
argument is needed to prove it to be the natural condition of adult life, and that 
the best successes of life are reached through a harmonious marital union. 

Among those living in "single blessedness," the strongest supporters are they 
who have not loved. They wonder what there is to induce any one "to commit 
matrimony;" from their standpoint the pros and cons are considered in a material 
vein, and the decision rendered accordingly. The bachelor says a wife divides his 
pleasure and doubles his sorrows. That the world is divided into two classes — those 
who are unmarried but wish they were, and those who are married but wish they 
were not. 

It is true the unmarried have opportunities for learning not possible, unless 
under the very best financial conditions, for the married. They may surround them- 
selves with books and other means of study, and broaden their intellect until the 
world does them honor. There is the beautiful story of Faust who had spent a life- 
time in delving into the mysteries of nature and found one lifetime was not enough 
to fathom them. Then he longed for a taste of human joy which his studious life 
had not allowed him, and sold his soul to the devil for the restoration of his youth, 
and for love. But Mephisto was finally vanquished after producing untold misery 
and death for Faust and Marguerite, by the great strength and purity of their love. 

Not every one is wedded to learning who lives a celebate life, but those who are, 
surely perpetrate bigamy in marrying a woman. No woman likes second place in 
her husband's thoughts, and the wife of a man absorbed in public work, or business, 
or learning, feels she is defrauded of attentions that should be hers; that she has 
been wooed and won as a matter of convenience, and there surely will come a time 
of rebellion in any spirited woman. Do not be bigamists. 

A woman student can better think her way through without the little cares of 
wifehood and possible motherhood. Dr. Stockham has made clear the idea that the 
maternal desire can be gratified by giving to the world child-thoughts — thoughts 
born of the mind — instead of children born of the body. 

Marriage is a school of itself, as life is a school. Even if everything has be- 
forehand been studied as how to attain the best conditions for these relations, it 
yet remains that few men and women will really and truly know each other until 
the intimacy of wedded life begins. There are little things to be overlooked in each 
other, and little discrepancies to be pruned out of ones own character. Pages and 
pages have been written on "Advice to Wives" and "Advice to Husbands," beginning 
with "don't do this," or "do that." But no one set of rules will apply. Each hus- 
band and each wife is an individuality, and if wise, they can be a law unto them- 
selves. "Of all actions of a man's life his marriage does least concern other people" 
says Selden, " yet, of all actions of oar life, it is most meddled with by other 
people." Now, the object of this chapter is not to meddle with any individual 
marriage, but to point out a few of the pitfalls common through ignorance. 

Eternal vigilance is the price of love as well as of liberty. Like all fire it needs 
constant fuel; so while the ups and dows of life come and go, do not neglect the 
courtesies and sweet expressed sentiments toward one another. "I love you" is just 
as sweet to the wife of five, ten, or fifty years, accompanied by lover kisses and em- 
braces as it was in the earliest days of courtship. It is a mistake to apply the fuel 
only once in awhile. Sometimes the fire for want of it may smoulder away and die, 
and the re-kindling will be no easy task. Guard well this holy flame that makes 
marriage sacred. 



MARRIAGE. 1019 



As to the other means of preserving" the fineness of true marriage, here are some 
suggestions of a miterial order and yet so closely related to the ethical that there 
should be no separation: 

Let no married lovers think of habitually occupying" one bed. It can do no 
good, and is undoubtedly one course of inharmony and lack of physical hardiness. 
What one may gain in vitality the other loses. The magnetic attraction is neutral- 
ized, if notuestroyd. Aside, and above all other reasons, is the one that separate 
beds will in a great measure help overcome sexual excesses. The close bodily con- 
tact under a common bed-clothing is a constant provocation to amoarous ideas and 
sensations. It is the purely sensual that needs to be put one side that the spiritual 
may have chance for growth. This idea of separate beds can not be combatted on 
any other than the ground of the sensualist. Children will be less liable to come 
unless wished for by both its parents. The mere gratification of sex desire is a very 
poor excuse for calling a soul into being, and a very poor heritage to bestow upon 
the little lives that should be occasion for purest thought before as well as after they 
are called into life. 

The world looks on in disapproval of any who attempt to handle the social ques- 
tion without gloves. It prides itself in its ignorance, and calls itself pure. Purity is 
not ignorance and never will be; it is a great insight. If ignorance were purity why 
are the sins of ignorance against natural laws visited with the same severity, as sins 
of any other kind? People are constantly sinning* against their bodies when a little 
light of knowledge would enable them to see wherein lay their offense. But the 
world has so ordained it that those who seek light must find it in hidden places. 

Not a single school text-book on physiology treats of the sex organs any more 
than if they did not exist; not a teacher, even if he be awake to the necessity of 
knowledge regarding that part of the body, dare mention it. And youth is not clean. 
Schools are even called hot beds of vice. 

When youth shall know himself he will be less liable to consider marriage a 
cloak for lust. He will then steer right his course in order to preserve happiness. 

At present a girl before marriage is kept from nearly all knowledge regarding" 
wifely or maternal duties. If the young man is informed it is usually of not one 
whit more practical character. He has probably no idea that there should be a 
limit to sexual gratification before exhaustion. 

The young wife who is rudely approached on her wedding night will always 
carry in her memory a nightmare of repulsion. 

All men do not go to the excess of brutality, it is true. Those in whom passion 
is strongest and who look upon marriage as the door of gratification are the worst 
sinners even if they do not so recognize themselves. 

A well known woman writer on this subject, who is brilliant in her denunciation 
of ignorance, asks these pertinent questions: "Is there one man in ten who does not 
insist on the payment of the conjugal debt on the first night of marriage, be his 
wife's reluctance and terrors what they may? Is there one man in a hundred who 
will give his new made bride a week to become acquainted and reconciled to the 
idea of the new relation to which she is pledged? Is there one in one thousand who 
is willing to wait with the same patience and to use the same art that the libertine 
in his superior wisdom knows so well how to employ — acts perfectly proper and com- 
mendable in lawful wedlock — even though it may take months before his purpose is 
pained, so that his wife shall be a willing partner to the consummation of mar- 
riage?" 

This, young man, is something for your consideration from a reliable source. 
Only a woman knows a woman's feelings. 



1020 MARRIAGE. 



And, young* woman, consider now some of your rights. There was a fine attrac- 
tion drew you to the young" man about to be your husband, aside from a kinship of 
ideas and similarity of tastes. An attraction so exquisite as to be a delight to you. 
Do not feel it to be your duty to give yourself over to your companion on the wedding 
night unless there is a perfect spontaneity on the part of yourself. Do not pretend 
to enjoy the sexual embrace because you love and are fearful of being misunder- 
stood if you do not. Prostitutes imitate desires, and you are too self-respecting to 
be a prostitute, either out of wedlock or in it. Women have always been weakest 
on this point when their love has been strongest, and yielded their bodies when their 
souls rebelled. 

To call forth passion in most women, it is necessary to bring out the love and 
tender graces of kindness and consideration, otherwise she is repelled. And it is 
her right to demand this consideration or with-hold herself. She belongs to herself 
alone, and no man has any moral claim to sexual congress with here when she does 
not freely and lovingly give him the right. If this were recognized in the marriage 
relation there would soon be fewer women sick in both soul and body. 

Another point that must be looked to by newly married lovers is the frequency 
with which they come together in the new relation. Avoid temptation now as you 
did before marriage, remembering "satiety blunts passion and clips the wings of 
love." Every natural appetite is for a good purpose, but excessive gratification is 
surely depraving. Hunger for food shows the system needs fuel, but eating because 
the food tastes well brings on dyspepsia and kindred ailments. The habit of indulg- 
ing any appetite too frequently rivets upon the sinner chains too strong to be broken, 
and brings in its train disaster. 

Each sex sees in the other that which it demands and craves. If they are 
mutually agreeable, they are drawn toward each other with impulses for which thejf 
forsake all other ties. Therein is great danger, for no other appetite binds its vic- 
tims more strongly than does the sexual passion when given unbridled sway. 

Some thinkers are inclined to the belief that procreation is the sole cause for 
the marital embrace, but that is the other extreme from the present idea of indulg- 
ence to the point of exhaustion. Persons of different temperaments and habit or 
occupation are benefitted by this love feast at intervals of varying lengths. For the 
hardiest and fullest of vitality no less time than a week should elapse. Occupying 
separate beds will help those who will to make their lives chaste. Chastity in the 
sense used here means, not an entire abstinence from sex relation, but a union in 
which mere sensuality is lost sight of. 

Children will be but the outcropping of the pure love of any well developed 
married pair, the number to be limited of course to the desire for and ability to pro- 
vide good pre-natal and post-natal conditions. 

Reproduction of the species is certainly not the end and aim of marriage. The 
world needs a better quality of people rather than larger numbers. But more of 
this in another chapter. 

Here is a stanza written in the dear, true spirit of welcome parenthood. 

" We used to think how she had come 

Even as comes the flower 
The last and perfect added gift 

To crown Love's morning hour; 
And how in her was imaged forth 

The love we could not say, 
As on the little dew-drops round 

Shines back the heat of day." 



DUTIES OF MARRIED LIFE. 1021 



With children conceived and welcomed in love, a married life is one of happiness, 
and a life worth living for. 

DUTIES OF MARRIED LIFE. 
i 

The ideal condition of human happiness is supposed to be in the married state. 
All the fond imaginings of youth lead up to it 8 and its portals are garlanded with 
hope and expectation. But how few of these hopes are ever realized — how rarely is 
the dream of enjoyment fulfilled in fact ! So harrowing is the contrary result that 
one of the standard topics of social discussion embodies itself in the question: " Is 
Marriage a Failure ? " And well might one answer in the affirmative every morning 
that he glances at the tell-tale Dewspapers, with their dark and endless catalogue of 
dissensions, woes and infelicities, of wrecked separations, and abandoned firesides, 
of heart-broken wives and homeless children, at contentions, divorce suits, deeds of 
violence and bloody deaths. Such are the weeds and poison-plants that grow in the 
fair garden, which we supposed was a very Eden of fruitfulness, peace and mutual 
delight. 

The question we well may ask ourselves is — why is this so ? Or why do thous- 
ands of persons assume the marriage bond every year if it is to be the knot of bitter 
disenchantment, of suspicion, deceit, barrenness and infidelity ? How can either 
men or women escape unhappiness and ruin in homes which are but the asylums of 
jaded consciences and appetite, and where mental and physical incompetence, or sin- 
purchased sterility, usurps the place of health, affection and fecundity ? It is a 
simple and absolute impossibility, and the sooner this fact is realized the sooner will 
the true causes be regarded with abhorrence. 

Let us consider the ordinary course of those who undertake to secure their life's 
happiness. A man selects his wife with almost total obliviousness of her fitness for 
the strain and burden of maternity; indeed if she be somewhat fragile she is only 
the more fondly interesting to him. A woman equally blind, commits the hopes 
and happiness of her future, in trustful recklessness; to an individual who may be a 
charnal house from past or hidden sin and who is more fit for the hospital, infirmary 
or asylum than he is for the honorable couch of matrimony. Such a deception on his 
part is surely no less than monstrous, for the untold misery and suffering of his 
partner and their offspring, the latter, if any there be, almost certainly proving to 
be weak, puny and imbecile, burdens to themselves and to society from infancy to 
the grave and only having strength enough to curse the very parentage that forced 
an existance upon them. If anyone would identify such products of wedded love, 
more often an unholy sentiment of cupidity, lust and tyranny, he will find them 
throughout this broad land both in the cottages of the humble and the mansions of 
the wealthy, though happily most of them sink into premature graves are or 
hidden from the public gaze in the living tombs of the insane. 

The duty thus suggested — nay, imposed upon every man under the penalty of 
cowardly crime — is one which should be as plain as the noon-day sun. No being 
with the semblance of manhood, or who holds one speck of honor in his breast, that 
has been affected with any form of sexual or venereal disease, should dare to under- 
take the rights of a husband and father until the last vestage of his frailty is ban- 
ished from the system. To do otherwise is against the very impulse of true manli- 
ness, and a high-handed defiance of nature's holy laws. It is unqualified brutality 
in the outset, and in the end it may prove to be murder — the death of the living 
from scorched and blasted affections, and the deaths of the yet unborn from evils 
which they inherited at the very dawn of life. Nor can any excuse be put forward 



1022 DUTIES OF MARRIED LIFE. 



for such criminal foolhardiness. Science has made such advances in this particular 
field that she is able to extend the remedies which will prevent all this suffering". 
Thirty years of experience, and the testimony of thousands who are happy heads of 
families, justify me in undertaking to repair the debauched human system. By a 
simple and not unpleasant course of treatment, based on the most advanced physio- 
logical studies, I can insure in the votary of Hymen a restored vitality and ambition, 
and the vigor of the life-current, that shall be a guarantee of mutual joy in the 
marriage relation and longevity to the progeny which blesses it. Then, too, the 
horrid thought shall be banished from the soul of the wife, that her condition shall 
ever be joyless, or that she be denied the caresses of children to which she aspired 
from innocent girlhood. 

The assertion is not infrequently made by charlatans — scoundrels is not too 
harsh a name for them — that marriage itself is the only remedy for seminal weak- 
ness. Let no man heed such villainous opinions. A defective virality only rushes 
into complete impotence by the privileges of wedlock. And, were it even otherwise, 
where is the monster so vile as to blast every enjoyment of a pure young spouse 
making of her wedded life one long malediction, rather than seek bravely to repair 
the ravages of his own folly? 

Even to a healthy man the first few years of marriage are liable to risks of 
which but few are aware. The generative organs of both sexes are recognized as 
the very masterpieces of created mechanism, perfect in adoption and in detail as 
they are in purpose. To expose these, on either side, to the rude disappointment 
which must arise from seminal weakness, sometimes, even, from mere physical in- 
capability, is to inflict a shock and injury which a life-time of devotion could not 
atone. Any man, therefore, who has reason to entertain the faintest doubt of the 
integrity of his own functions, either from past errors, weakness or other less obvi- 
ous causes, is quite as much bound to adopt humane precautions as he would be to 
avoid building a fire against the side of his neighbor's dwelling. There is homicide 
in the very thought of the one as of the other, and to those who would madly ven- 
ture it, we say in all sincerity that it is their duty to acquaint themselves with the 
pre-marital treatment and appliances obtainable from me on such easy terms. If 
not they can only have themselves to blame for the pains and afflictions that will 
dog their married life, and which must end in bitter remorse, where they expected 
only to quaff the cup of happiness. It is the leakage repaired in time, and 
before leaving her safe harbor, that saves the gallant bark from shipwreck on the 
ocean. 

As for those unhappy men who have injured or imperiled the sexual functions 
by abuse in early years, or comparatively exhausted it by later excesses, they stand 
more than all others in need of advice and help when contemplating this tender 
union with wife. General treatment comprises nerve and sexual tonics according to 
their condition, primarily to strengthen and tone up the general system, also to 
fortify and invigorate the sexual organ, and every nerve, duct and fibre of which 
have been impaired from their nominal efficiency, and, in the end, to eliminate ab- 
solutely from the system all poisonous or contagious material that might survive 
former conditions even where recovery seemed perfect. With these changes ac- 
complished in the man, he may enter on the married life in confident assurance of 
adding to his happiness and dignity, of finding in his wife a loving and contented 
partner, and of being saved from the dread result of contaminating her or her off- 
spring with the poison of his own forgotten vices. Thus may affections and peace 
abide with him through life, and he be saved from all the miseries faintly outlined 
above. 



THE SEXUAL ORGANS OP THE HUMAN BEING. 1023 

THE SEXUAL ORGANS OF THE HUMAN BEING. 

The sexual organs of the female occupy the front lower portion of the -abdomen 
and the central part of the pelvic cavity. The colon passes behind these organs, 
while the bladder is placed in front of them. The principal divisions of this set of 
organs are the vagina, the uterus, the ovaries, and Fallopian tubes. The 
vagina is a soft, muscular tube, more than an inch in diameter, and four or more 
inches in length It opens out of the body through the vulva, which forms a mouth 
for it. At the outermost part of the vagina, a tube from the bladder also opens 
into the vulva. The innermost part of the vagina is connected with the uterus, for 
which cavity the vagina forms a passage-way. The walls or sides of the vagina rest 
agaiDst each other, closing the passage, except as they are pressed apart by the 
presence of something in the vagina; the walls are formed chiefly of muscle and are 
lined with mucous membrane. 

The uterus is a hollow, muscular body about one-third as large as the closed fist, 
and has the shape of a flattened pear. It is above the vagina, with the tapering 
portion pointing downward and backward, and extending into the upper part of 
the vagina. The walls of the uterus are thick and strong. The cavity within is 
small and flat, somewhat triangular in form, and is lined with delicate mucous 
membrane. The neck of the uterus is about as large around as the thumb, and the 
opening through this portion into the interior of the uterus is not much greater in 
size than a common goose-quill. The main cavity of the uterus is connected with 
the ovaries, one on each side, by means of minute tubes called the Fallopian tubes. 
The uterus is the part in which conception occurs and in which the child is formed. 
Although so small at first, if conception occurs, the uterus increases in size to accom- 
modate the growth of the child within, and, after the birth of the offspring, the 
uterus returns to its former size again. The uterus is supplied with a vast number 
of blood-vessels, so that during pregnancy the young child receives its nourishment 
from the mother's blood through the blood-vessels that fill the lining membrane of 
the uterus. 

The ovaries are two in number, one on each side of the uterus, at a distance of 
three or four inches away. This places an ovary in each side of the abdomen near 
the groin. They are joined with the outside of the uterus by broad ligaments 
which aid in holding both them and the uterus in position, and they are also con- 
nected with the interior of the uterus by means of the Fallopian tubes. Each ovary 
is a roundish, flattened body, about an inch and a half in length, less than an inch in 
width, and about half an inch in thickness. The ovaries are the peculiar and im- 
portant division of the sexual organs of the female; in them are formed the germ 
cells from which offspring is formed. On close examination; each ovary is found to 
produce and to contain a great number of cells or vesicles. These are really minute 
ova (eggs), called the Graafian vesicles. Each of these vesicles is composed of a sac 
or covering, within which is a germinal or embryonic cell. The larger of 
these vesicles vary in number from ten to twenty, and in size from that of a grain of 
mustard-seed to that of a pea, while there are great numbers of still smaller and 
less mature ova in the mass of the ovary. 

At the time of each monthly period a large, ripe Graafian vessel bursts, and the 
ovum thus set free from the ovary makes its way through the Fallopian tubes into 
the uterus; this ovum is retained in the tube and in the cavity of the uterus for sev- 
eral days, during which time it may become impregnated and form an embryo in 
the uterus. If not impregnated, it passes out with the menstrual flow, or is de- 
stroyed and absorbed. 



1024 THE DETERMINATION OF SEX. 

The Fallopian tubes are two slender tubes which extend from the upper portion 
of each side of the uterus to the ovaries. The outer ends of these tubes are singu- 
larly fringed and made to connect with each ovary in such a way that the ova from 
the ovary may pass through these tubes into the uterus. 

The male sexual organs are somewhat more simple and are more nearly external 
than those of the female. They consist of the testicles with their tubes and the 
penis with its glands (Fig. 10). These testicles are the peculiar and important 
sexual organs of the male, for it is their purpose to produce the spermatozoa, or 
sperm-cells. The testicles are two in number. They are firm, oval glands, about the 
size, and somewhat the shape of small hen-eggs. They are suspended from the lower 
front portion of the body and are inclosed by the scrotum. The interior of the testi- 
cle is a delicate and complicated glandular structure. From each testicle there is a 
minute tube extending from the inner portion of the testicle, through the spermatic 
cord, to the seminal sacs, which form minute reservoirs just below and behind the 
bladder. The seminal sacs are connected by tubes with the urethra of the penis. 

The spermatozoa grow in the delicate structure of which the interior of the 
testicle is formed, and, when they mature, they become detached and make their way 
through the winding tube which conveys them to the seminal sacs. Here they col- 
lect in great numbers, ready to be thrown out through the penis in time of sexual 
intercourse. 

The penis extends from the body just above the scrotum. It is an inch or more 
in diameter and five or more inches in length. Through the penis extends a tube 
called the urethra, which, by its internal connections, forms an outlet for the urine 
from the bladder and the semen from the seminal sacs. 

The semen is a thin, milk-like fluid, supplied in part from the testicles and in 
part from the glands about the neck of the bladder and elsewhere upon the penis. 
The spermatozoa mingle with the semen and are carried by it. 

THE DETERMINATION OF SEX. 

To know what decides the sex of offspring is of peculiar interest. The subject 
presents much that is of scientific importance, since it is so closely connected with 
the origin of life and the influence of environment, while parents desire to learn 
what regulates the sex of their children, and to ascertain if these determining con- 
ditions are such as lie within parental control. 

Many theories have been advanced in times past which have proposed to explain 
the intricacies of sex-origin. None, however, have fully solved the problem, while 
the most of these theories have been so wholly wanting in a reliable basis of careful 
observation as not to entitle them to any serious consideration. More recent inves- 
tigations have proved less unsatisfactory, and, by reason of trustworthy and com- 
prehensive research, have approached much more closely to definite answers to the 
interesting queries which arise concerning the genesis of sex. 

Undoubtedly there are certain natural causes, operating in obedience to immu- 
table vital laws, which decide the sex of offspring. In the human being, as in all of 
the higher classes of animals, this decision is reached at such an early period in the 
development of the embryo that observations for ascertaining the causes and conditions 
which make the young being become male or female are especially difficult. In 
some of the lower order of animal life, the development of the sex is delayed until a 
much later date in the life of the embryo, and, in certain of these cases, the decision 
as to the maleness or femaleness is not established until the animal has lived for a 
considerable time as a separate individual. For these reasons, observations for ascer- 
taining the causes for the difference in sex are much more simple and satisfactory in 



THE DETERMINATION OF SEX. 1025 

the lower beings of the vital scale than among 1 the higher classes of animals, in 
which, as has been said, the conditions are intricate and the operations are obscured 
by their early occurrence in embryonic life. 

The higher animals do not appear to be in any way exceptional in the operations 
of the laws which govern their existence, and in accordance with which they have 
their development. All animate creation, including every phase of such beings, lives, 
grows and reproduces its kind in obedience to the same general vital laws. So true 
is this that there is every reason to suppose that the causes and conditions which 
operate in the lower orders of animals in producing differences in the sex of 
offspring, act in the same general manner in producing like differences of sex in the 
offspring of higher animals, including the human being. By observations made upon 
the inferior animals, it is possible to discover certain tendencies in sex-determination. 
These tendencies may be traced with similar results into the superior orders, and 
serve to indicate the relation of cause and effect to be watched for and recognized in 
sex decision, even in the human family. It is from such study and experimentation, 
such careful observation and inference, that the most trustworthy explanations have 
been produced, of the origin and determination of sex. 

It is proper, however, to state that, while much is now definitely known in this 
regard, the whole has not been ascertained. What has been fairly ascertained to be 
true does not place the matter of the control of the sex of offspring within the easy 
command of parents; it does establish the fact, nevertheless, that the regulaton of sex 
is within their partial control, at least. 

As ought to be supposed, the production of the two conditions, male and female 
— on which difference in individuals the continuance of life depends — is, in great 
measure, self -regulating, based upon such economic laws of supply and demand in 
nature as are in accord with the utility of sex and the welfare of the race. Evidently, 
nature must maintain a reasonable balance between the sexes. If from any cause the 
tendency were to produce males in excess, other causes must counteract such a ten- 
dency by the production of females, and, in like manner, any excess of females must 
be offset by corresponding tendencies to produce males. Such appears to be the case. 
It would be disastrous if the individuals of either sex were largely to outnumber 
those of the opposite sex, and it would be absolutely fatal for either sex to cease to 
be produced. It will be found, therefore, that the regulation of sex is a matter of 
such concern that its decision is not left to the whim, caprice or carelessness of the 
parent, but is founded so deep in the conditions and interests of life that it is quite 
beyond human agency to alter, even in individual cases. It is possible, however, to 
recognize the general laws which tend to regulate sex, and possible, also, by con- 
formity to their operations, to realize a desired result through their natural agency. 

Each individual among higher animals, whether male or female, begins as an 
impregnated ovum in the another's body. Any such ovum contains elements of con- 
stitution from both of the parents. In the earliest existence of this impregnated 
ovum, there is a season of sexual indifference, or indecision, in which the embryo is 
both male and female, having the characteristic rudiments of each sex, only indif- 
ferently manifested. In this stage, the embryo is susceptible of being influenced by 
external conditions to develop more strongly in the one or the other direction and 
thus become distinctly and permanently male or female. It is evident that this is 
the season in the development of the individual in which influencing conditions and 
causes must operate in deciding its sex, although it is possible in some of the lower 
animals to alter the tendency of sex in the embryo, from one sex to the other, even 
after it has been quite definitely determined. 

It is well established, in fact, that differences in sex do not come from a differ- 



1026 THE DETERMINATION" OF SEX. 



ence in the ova themselves; that is, there is not one kind of ova from the female 
which become female, while other ova become male, for it is possible to alter the 
tendency toward the one sex or the other after the ovum has been fertilized and the 
embryo has begun its career of development. This possible change in sex tendency 
in the embryo also proves that sex is not decided by a difference in the spermatozoa; 
that is, some of the sperm cells from the father are not male, while others are female, 
in their constitution. 

It is incorrect to suppose, as has been held by some theorists, that one testicle 
gives rise to male sperms and the other to female sperm cells, for both male and 
female offspring- have been produced from the same male parent after one testicle 
or the other has been removed. The same is true in cases in which either ovary has 
been removed from the mother; that is, male and female offspring- are produced 
from mothers in whom either ovary has been removed. In like manner, the sex of off- 
spring- is shown not to be materially affected by the comparative vigor of the parents; 
thus a stronger father than mother does not necessarily produce one sex to the ex- 
clusion of the other. These negative decisions are important because they simplify 
the solution of the problem of sex-determination, by excluding, more or less fully, 
various causes which have been supposed to operate quite f orciby in deciding the sex 
of offspring. 

Some of the more positive agencies that enter into the determination of sex are 
found (1) in the influence of nutrition upon the embryo during its indifferent stage 
of sexual development, and (2) in the constitution and general condition of the 
mother before and during the early stages of pregnancy. These two factors appear 
to enter more fully than any others into the decision of the sex of offspring, and de- 
serve the greatest consideration in this treatise. The influence of food in supplying 
the embryo with nourishment for its development is, perhaps, the most potent of 
these determining causes. 

The effects of nutrition are shown in suggestive manner in some of the lower 
orders of animal life, in which the conditions and results are readily observed. The 
classes of animals most satisfactory for experiment in this connection are such as 
pass through different phases of individual life before reaching the highest and 
most fully developed stage. The insects afford an illustration of these differing 
stages of individual development, (1) the egg is perfected and deposited by the fly; 
(2) this egg hatches into a grub or worm-like animal; (3) this grub, when fully grown, 
enters the chrysalis form and undergoes such complete re-organization that it comes 
forth as (4) the perfect fly. Here are four complete and distinct stages, during which 
periods the sexual function and development are more or less delayed until the pre- 
paration of the insect for its fourth stage, and the tendencies toward one sex or the 
other may be repeatedly changed from one to the other during the earlier stages of 
the individual, by the iufluence of more or less favorable vital conditions. Frogs 
present another series of changes, which make them a favorite means of experimen- 
tation; thus the frog perfects and deposits (1) the spawn; this spawn hatches into (2) 
the tadpole, which, after a season of development and life as a tadpole, gradually 
becomes transformed into the highest phase of the individual's life, (3) the frog. 
Here are three forms of life in the same animal, quite distinct from one another, 
each being preparatory to the next in the scale. Complete sexual function is neces- 
sary only in the highest or frog stage, and during the tadpole stage sexual develop- 
ment is more or less indifferent, the tendency during the life and growth of the tad- 
pole to become distinctly and permanently, either male or female being dependent 
in great measure on surrounding circumstances, especially so upon the influence of 
food, whether it be abundant and nutritious or the reverse. 



THE DETEEMINATION OP SEX. 1027 

Experiments upon frogs and insects tend to establish the truth of the doctrine 
that abundant nourishment during" the stage of sexual indifference inclines to pro- 
duce femaleness, while want of proper nutrition during these formative or prepara- 
tory stages inclines to produce maleness in the individual. Some of the most 
significant experiments for testing the influence of food in deciding sex are those 
made upon tadpoles. A notable case is described by Prof. Geddes, from the experi- 
ments of E. Yung, in which, he says, "from the experience and carefulness of the 
observer, these striking results are entitled to great weight." 

It appears that, in this remarkable experiment, of three hundred tadpoles, when 
left to themselves, the ratio of females to males was as 57 to 43. These were divided 
into three lots of 100 each and fed upon different kinds of nutritious diet to ascer- 
tain the change in sex- tendency due to such food. It should be remembered in this 
connection that the tadpole represents the stage of sexual indifference in the life of 
the young frog, and that external conditions may alter sex-tendencies during such 
period of sexual instability. The first set, in which the original ratio of female- 
ness to maleness was 54 to 46, were fed abundantly on beef, from which cause the 
ratio altered so that it became 78 females to 22 males. The second portion, in which 
the ratio of sex in the beginning was 61 females to 39 males, were fed upon fish, by 
whose more nutritive effects the ratio was raised to 81 females to 19 males. The 
third section, in which the ratio of sex stood 56 females to 44 males, were fed upon a 
still more nutritious diet, that of frogs, whereby the proportion of females was 
elevated to the astonishing ratio of 92 females to 8 males. Each feature of this 
experiment is suggestive in indicating that a rich diet, abundant nutrition, favor- 
able conditions for life, during the season of sexual indifference in the embryo, tend 
to develop femaleness. In the above experiment, no less than two out of the three 
of all the tadpoles which were at first male in their tendencies became female. 

Another of the most interesting and suggestive examples of the effect of diet in 
deciding the sex of an embryo is presented in the case of bees. In keeping with 
other insects, the bee develops through different stages of individual life. The 
eggs are formed and deposited by the mother-bee; these hatch into larvae, which 
by proper growth, development and transformation become bees. Three kinds 
of bees, the queen, the workers and the drones, are produced from the larvae; they 
exist together as the related members of the colony, and perform the various duties 
of the swarm within the hive. The queen is the perfect female, the only one of 
all the number capable of being the mother of a generation of offspring. She is 
the largest and most fully developed, and, by reason of her larger size, her 
finer appearance, and her superiority in other respects, is fitly recognized as the 
queen. The workers are the small, active bees, through whose diligence and sa- 
gacity the honey is collected, the comb is fashioned, the young are fed and the 
colony is protected from dangerous intruders. These workers are imperfect females, 
incapable of producing eggs. The drones are the male bees; they originate from 
unfertilized eggs of the queen, and preform no other function in the life of the 
colony than that of fertilizing the ova of the queen. They live a comparatively 
short and inactive life, and having performed their special sexual function, they are 
stung to death by the workers and thrown out of the hive. 

The facts of greatest interest in regard to this curiously organized colony, or 
family, are such as concern the differences between the queen, whose motherhood is 
complete, and the imperfect female workers. The queen bee is produced from a 
fertilized egg which is deposited in a cell sufficiently large to admit of the superior 



1028 THE DETEBMINATION OF SEX. 

growth of the larva which hatches from it; this larva is fed with "royal diet." This 
"royal diet" consists of the most nutritious and stimulating" bee-food, gathered and 
preserved for this special purpose of serving 1 as the nourishment for the baby queen- 
By reason of these more favorable conditions of room and food, the larva becomes 
perfected in its development so that it finally becomes the queen in size, appearance 
and function. The workers are produced in like manner from fertilized eggs, but 
the larvae from these eggs are restricted to smaller cells for their growth, and 
limited to the ordinary bee-food. The result is they are dwarfed in size, and, 
though female insects, they are incapable of performing the crowning function of 
the female — they produce no eggs. 

Now, it so happens at times that some of the larvae, which would otherwise 
become workers, receive, by accident, crumbs of "royal diet", and such is the effect of 
this richer food upon the larvae which receive it that they grow to an extra size, and 
may even become fertile workers. Certain it is, too, that the nurse-bees often select 
larvee which would otherwise become the dwarfed female workers, and feed these 
larvae fully upon the "royal diet". By such means, these well-fed larvee become young" 
queens. Thus it is that "royal diet" determines that a larva, fed upon such food, 
shall become a queen, fully endowed with motherhood, while the larva nourished by 
the ordinary bee-food produces a sterile worker. 

In this case it appears that fully devoloped femaleness is due wholly to the effect 
of an abundance of suitable food and other favoring conditions during the season 
of sexual indifference which exists in the larva, and that the fate of the female 
embryo, whether it shall become a queen or a worker, is determined within the first 
few days of its larval life, by the effects of the kind and degree of nourishment it 
receives. 

This is in exact accord with the results of the experiment already described in 
regard to the effect of food in detremining the sex of frogs, and tends quite forcibly 
and conclusively to establish the principle that favorable conditions of food and 
opportunities for growth tend to produce the high degree of devolopment in the 
embryo which results in a female offspring. It is fair, too, to infer that femaleness, 
with its wonderful capacity for maternity, is a higher phase of" devolopment, due to 
and determined by superior conditions of embryonic life. 

What is here given in regard to bees is true, in the same sense, with other kinds 
of insects. Thus caterpillars which are poorly fed before entering the phase of the 
chrysalis come forth as male butterflies, while such as are abundantly fed, and which 
enter the chrysalis in a high state of devolopment, become female butterflies. 

In the higher animals, the mammals, in which class the human being is included, 
the embryo is retained within the mother's body until it has developed into a being 
like herself and is ready to be born alive and be nourished by her milk. The changes 
in its growth, corresponding to the different stages through which the insect and 
frog pass, are performed in the hidden conditions of her body; hence, it is not pos- 
sible to observe so definitely the effects of favorable or unfavorable vital conditions 
in determining the sex of offspring from the mammal. Following the indications 
derived from experimets with the lower animals in which it is convenient to watch 
the effects of certain external causes, it is possible to observe with a fair degree of 
certainty the influence of food, temperature, shelter, comfort and quietude, in decid- 
ing the sex of the young of the upper divisions of the vital scale. Results of interesting 
character are reported from experiments made upon sheep and other mammals. 

A collection of three hundred ewes was divided into two lots, of one hundred and 
fifty each. The first division were extremely well-fed, and were attended by young 



THE DETEEMTNATIOlSr OF SEX. 1029 

rams; as a result, the sex of the lambs produced was in the ratio of 60 females to 40 
males. The second division were sparingly fed and were associated with old rams, 
in which case the ratio of sex of offspring* was 40 females to 60 males. It was also a 
noticeable fact that the heavier ewes, such as showed fuller devolopment and the 
happier effects of favorable conditions of life, produced chiefly female offspring". 

Other experiments of similar kind made upon domestic animals tend also to estab- 
lish the conclusion that with the superior animals, as well as with the inferior orders, 
favorable conditions of life for the mother, as regards food, shelter, temperature, 
quietude and contentment, tend to produce femaleness in her offspring, and that 
reverse conditions tend to produce maleness. 

In order to produce offspring, a mother must be properly devoloped in sexual 
function. Undoubtedly, female parents make a more serious productive sacrifice in 
bearing young than is required of male parents. To be capable of such sacrifice as 
is demanded of the mother, and thereby be fully female, requires a higher degree of 
vital development of the embryo and offspring that is to become a female. In order 
to establish its sex as a female, correspondingly superior conditions for development 
are necessary during the formative period in which its sex is decided. In this con- 
nection, the female appears as the superior organism, complete m its own endowment 
for individual life and capable of reproducing its kind, needing at most only the 
fertilizing element from the male, and, in many of the lower orders of life, not even 
requiring a fertilizing germ, but fully competent of itself to produce its young. ' ' Royal 
diet" for the larva of the bee determines the complete motherhood of the queen bee. 
The best external conditions for the embryo frogs decide the greatest ratio of female- 
ness in adult frogs. The most favorable conditions of ewes during the season of con- 
ception and early pregnancy beget the largest number of female lambs. In general, 
it is reasonable to infer that the higher sexual organization which constitutes the 
female is to be attained in the greatest number of cases by embryos which have 
superior vital conditions during the formative sexual period. 

Among human beings, some facts of general observation become significant in 
the light of the foregoing inferences. After epidemics, after wars, after seasons of 
privation and distress, the tendency is toward a majority of male births. On the 
other hand, abundant crops, low prices, peace, contentment and prosperity tend to 
increase the number of females born. Mothers in prosperous families usually have 
more girls; mothers in families of distress have more boys. Large, well-fed, fully 
developed, healthy women, who are of contented and passive disposition, generally 
become mothers of families abounding in girls; mothers, who are small or spare of 
flesh, who are poorly fed, restless, unhappy, overworked, exhausted by frequent 
child-bearing, or who are reduced by other causes which waste their vital energies, 
usually give birth to a greater number of boys. 

As a general proposition, the foregoing facts and inferences tend to establish 
the truth of the doctrine with women, that, the more favorable the vital conditions 
of the mother during the period in which the sex of her offspring is being deter- 
mined, the greater the ratio of females she will bear; the less favorable her vital 
conditions at such time, the greater will be her tendency to bear males. 

That many apparent exceptions occur does not disprove the general tendency 
here maintained. Moreover, it is impossible to know in all cases what were the con- 
ditions of the mother's organism at the time in which her child was in its delicate 
balance between predominant femaleness or maleness; else many cases which 
seemingly disprove the proposition would be found to be forcible illustrations of its 
truth. Still further, it is probable that other causes besides those here mentioned 
act with greater or less effect in determining the sex of offspring. 



1030 SEXUAL ISOLATION. 



The doctrine herewith deduced that the female offspring- is the more highly 
organized, though differing from notions current in the minds of some persons who 
are imbued with the idea tha't the male is the perfect type, is in accord with the 
plan of reproduction of vital bodies throughout the entire world of living beings. 
In the plant kingdom, that for which all other parts of the plant exist, that to 
which all other portions are subservient, is the pistil, or female organ of reproduc- 
tion; a part which it is the crowning function of the plant to perfect, a part which 
is the most complex, most highly organized and most precious. In the lower orders 
of animals, the female organism usually shows its superiority in its greater size and 
fuller development, as well as in its capacity for producing young beings. The 
ability to reproduce perfect beings as offspring is of itself the strongest evidence of 
the superiority of the female. Among insects, birds and mammals, the female is 
usually of larger size, and, though often less attractive in appearance and less de- 
monstrative in habit, she is more passive in disposition, more complacent and happy 
in temper. While greater stature and greater muscular development often accom- 
pany the more pugnacious and restless spirit of the male, such differences do not 
necessarily argue that the male is the more highly organized or more nearly perfect. 
These differences, when they exist, are in great measure due to the fact that the 
animal is male, and, having less organic sacrifice to make in other respects, has more 
muscular development, which is increased by his more restless and unsatisfied con- 
stitution. , 

As has been said, the capability of producing offspring is a sufficient evidence of 
perfect organization in the mother, and shows, too, that she possesses a requisite 
surplus of vital energy and organic power to endow her child ^ith life, both of 
body and soul. That woman possesses higher nervous sensibility, is evidenced in her 
finer delicacy and refinement, in her acuteness to mental impression, and in her 
keener and surer moral sense. Man is less complex. He makes less sexual sacrifice. 
He is not compelled to hold in reserve a surplus energy sufficient to equip a new life 
with being. He has more to spend in his own muscle, brain and brawn. He may, 
therefore, excel in strength, in stature and in intellectual attainment; but such 
features of excellence are not necessarily an evidence that his organism is more 
complex, more refined, more perfect than woman's. Greater muscular and intel- 
lectual power accord with the restless life of the male, and fit him for dominion over 
brute force, but such endowments pale in significance when contrasted with the 
exquisite sensibility of woman, whereby she is fitted for maternity, gifted with a 
creative art and power capable of making men and women. Woman's motherhood, 
whereby the race is continued and its higher destiny is evolved, caps and completes 
the exalted rank maintained by the female element throughout the entire scale of 
vital being. 

Sexual Isolation. 

Some of my readers who have given little or no attention to the subject of animal 
magnetism, personal magnetism, individual electricity, etc., as it is variously denomi- 
nated, will be startled at the above heading, in the chapter giving some of the prin- 
cipal causes of blood and nervous derangements. Especially will coarsely made, 
blustering men, who never deny themselves any indulgence of appetite or passion, 
and frigid, unsympathetic women, who could live in the Arctic seas on an isolated 
cake of floating ice, turn up their noses at this new bubble of sickly sentimentality. 
There are two classes, however, of both sexes, who will instinctively comprehend 
the subject under consideration before reading any thing more than the caption. 
One is composed of girls and boys, and women and men, who possess fine sym- 



SEXUAL ISOLATION. 1031 



pathetic organizations, easily affected by atmospheric changes, or by social or 
domestic discord, and whose condition in life has been such as to cause them to live 
more or less isolated from those of the opposite sex. The other embraces warm- 
blooded, affectionate, impulsive people of both sexes, who have been compelled by 
various circumstances to live in sexual isolation. Both of these classes will under- 
stand me, and say amen, when I place sexual starvation among the principal causes 
of derangement of the nervous and vascular systems. 

There is, throughout all nature, a male and female element, between which there 
is an irresistible attraction. The observer at once recognizes it so soon as he leaves the 
mineral kingdom, and the higher he ascends in the vegetable and animal world, the 
more prominently sexual distinction and attraction -present themselves. In the 
vegetable kingdom, and among the lower orders of animal life, sexual attraction and 
magnetic interchange find expression only in physical contact for reproduction. 
Among the higher types of animal life, before reaching the human being, they find 
expression chiefly in sexual contact, in performing the function of reproduction, but 
to a moderate degree, in physical contact, in unimpassioned association. When we 
ascend to the family of mankind, we find specimens of low spiritual and mental de- 
velopment, but one remove from the brute creation, who are governed by the in- 
stincts of the latter. Above them, we meet men and women with considerable men- 
tal and spiritual development, but with a preponderance of the animal organization 
and impulse, whose sexual attraction leads to considerable interchange, socially, but 
more to the impetuous interchange which characterizes sexual contact. Looking 
still higher in the family whose members "were created in God's image, we find in- 
dividuals of greater moral, mental and physical perfection, in whom spirituality and 
mentality predominate over the animal instinct, and among whom sexual attraction 
leads chiefly to magnetic interchange by social proximity, while direct sexual 
contact occurs only incidentally and occasionally, and is in no instance pre- 
meditated. In other "words, the reservoirs of sexual magnetism in these people are 
located in the superior brain at the head of the spinal column, among the intellec- 
tual and affectional faculties, from which the element radiates diffusively, and en- 
velops the object of attraction, and occasionally extends to, and ignites the magnetic 
combustible elements below and not in the inferior brain, seated between the hips, 
near the extremity of the spinal column, from which, when so located, the element 
radiates more intensely, but seldom so diffusively, as to light the fires of the affec- 
tional nature above. It should be understood in this connection, that the plexus of 
nerves located near the extremity of the spine is sometimes known by the name of 
the inferior brain. 

Looking neither higher nor lower in the mass of humanity, we find a few who 
possess apparently no susceptibility to the influence of sexual magnetism. If abso- 
lutely none, they are not a whit more celestial than their more susceptible 
neighbors, and are invariably found on examination, to be diseased specimens and 
not a distinct type having healthy physical organizations. 

If now, reader, you are prepared to dismiss all question as to sexual attraction 
being natural, and to admit that interchange of sexual magnetism is instinctively 
demanded, you are also prepared for the logical conclusion that sexual association 
is beneficial, and sexual isolation injurious, for nature's laws are imperious. 

There are two essentials to the immediate support of animal life which are 
known to all, viz.: air and food. Without the first, an individual must perish in a few 
moments; without the latter, in a limited number of hours. There are four essen- 
tials to physical and spiritual health which are too seldom recognized, viz. ; vital 



1032 SEXUAL ISOLATION. 



electrical air; food possessing not one, nor two, nor three, of the elements of nutri- 
tion, but all the heat-producing and blood-making properties of true ailment; sun- 
light; sexual magnetism. Especially are the two latter more instinctively and im- 
pulsively than intelligently sought after, and a house-builder strains his inventive 
genius to shut us out from the sunlight, while the conservative tinker of our social 
institutions labors to isolate the sexes, suppress sexual attraction, and ignore the 
existence of sexual magnetism. 

Do some readers inquire why the nervous system requires sexual magnetism to 

preserve it in health! If so, and you will enter into the mysterious science of life 

sufficiently to tell me why the nervous system requires sunlight, I will undertake to 

answer the question propounded. I have no doubt that plausible reasons could be 

given for both of these necessities with a little reflection, but it is not necessary for 

the purposes of this essay, to enter upon any long-winded theory to account for them. 

Enough is contained in this essay to lead irresistibly to the conclusion, that the 

sexes cannot maintain perfect health in isolation. Where the isolation is only par-' 

tially maintained, as in Shaker communities, the effects of sexual starvation are 

indicated. As a body, they look physically dried up. The health of the women, 

who the more rigidly and conscientiously carry out the principles of Ann Lee, is, 

according to the testimony of a seceder, not up to the standard of women outside of 

their communities; insanity is common among them; and yet among these people, 

under certain restrictions, the sexes have times of meeting. In nunneries, we meet 

with the most marked cases of sexual starvation. Nuns are seldom if ever vigorous 

looking. Even if they are apparently healthy, there is a paleness about them 

which indicates a deficiency of that magnetic vitality and red corpuscle which give 

the true indications of health. They may protest that they are healthy, but their 

countenances tell a different story, especially to the practiced eye of a medical man. 

Only lately, I was called upon by a well-dressed, intelligent looking woman, having 

in charge a delicate, bloodless, cadaverous appearing young woman, of about twenty 

years of age. On examining her case, I found no indication of organic disease. She 

seemed to be simply bloodless, and completely wanting in electrical or magnetic 

vitality. I instinctively diagnosed her case as one of sexual starvation, and 

turning to the elderly lady, remarked that I should suppose this young woman had 

been carefully restricted to the society of her own sex. What visible effect this 

announcement had upon the young invalid I know not, as I was addressing and 

looking directly at the one who accompanied her, and who appeared for a moment 

surprised and confused, but finally sufficiently recovered her self-possession to 

remark that her niece had been, till very lately, for several years in a convent! Now 

this young woman had on nothing of the dress peculiar to a nun, and I had not even 

suspected the aunt and niece of being Catholic in their religious proclivities. I 

simply diagnosed the case according to its physical aspects, with no word, hint, or 

suspicion to aid me in forming an opinion. But observation had taught me that 

such physical prostration is often produced by sexual starvation, and I was convinced 

it was the cause in this instance, without ^mistrusting the verdict would receive 

instant confirmation. My advice was — "Take no medicine — let doctors alone. Go 

at once into the society of both sexes, encourage the attentions of honorable men, 

and by social contact draw out of them all the masculine magnetism you can." 

The case cited is not the only one I have examined, coming from convents, giving 
indications of sexual starvation. I have had also, from young ladies' seminaries > 
similar cases. Institutions for young ladies where the exclusion of gentlemen's 
society is too rigidly enforced, are quite as bad for the pupils as convents. Large 
factories and cotton mills where females are exclusively employed, generally contain 



SEXUAL ISOLATION. 1033 



hundreds of pale, emaciated women who are slowly dying of sexual starvation, their 
physical exhaustion being" aggravated, of course, by the sedentary character of their 
labor. 

The Christian world is full of women contemptuously called "old maids" who t are 
drying up, and daily growing more fretful and nervous in consequence of sexual 
isolation; for men, as a rule, cruelly avoid women of a certain age when Mrs. Grundy 
brands them with the common distinguishing epithet by which they are known. 
It is one of the great evils of the marriage institutions that a woman may not remain 
single, enjoying the social consideration of the married, and the social attentions of 
men, especially when marriage is such a "leap in the dark," and often proves so dis- 
astrous to the happiness of her sex 

Large cities and villages have swarms of women, young and old, belonging to 
what are denominated as the "working classes," a large number of whom are ex- 
cluded from good society while possessing native refinement, which renders it 
impossible for them to associate with uncouth and often unprincipled men, who ever 
stand ready to extend the hand of pretended sympathy and affection to females in 
their position. Men morally and mentally suited to the best of this class of women, 
have so many better advantages in a business way to rise above indigency and hum- 
ble social position than their female equals. There are never enough of the former, in 
the social circle of the latter, to keep up anything like an equilibrium between the 
male and female magnetic elements, and woman, of course, is the sufferer. 

Wealth, however, does not always place women in a position to receive a nealth- 
ful supply of masculine magnetism. The pride of aristocracy often steps in between 
the young women of wealth and those young men of little money, but much virtue 
who would gladly associate with them; while the young men pecuniarily able to 
move in the social sphere of the former are, in a great majority of instances, attracted 
to association with those wi h whom their money will purchase the most unlimited 
privileges. As a rule, having quite too few exceptions, young men of wealth are 
given to habits of dissipation and licentiousness which disqualify them for associa- 
tion with the respectable daughters of affluent parents, and consequently, if the 
latter have the pride of caste common to people of this class, their daughters are 
deprived of the society of men, and 8 with all their advantage of position and 
material comfort, must suffer from sexual starvation. 

Occasionally, we hear of men effecting great cures by the "laying on of hands,' 
and the response is often playfully made, "Pshaw! He only cures women!" While 
this is not strictly true, and while the male magnopath sometimes effects cures by 
imparting his healthy magnetism to a debilated person of his own sex, it is never- 
theless a fact that a majority of his cures are affected in cases of women; the 
simple reason for which is, that the want of masculine magnetism led to the nerv- 
ous derangements, which, in turn, produced the diseases from which they seek re- 
lief. In any given case we may not always find the invalid to be a single woman. 
She may be the wife of a sickly man, who generates scarcely enough magnetism to 
keep his own vital machinery in motion, and if he give off any, it is of an unvital- 
ized quality; she may be the wife of a husband who is magnetically repulsive to 
her; the husband and wife may be so much alike in temperament, that the forces 
each generates have, by years of contact become similar in character or quality. In 
any such case, if the wife goes to the magnopath, and he manipulates with his mag- 
netic hand, some part of her body which has become the seat of disease, she re- 
ceives benefit and possibly experiences an entire cure. She receives what her 
system required, for the time being at least, and she revives. Women often cure 
male invalids by the "laying on of hands," etc, "magnetic manipulation/' etc. I re- 



1034 SEXUAL ISOLATION. 



cently saw a letter from one conservative gentleman to his equally conservative 
brother, in which, after telling how much he had suffered from nervous prostration, 

he said: "I have experienced marked relief from Mrs. 's rubbings, which put the 

animal magnetism into me, and they are more powerful and reviving than any 
electrical battery. "You," he continued, "may laugh at this, but I, as one who has 
suffered so much, and received such decided relief, and in so short a time, could not 
doubt her wonderful power." This letter was shown to me with quite an expres- 
sion of surprise by the party to whom it was written, but its contents to me were 
not at all surprising, for the philosophy of the whole thing was entirely familiar to 
my mind, for I had been cognizant of many cures of male invalids by the hands of 
female magnopaths. 

Cases of disease produced by sexual starvation are not so common with the 
masculine as with the feminine sex. "Men are priveleged." Why, the God of 
nature cannot tell, but undoubtedly Mrs. Grundy can. Men only are allowed to 
make advances — they do all the courting — often shabbily — but they do it all; they 
even allure young and thoughtless girls into trouble; get drunk, swear, chew 
tobacco, etc., without greatly affecting their personal or family respectability. 
They may become the fathers of illegitimate children, with, the applause of the 
vulgar, the harmless jests of their associates, and the mild censure of staid people; 
while the mothers of illegitimate children are turned out of good society, and fre- 
quently from their mother's door, without shelter for themselves, or the innocent 
victim of their thoughtlessness. With all their privileges and opportunities, how- 
ever, I have met with some men, old as well as young, of conscientious or bashful 
traits of character, or without social opportunities, who were really suffering from 
physical derangements caused by sexual starvation. There are those who think 
they should bestow no attention upon a young woman unless with the intention of 
marriage, and their moral nature revolts at association with disreputable women. 
There are conscientious young men in large villages and cities, who, not having op- 
portunity for introduction into good society, live as isolated from women as hermits, 
having no other society than that of men with whom they are employed. Many of 
these, however, are finally conquered by their instinctive longing for the society and 
magnetism of the opposite sex, and denied the society of the good and respectable, 
they lay their conscientious scruples a sacrifice at the feet of harlots. 

Years ago the New York Tribune, in speaking of the social life of young men, 
made some remarks which might appropriately find place here. The editor was 
calling attention to the large and increasing number of youths between fifteen and 
thirty years of age in our large cities who were without resident friends and kindred, 
''striving to conquer a foot-hold, and" exclaimed the writer, "how hard the contest! 
What daily widening gaps between those who have succeeded, and those just enter- 
ing the field! Neither the religion nor the social enjoyment of our prosperous men 
seems broad enough to include their employees. Look at the growth of aristocracy 
and seclusion; the world of folly, luxury, and fashion; the enormous cost of subsist- 
ence; the meagre salaries in vogue, and see what chance of comfort or sympathetic 
ease the town has to proffer her clerks, apprentices and students. Herded together 
in the beds and attics of boarding-houses, shut out from the happy homes established 
by long residence and success, they are almost driven to the public saloons for light 
and warmth, and for that friendly corrupanionshi'p" (and I will add magnetism), 
"which, either for good or evil, youth instinctively craves and will obtain." 

"The employers are surrounded with all the appurtenances which make virtue 
attractive. The employees are not only urged into vice by their discomforts, but it 
is vice alone which tenders them an alluring hospitality. She sets forth her con- 



SEXUAL ISOLATION. 1035 



venient bar-rooms, her billiard-tables, her concert-saloons, her houses of prostitu' 
tion — in all of which he will find a merry welcome." It maybe added that the 
young" men of larger means and opportunities have their clubs, and the more favored 
individuals of the other sex have their exclusive associations, each not only giving" 
facility to sexual isolation, but rather encouraging- the same. 

Young* men crowd the beer saloons where "pretty waiter girls" are employed, and 
really simply for magnetic association with women. Lager, wine, or some other 
beverage is called for, and often drank reluctantly, for they wish it to appear that 
the drink is what they are after, at least to those who observe them descending or 
ascending the steps of the saloon. Sometimes the contents of the glasses are left 
undisturbed. Many of these young men enter with no libidinous intentions. They 
feel thirsty or hungry for something, they hardly know what; it is not whiskey — it is 
not beer — it is not tobacco — all these they may purchase at almost any corner, and 
the tobacco may be chewed or smoked in the streets. No, nothing will satisfy 
the physical and soul yearnings but the magnetism of women. They may not have 
thought of this element — they may never have asked themselves or anybody else, 
what animal and sexual magnetism is; they may never have thought of any such 
thing; but here they get what they hanker for without asking the name or quality 
of the article. 

People of both sexes generally recognize the fact of sexual attraction; few have 
given the least attention to the subtle element which constitutes it. This element, 
if investigated, is found not only to be a nutrient, but a stimulant more potent than 
alcohol, and naturally possessing none of the injurious properties of the latter. It 
gives vigor, and, in reality, it imparts erectile power to all the tissues of the body, 
and aids in producing and preserving plumpness of form. It stimulates ambition, 
imparts elasticity to the muscles, and brilliancy to the eye of those who are favored 
with its influence. Both sexes have an appetite for it, and frequently without 
knowing it. They long for something", they know not what, and seek to appease an 
indefinable desire by resorting to narcotics, stimulants, and nervines. Herein, 
drunkenness has an incentive, which has perhaps never before been thought of; but 
it is a fact that, with the imperfect social arrangements which characterize our so- 
called civilization, and which attempt to regulate the social intercourse of the sexes, 
men and women go up and down the earth famishing for something, they cannot, or 
will not, tell you what — unhappy, unsatisfied, hungry, starving — in some cases stark 
mad — and finally, in their blind search for what their systems crave, take to liquor, 
tobacco, or opium. 

There are in fact, to cover the whole ground, two kinds of invisible sustenance 
for which nearly all men and women are starving, viz: the spirit of good, and sexual 
magnetism. One nourishes the moral nature, and by its elevating effects upon the 
corporeal system, imparts physical health. The other nourishes the physical struc- 
ture, and by its exhilarating effect upon the nervous system, makes the spiritual 
■nature buoyant and receptive. Both may be made attainable. To invoke, and receive 
the spirit of good, one has only to sincerely and heartily resolve to make moral 
improvement the chief aim and most important work of his life, and he finds at once 
a steady influx of the elevating influence. To obtain sexual magnetism, nothing is 
necessary but association of the sexes, and Society and State should institute such 
regulations as will not unnecessarily restrict this. Many suggestions bearing directly 
or indirectly on this subject will be found in Part Third. But I will here present one 
way in which sexual starvation might to some extent be remedied, without weaken- 
ing, but rather strengthening, the props of our social system. I would advise the 
establishment in every community, large or small, at public expense, reading and 



1036 PKEVENTION OF CONCEPTION AND CONSTITUTION. 

conversation rooms, numerously in cities, where the sexes may socially intermingle, 
whether acquainted or not. They should be under the supervision of a certain num- 
ber of eminently respectable ladies and gentlemen, appointed as trustees, whose duty 
it should be to enforce order and decorum, and to exclude only persons of dangerous 
character. Such rules and regulations could be easily devised and enforced as would 
effectually prevent those who would contaminate the moral atmosphere of the place 
from being admitted ;but with these precautions not too stricly instituted, all who are 
allowed to enter should be admitted without fee and allowed free social intercourse 
without the formality of introduction, unless a committee, with badges to designate it 
be organized for the purpose of conducting personal introductions, a practice already 
in vogue to some extent at balls and sociables. These reading and conversation rooms 
should be well supplied with books and papers of interest, and open alike to rich and 
poor of both sexes, and all conventional reserve should be thrown off while at these 
places, even if put on again when outside of them. Would not such places of resort 
be full of entertainment for women, and also full of attraction for men? Would they 
not, if properly managed, success fully compete with the drinking saloons, gambling 
hells, and houses of prostitution, in arresting the interest, and securing the presence 
of young men who are now the patrons of demoralizing attractions? If we create free 
public schools for the education of our children, may we not with equal benefit to the 
community, create institutions which shall encourage moral, intellectual, and phy- 
sical devolopment of men and women? At what fixed age should the State abandon 
the intellectual and physical culture of its people? 

PREVENTION OF CONCEPTION AND CONSTITUTION. 

Since the ultimate redemption of the human species depends on every person 
being well born, it would seem almost superfluous to add further argument to prove 
that limitation of offspring should be within the knowledge of all parents. 

There is, however, a certain class of moralists whose pharasaical minds are 
closed to all reason on this subject, and it is because of their influence over many 
who are seeking for light which makes further explanations necessary. 

This class of persons whold have us think a general knowledge of methods to 
prevent conception would tend to produce greater immorality than at present; that 
women would shirk the responsibilities of motherhood entirely, to indulge in frivol- 
ity, that it is thwarting nature's plan, etc., ad nauseum. 

In a recent session of the U. S. Congress, a bill was lobbied through by these 
people with "beams in their own eyes," which makes it unlawful to publish any mat- 
ter to enable parents to control the number of children in a family. This is to be greatly 
regretted, but since it is, the next best thing is to arouse the public to the necessity 
of this knowledge and a new congress can be selected to repeal the law. 

Chance conceptions have filled the world with a clamorous and contentious gene- 
ration of people. Contraception would overcome this. Only such children as were 
desired would be called into life, and it is quite certain these would not be from 
among the criminal classes. Their offspring is barely tolerated. 

It could not possibly produce a greater degree of immorality than exists now, in 
the ignorance of the many. At present it is only the well-informed people who pos- 
sess this valuable knowledge, while the poor laborer who most needs it is kept in 
the dark. Do not parents of large families suffer at the thought of adding another 
life to the family already too great to be properly cared for? Is a large family, with 
small means, more happy or better than one of a number within the bounds of pro- 
per care? A mother's life is sacrificed by too frequent child-bearing as surely and 
as cruelly, as if she were slain by running the gauntlet of military lash. 



PREVENTION OF CONCEPTION AND CONSTITUTION. 10^7 

In that splendid story "The Strike of a Sex," the author inserts a letter from a 
woman robbed of all the sweetness of life by enforced maternity. In bitter language 
she expresses herself in these words: 

" Poetically speaking", children are the rose-buds of life; practically they are the 
torments of existence. I speak from a long- aud miserable experience. I am now at 
thirty-five 5 the mother of seven children, the eldest, nine years, the youngest, nine 
weeks. I am called their mother, but am really their slave. I was once a careless, 
happy joyous girl, but my children have made me a fretful, nervous, care-worn 
woman. All the romance of my life has gone,- the poetry of existence changed 
to the dullest prose. I live in the midst of quarreling children, instead of enjoying 
the society of congenial friends. From Monday morning to Saturday night I am 
working for my children, yet they show not the slightest gratitude, or make not the 
least return for all the devotion lavished upon them. Sick or well I am compelled to 
live in a state of noise and confusion distracting to my nerves and detestable to 
all my finer feelings. ******* ***** 

* * * I feel — I know I am made for a better, a higher destiny than to be 
the helpless victim of seven domestic despots. * * Had I known that mar- 
riage would have made my life what it is, I never would have married." 

Would the moral Pharisee state who would have been injured had the above lady 
been the mother of one, or two, or three babies instead of the seven? Preventing 
conception does not mean destroying an embryo; it does not mean to take life. No 
existence is begun until the sperm-cell unites with the germ cell. It is perfectly true 
that " children have a right to be born" — further than that they have a right to be 
well born. And if conditions are not such as to make that possible they should not 
be called into existence. A spermatozoid is not a child; an ovum is not a child. That 
which is not, can not possibly have " rights," either to be bestowed or withheld. 
The rights of the might-have-been children of those who never marry could as well 
be- called in question, as the rights of children not conceived, in the married state. 

Children do not come by special Providence; they come as the result of one of Na- 
ture's laws, which is: a union of male and female germs under proper conditions 
will produce another being of the same kind. 

Nature can be improved upon by applying the knowledge which man possesses, 
in nearly every way. The flavor and quality of the fruit is improved by pruning 
some of the shoots of vine or tree. The strawberry plant tends to run to vine, to 
create other strawberry plants, but the fruit grower cares for the kind of berry, 
and prunes the runners. The vitality of the plant which otherwise would have 
gone to produce runners is thrown into the fruit. In this way a superior quality is 
developed. The human mother may be likened to the plant, in that she can not give 
the same strength and vitality to many little lives which are the fruit springing 
from her own, that she could to two or three. 

The world does not need quantity in its population, and it does need quality. 
One good, useful life is worth a hundred quarrelsome, selfish lives. 

The necessity to "multiply and replenish the earth" is not so apparent now as 
it was in the days of Adam and Eve, and Noah, the man saved in the Ark, with his 
wife, his three sons, and their wives; hence that injunction is void. 

Dr. Sidney Harrington Elliot says: "There are times and conditions when the 
birth of children is a wrong to the community. It is a wrong either knowingly or 
igmorantly, to bring into the world, through no fault of its own, a being impure, un- 
healthy and incomplete, only to suffer and die, or to live a life of misery and imper- 
fection and perpetuate the curse in succeeding generations. Yet so much is this fact 
disregarded, that one-half the human race perish in early childhood. 



1038 PREVENTION OF CONCEPTION AND CONSTITUTION. 

"Nor can this be wondered at when it is considered from what unsound seed 
they come and under what unfavorable circumstances many of them are conceived, 
born and reared. If people will violate nature's laws and have children by hap- 
hazard conception when they are neither in a fit state of mind or body; if they will 
continue to exert unfavorable influence during- gestation; and if they will disregard 
all laws of health and reason in bringing up their children, then nature is only doing 
a kindness in keeping the world from ruination by wiping such misbegotten, un- 
fortunate beings off the earth." 

Signor Mantegazza, in "Elements of Hygiene" says: "Political economy, 
which is merely a hygiene of society, ought to say to the poor man who has noth- 
ing to offer his children but want, or the foundling hospital, 'Love, but do not have 
offspring '. " 

In connection with the above statement, a timely suggestion can be added. 
No political economy is truly hygienic when it denies to any man the right to labor 
for his family's support, or refuses him sufficient pay for the same. 

An able medical writer says, "While regeneration may be necessary for those 
who are already born morally and physically accursed, let us look to the laws gov- 
erning generation that regeneration, will be rendered unnecessary. -To say nothing 
of the 'headachy,' the dyspeptic, the consumptive, scrofulous, idiotic, insane, blind, 
deaf and dumb; the inefficient, indigent, and squalid; the pauper generating swarms of 
paupers and the beggars at every thrifty door; the thief and highwayman reproduc- 
ing new broods of their kind and feeding them on the storehouse of the industrious; 
to say nothing, I repeat, of all these which affect family and society, every com- 
munity is inflicted with physical weaklings and natural-born sinners of less marked 
type who stand in the path of human progress. But our legislators practically say 
that the State has need of all this stuff, and that accidental reproduction shall 
go on " 

Another medical authority says, "The world is groaning under the curse of 
chance motherhood. It is due to posterity that procreation be brought under the 
control of reason and conscience." 

John Stuart Mill, in "Principles of Political Economy" wrote, "Little improve- 
ment can be expected in morality until the reproduction of a large family is regarded 
in the same light as drunkenness or any other physical excess." 

The Arena which is the foremost American periodical, in discussing vital ques- 
tions often gives its readers food for thought on the evils of uncontrolled propaga- 
tion. Under the title "Wellsprings of Immorality" the editor says, "Among the 
most fruitful sources of triumphant lust in modern society may be mentioned heri- 
ditary and pre-natal influences. Children come into the world cursed with an appetite 
far more terrible and insatiable than the drunkard's thirst for drink. They are the 
legitimate product of a society which, while making clean the outside of the cup, 
refuses to have the poison within removed, lest the sensibilities of its offenders be 
hurt by the operation." 

A feeble remonstrance often made in regard to methods of prevention is this: 
that wives will be more apt to be unfaithful to their husbands should they know 
how to avoid unwelcome maternity. 

Robert Dale Owen well answers this class of objectors in the following words: 
"Is, then, this vaunted chastity a mere thing of circumstance and occasion? Is 
there but the difference of opportunity between it and pros itution? Would their 
(the objector's) wives, and their sisters, and their daughters, if once absolved from 
the fear of offspring all become prostitutes— all sell their embraces for gold, and 



PREVENTION OF CONCEPTION AND CONSTITUTION. 1039 

descend to the level of the most degraded? * * Constancy, when it actually ex- 
ists, is the offspring- of something more efficacious than ignorance." 

"If ignorance is all that restrains her now," says the keen and brilliant Mrs. 
Duffey, in "The Relation of the Sexes," "her chastity is hardly worth the keeping"." 
If a true marriage exists, constancy will never be questioned, because its greatest 
pleasure is to be loyal to its highest and best love." 

The most deplorable state of womanhood is in that marriage wherein she is 
made the victim of her husband's lowest propensities. As Dr. Nichols says, "The 
world is full of miserable wretches, the result of sexual commerce forced upon a 
loathing wife by a drunken husband." 

The world is full of the anguish of women who suffer physically and mentally 
from conjugal outrages, and can only be overcome by a renouncing of any claim 
heretofore recognized as superior to her own right to her own person. What is 
known as "the marriage debt" or "conjugal rights," does not exist. The conjugal 
embrace should never occur except as the highest form of the blended love of lovers, 
aud can never be a duty since duty implies a mechanical obligation, which may or 
may not be rendered gladly. A woman abuses herself by yielding her body to a 
lustful husband through months or years of married life as certainly as if she were 
prostituted outside of marriage. 

It has come to be more than a question of right to herself when children are 
born of a mere physical union in which the wife is an unwilling partner. No matter 
what the result of refusal is, complying is too great a price paid for something not 
worth the sacrifice. 

Foeticide is largely the result of enforced motherhood, and Henry C. Wright in 
"The Unwelcome Child," gives a letter from one who had suffered the tortures of 
both foeticide and giving birth to unwelcome children." Following is a part of the 
letter: 

"When my first-born was three months old, I had a desperate struggle for my 
personal liberty. My husband insisted on his right to subject my person to his pas- 
sion before my babe was two months old. I pleaded with tears and anguish, for my 
own and my child's sake, to be spared; and had it not been for my helpless child, I 
should have ended the struggle by bolting my legal bonds. For its sake I submitted 
to that outrage, and to my own degradation. For its sake I concluded to take my 
chance in the world with other wives and mothers, who, as they assured me, were 
all around me, subjected to like outrages, and driven to the degrading practice of 
abortion. 

"But, even then, I saw and argued the injustice of my personal right in regard 
to maternity, and the relation that leads to it, as strongly as you do now. * * * 
I insisted that it was for me to say when and how often I should subject myself to 
the liability of becoming a mother. But he became angry with me; claimed owner- 
ship over me; insisted that I, as his wife, was to submit to my husband 'in all things'; 
threatened to leave me, and declared I was not fit to be a wife. Fearing some fatal 
cod sequences to my child or to myself — being alone, destitute, and far from helpful 
friends, in the far west, and fearing that my little one would be left to want — stifled 
all expression of my aversion and painful struggles in my own bosom. 

"In every respect, so far as passional relations between myself and husband are 
concerned, I have felt myself to be a miserable and abject woman. I now see and 
feel it most deeply and painfully. If I was with a child in my arms I was in con- 
stant dread of all personal contact with my husband, lest I should have a new ma- 
ternity thrust upon me. * * * 

"It was not a want of kindly feeling toward my husband that induced this state 



J 040 PROSTITUTION. 



of mind, for I could and did endure every privation and want without an unkindly 
feeling or word, and even cheerfully, for his sake. But every feeling of my soul did 
then, does now, and ever must, protest against the cruel and loathsome injustice of 
husbands toward their wives, manifested in imposing upon them a maternity un- 
called for by their own nature and most repulsive to it, and whose sufferings and 
responsibilities they are unprepared for, and unwilling to meet." 

Women, who endure rather than enjoy the conjugal embrace, should certainly 
be fortified against enforced maternity with a knowledge of preventives, so as not to 
be the helpless accessories to the making and moulding of lives cursed before they 
are born. 

Helen Williams has truly said, "Enforced motherhood should stand on the 
criminal docket second only to the crime of taking life, and its punishment should 
be commensurate with its hideousness." 

The law of continence is the one truly elevating and spiritual way to govern 
procreation. As a compromise between continent lives and abortion, prevention of 
conception takes rank. It does not appeal to the finer senses as does the law of con- 
tinence given in a previous chapter, but does not shock and injure and degrade wo- 
manhood as do abortions. There should be a general knowledge of preventives if 
for no other reason than to overcome the suicide of mothers in producing abortions. 

This is an evil more widespread and destructive to health and woman's better 
self than can be imagined by those not knowing facts. To women it is a choice 
between two evils, and they choose what to them appears the lesser. The practice 
cannot be too heartily condemned, but the condemnations will never be heeded by 
her who is desperate enough to take her life in her own hands, unless an alternative 
is offered. 

PROSTITUTION. 

To prostitute, is to turn from its natural use any function of body or brain; but 
the common acceptation of the term prostitution is associated with the barter and 
sale of woman's body to the sensuality of man. It is a heritage from a benighted 
past which is not to be uprooted until the race comes to believe its extermination to 
be a possibility. When the mind is converted to a belief the body will come to act 
in accordance with that belief. "All evil deeds have their root in thoughts of evil." 

Prostitution seems to have come in existence co-evii with society and has con- 
tinued down through ages without a pause, or a moment's obscurity. It has polluted 
the morals of all nations, and, in their decay, nothing more surely can be located as 
a chief cause, than social impurity. 

Greece and Rome, in the days of their decline, were saturated to the core with 
sexual vices and other intemperate indulgences. 

Wine and women have been classed together from the days of ancient history as 
tempters of men, and, considering women in the physical sense, there is a resem- 
blance in the intoxication of the two W's. The appetite for sexual indulgence and 
the appetite for drink both bind the victim in the despotic chains of habit, until the 
inherent good is obliterated in what finally comes to be depravity. The indulgence 
in any thing that creates an unnatural nervous stimulus leads to the temptation to 
expend it in amourous indulgence. Both forms of intemperance, singly or togeth- 
er, break down the health and are the wellsprings of degradation and crime. 

The temporary pleasure gained from association of men with public women does 
not in any way compensate for the loss entailed, One indulgence calls for another, 
until the finer sensibilities are blunted; and physical ruin is inevitable when passion 



PROSTITUTION. 3041 



is given unbridled sway. It was Seneca who said, "The more a man becomes addicted 
to sensual pleasure, the more completely is he a slave. People may call him happy 
but he pays his liberty for his delights, and sells himself for what he buys." 

Concerning the Jews, the very first book of Moses makes clear that harlots were 
not unusual. In the sixteenth verse of the thirty-eight chapter, woman, replying to 
a solicitation, asks "What wilt thou give me that thou mayest come in unto me?" So, 
it is seen that such favors from women were salable then as now. 

Portions of the Mosaic law were given with the object of checking disease (as in 
Leviticus xv.) which modern medical science believes to have been gonorrhea. 

Other Biblical historians leave no room for doubt that prostitution continued as 
long as the Jewish nation lasted. 

Sex worship was a prominent part of the religion of sun- worshipers, and pervaded 
all countries. The mysterious and wonderful power of the creative organs to repro- 
duce human beings caused the pagans to deify them, to make idols in their image 
and worship them. 

In the religion itself there is nothing degrading for it is true that the function 
of procreation is the highest in the natural power of the human. The Divine Archi- 
tect did not intend part of the body to be impure, but in its entirety to be noble and 
good and useful. 

The earliest mental devolopment of the ancients was in the direction of religion 
of some kind, and the best of mankind's possession was required as a sacrifice or 
offering. That most shocking enormities were practiced in tho name of the deity 
reverenced. For instance, in honor of Mylitta, the Chaldean Venus, every woman was 
compelled to prostitute herself once in her lifetime by giving her virtue to any man 
within the temple who might solicit her. The fee, a silver coin, was received with 
the salutation "The goddess Mylitta prosper thee,'' and deposited upon the altar. In 
Phoenica, in addition to forced prostitution in the temples, the maidens were required 
to bestow their favors on any stranger who visited the country. 

It is said that the Hindus still retain a class of women in the temple whose duties 
are to perform certain religious rites, and minister to the sensual wants of priests, 
and pilgrims who visit the temple. 

The history of this institution in early and middle ages gives more light as to 
the origin and strength of the evil to be combatted in the present. 

Established in Athens during the time of Solon, about the year 600 B. C, were 
houses of prostitution filled with female slaves. These houses were kept up by public 
money, and the inmates were bound by law to satisfy the demands of all who visited 
them. But these slave women were not allowed to enter the temples or take part in 
religious ceremony, and when they appeared in the street, were obliged to wear a 
certain costume as a badge of infamy, to be known apart from the reputable Athe- 
nian women. 

Later, there came to be four classes among Greek prostitutes, the Hetairas, the 
Auletrides, the Dicteriades and the Concubines. 

The Hetairae constituted the society of the age; they were the most important 
women in Greece. They were educated, intelligent and refined in manner while the 
virtuous wives were ignorant, and kept in restraint in order that the fatherhood of 
children might not be questioned. The Hetairae alone of all women saw the plays of 
Alexander and Aristophanes; they alone heard Socrates reason, and discussed politics 
with Pericles; they alone might enter the studios of Phidias and Apelles. Jt was 
poor recompense to virtuous women to know that the Hetairae might not take part in 
religious services, or give birth to a citizen, when in aii else the virtuous were out- 
rivalled. 



1042 PROSTITUTION. 



Aspasia, a remarkably intellectual woman, established a house of prostitution in 
Athens and peopled it with the loveliest of girls. She lectured publicly among her 
girls and their visitors upon rhetoric and philosophy with such ability that many of 
the first men of Greece became her patrons or lovers, including Socrates, Alcibiades 
and Pericles. 

Phryne was an enormously wealthy and beautiful woman, and a great favorite 
in Athens. Among her lovers were Hyperides, the orator, ' Apelles, the painter, and 
Praxiteles, the sculptor. In the festival of Neptune and Venus she was selected to 
take part, and at a certain point in the ceremony, appeared on the steps of the temple 
at the seaside. Here she disrobed in the presence of the people, plunged into the 
waves and offered a sacrifice to Neptune. Returning, she would dry her hair from 
which the water dripped over her exquisite form, pause a moment before the crowd, 
which applauded in a frenzy of enthusiasm, and disappear in a cell of the temple. 

In contrast with other dissolute women of antiquity the leading trait of the 
Hetairae was their intellectuality, and no wonder Greece was swayed by their influ- 
ence; however this was mainly during the years of their youth and beauty. When 
age crept upon them the majority were outcasts, the case in all ages and all countries 
down to the present. 

In Corinth, nearly every house in the place was a house of prostitution. There 
were regular schools where the " art" of debauchery was taught, and there was an 
old adage which alluded to the dangers of visiting Corinth. 

Lais, who was the mistress of the philosopher Aristippus, began her profession 
in Corinth. She was capricious, and would not yield herself even for enormous 
sums of money unless she wished. She refused two talents ($2,000) from Demos- 
thenes, who had actually turned his property into money to lay it at her feet, but 
gave herself gratuitously to Diogones the cynic, who is said to have lived in a tub. 
The people of Corinth desired to posses her statue, and Myron the sculptor, was sent 
to model her charms, but fell a victim at his second visit, and laid all his savings at 
her feet. The statue was not made. But Lais' charms vanished in old age. Epic- 
rates depicts her as a drunken old woman wandering over the quay at Corinth seek- 
ing to sell for three cents what had been considered cheap at two thousand 
dollars. 

The Auletrides, or flute-players, were next in influence to the Hetairas. Flute- 
playing itself had a powerful fascination, and when in the hands of graceful, beau- 
tiful girls whose work it was to captivate the senses, it became almost an indispen- 
sible accompaniment to a Greek banquet. The players did not wholly rely on their 
music, but danced as well, keeping time with every note, with a harmonious move- 
ment of the body. They were usually draped with semi-transparent veils which 
were thrown aside during the performance. At the close of the banquet their favors 
were sold to the highest bidder. This was often the occasion of fierce conflicts be- 
tween the ' 'best men" of Greece, and the flute-player of fashion boasted of the riots 
she had caused. 

The Dicteriades were the common prostitutes, corresponding to those of the 
present, except that they were bound bylaw to give themselves whenever requested, 
on the payment of a fixed sum, and might not leave the state. 

The Concubines were slaves owned by men of wealth, with the knowledge and 
consent of their wives, and served equally the master's passion and caprices of the 
mistress. 

Passing next to the history of Eome, there seems to be no doubt of the fact that 
prostitution existed there as early as the third century B. C. 

From Tacitus is learned that prostitutes were required to register themselves, 



PROSTITUTION. 1(KT 



giving age, place of birth, real name and assumed name, and the sum to be demanded 
of customers. This was a black list to be forever against her. 

The Julian laws further degraded prostitutes; and Tiberius sanctioned a decree 
making the laws more severe; still the institution flourished. During Trojan's reign 
the police were enabled to count thirty-two thousand in Rome, but this fell short 
because of the many not registered or paying tax to the state. Both in Greece and 
Rome there were male prostitutes in numbers almost to equal the female, and to 
judge from many writers of first, second and third centuries, A. D., it appears this 
unnatural lust was preferred. 

Regular houses of prostitution called lupinaria were rivalled by the arches 
under many public and private houses, which became refuges for prostitutes; 
and in later years, by the public baths where the sexes mingled indiscriminately. 

On the streets these women were compelled by law to wear a distinctive dress; 
their hair was dyed yellow or red; they were not allowed to ride. These laws were 
not obeyed in all cases, as laws never have been in any age. 

As in Greece, the dancing girl was a favorite, though in opposition to the law. 

When Rome began to decline as a nation, great profligacy existed everywhere. 
It was often said the more prostitutes, the safer would be virtuous women. In later 
years the statutes against the social evil became a dead letter as far as enforcing 
them went. 

Julius Caesar was said to be the "husband of all men's wives. 5 ' 

Nero was a habitual frequenter of houses of prostitution. On down through the 
reign of different emperors, is. a history of debauch. 

Of course, with this promiscuous and beastly mingling of sexes, venereal disease 
made its appearance. Roman doctors declined to treat the disorder, it being consid- 
ered unbecoming to confess to it or to treat it. 

When the Christian religion was introduced, the most marked originality over 
other religions was the stress laid upon chastity, and the obvious merit of this fea- 
ture was influential in rallying the better class of minds to its support. Persecution 
of Christians aided in purifying public morals by keeping in view this feature upon 
which early Christians prided themselves. 

During the time of Marcus Aurelius, Christian virgins were condemned to the 
brothel, when they refused to offer sacrifice to idols'. This practice led to the clearer 
enunciation of moral chastity of which the Romans could not conceive. 

Shakespeare, in his story of Lucrece, whose body was violated by Tarquin, has 
her say. 

"Though my gross blood be stained with this abuse, 
Immaculate and spotless is mine mind ; 
That was not forced ; that never was inclined 
To accessory yieldings, but still pure, 
Doth in her poisoned closet yet endure.'' 
The poniard released her soul from its "polluted prison." 

This principle has descended to the present. The woman who sins once, or is 
sinned against, considers she is forever lost, instead of giving herself the sustaining 
strength of her own mind. Real virtue consists in rising above the fall, and making 
the great mistake a stepping stone to purer life. The polluted mind will never rise, 
will never have the desire, and will continue to pollute the body. The differ- 
ence can be readily known by one whose soul is nobler than the circumstances 
of her life. 

Briefly considering prostitution in France, it is found that the female population 
of Gaul for two or three centuries after the Roman conquest was undoubtedly virtu- 
ous. But when the Franks and Gauls consolidated, the establishment of concubi- 



1044 PROSTITUTION. 



nage was sanctioned by the law and by the church. All the Frank chiefs, who could 
afford it had harems, or gynencea, peopled by young- girls. Charlemagne was very 
severe upon common prostitution; but saw no mischief in the gynencea. What was 
a crime among the poor, was excusable in the rich; another relic of barbarism pre- 
served in this century. 

The history of the Middle Ages shows a lax state of morals among all classes, 
not even the clergy being exempt. Purity of morals among the common people 
could not be expected with the examples set by those whom they believed to be 
higher than they. The average minds, up to date, it does not appear right to criti- 
cise the powers above them, no matter what their acts may be. 

The fathers of the church in Prance admitted the existence of demons, male and 
female, who assailed the chastity of girls, and robbed boys of their innocence. 

"The witches' vigil" were frequent nightly gatherings where prostitution was 
carried on under the cloak of witchcraft. The Inquisition took the matter in hand, 
along with everything else considered by those who composed it, to be of the devil. 

From the Middle Ages to Louis XII, the courts of France were monstrously impure. 

Charles VI went mad induced by sexual excesses. 

Louis XI had many wives and a colony of illegitimate children; for his favor- 
ites he had no affection, but used them merely to gratify his lust. 

Charles VIII died of indiscreet sexual commerce. 

Francis I was an early victim of syphilis. 

Of Henry, King of Navarre, it is said he would have been one of the greatest 
heroes had he not expended his energies in sexual pleasures. 

The history from the time of Louis XIII does not differ materially, only vice did 
not saturate so completely the public mind. More attention was given to cultivating 
the intellect, than the vices; although it was said of the women that they were as 
dissipated as they were refined. Refinement, however, caused an evolution of morals 
in time, until purity became a recognized reality instead of a name. 

Prostitution in France at present is maintained under police regulation. No 
one can keep such a house without authorization from the police; no woman can 
obtain a license unless she has been a prostitute herself. The houses must contain a 
room for each girl, and cannot have back or side doors, nor communicate with ad- 
joining buildings. 

To prevent venereal disease from spreading,. Dispensary physicians visit brothels 
once a week and inspect the inmates, a memorandum of which visits they keep. In 
case of disease the mistress is notified not to let the girl receive visitors; she is 
removed to the Dispensary, and sent to the hospital for treatment. 

The history of Great Britain, Germany, Spain, Italy, Russia and Sweden does 
not differ from that of France. 

In all countries, except Sweden and Russia, prostitution has been allowed "as a 
necessary evil," under the surveillance of the police. Under strict police regulation 
there has been much less danger from the spread of venereal disease, but in no way 
was the moral atmosphere purified. 

Stockholm, in Sweden, is said to be "one vast, seething, hot-bed of private har- 
lotry." Bayard Taylor, writing from Stockholm under date of May 1, 1857, says, 
1 'It has been called the most licentious city in Europe, and I have no doubt, with the 
most perfect justice. 

* * * There are no houses of prostitution in Stockholm, and the city would be 
scandalized at the idea of allowing such a thing. * * * I have never been in a 
place where licentiousness was so open and avowed, and yet where the slang of a 
sham morality waa so prevalent. * * * Which is best, a city like Stockholm 



PROSTITUTION. 1045 



where prostitution is prohibited, or New York, where it is tacitly allowed, or Ham- 
burg, where it is legalized?" 

In Norway and in Switzerland are the conditions most favorable to virtue and 
independence, the absence of extreme wealth and poverty. Both countries are com- 
paratively isolated from the rest of the world. In Switzerland as well as Norway, 
there is an absence of large masses pent up together it cities, the population being 
distributed in small numbers of the country. Sir John Bowring, sent from England 
to investigate Swiss society, found that "a drunkard is seldom seen, and illegitimate 
children are rare " As a people, these Swiss are a testimonial to the doctrine of 
equal distribution of wealth and temperate habits as preventive of immorality. 

The history of the United States is the history of all countries as regards prosti- 
tution. The population is made up of all nations, civilized and semi-civilized. In 
the majority of cases poverty is the greatest incentive to prostitution. Permanent pros- 
titution has a numerical relation to the means of occupation. 

At the present time, in all parts of the United States, the lower strata of men and 
women are deprived of the results of labor except in quantities barely sufficient to 
retain life in their bodies. They are huddled together indiscriminately as to sex, in 
close crowded quarters, so that the ordinary delicacies of life can not be practiced 
even if there should be a desire. The chiefest and often the only form of pleasure 
within their reach is that given by nature for the purest and best use of life, but 
which comes to be the veriest debauchery. Children and youth growing up among 
adults, depraved becausa no ray of light was shed to show the way for moral and 
physical uplifting, must naturally imbibe the miasma of social impurity. From the 
very cradle through life, their influence is to further degrade themselves and each 
other. 

On the other hand is the extreme rich who, not being compelled to labor for sus- 
tenance, spend their time and money in selfish enjoyment. In contrast with the ex- 
treme poor, they have every possibility to cultivate the good in themselves, but will 
not, and it grows pale and sickly among the rank weeds of their selfishness. 

Chiefly, among* self-gratification, is sexual indulgence, especially on part of th« 
men of wealth. Their manner of life, the food they eat, creates a fictitious force 
which must expend itself. They may have a chivalrous regard for the women of 
their class, but consider all women below them to be legitimate prey. 

Relying on their wealth to insinuate themselves into the good graces of young 
women, by supplying them with such things as will gratify vanity, the offspring of 
rich parentage find fascination in pursuit of their object. When she is at last won, 
and her virtuous scruples overcome, she is thrown aside like the wilted flower which 
has yielded all its perfume. The brothel is open to receive all such, particularly if 
she be handsome of face or form. 

New York, Chicago, St. Louis, any great city will furnish examples by the 
thousand. Where one girl enters this life from choice (through sensuality inherited 
from the lust of her father, no doubt), ninety-nine are sucked into its whirlpool by 
force of circumstance. The young woman who is a clerk, is paid an amount which 
will barely cover the cost of living. She is expected to dress well, and if she pro- 
tests that she cannot, is told to rely on some "gentleman friend" for other ex- 
penses. Likewise in factories and shops. Only she who is protected by home asso- 
ciations, and whose labor is done to add to the general home comfort, can hope to 
escape, and then not always. 

With the present system of government, each year tends to annihilate the middle 
class, in which lies a nation's strength. 

"Ill fares the land, to hastening ills a prey, 
Where wealth accumulates, and men decay." 



1046 PAINLESS MIDWIFERY. 



While extreme poverty exists on one hand, and extreme wealth on the other, it 
would be as plausible to dam up Niagra Palls as to stip prostitution by legislating 
against it. The current, when checked in one course, is bound to break out in an- 
other, and with all its pent-up force. Human life, like the river, is bound to flow in 
the channel of the least resistance. 

Nature planned the association of the sexes as surely and as inevitably as any 
other of her laws. Whenever her laws are trespassed upon in any way, there is suf- 
fering*. The wretched conditions of the poor, and the perverted natures of the 
wealthy, cause sex association in prostitution. 

Give to all young" men and women honest means of livelihood, with extra time 
and resources for the cultivation of their talents and their better selves, honorable 
marriage would be preferred to prostitution in nearly every case. 

There is no hope for moral purification among the wealthy until such time as 
they will use their time and talents in useful work. An enormous field for mission- 
ary work would be for some one of ability t'o convert the wealthy world to the 
religion of useful work. As a self-evident truth, no able-bodied person has the 
right to live off the labor of another person. Instead of the many working to the 
last notch of human endurance that the few may live in luxury and idleness, there 
should be labor for all and enough for all. Money, however, is without love, or 
patriotism, or kindness— is all powerful, and is fawned upon, and catered to, by 
those possessing it in limited quantities. 

The remedy for prostitution as well as other evils lies in the hands of the Amer- 
ican people themselves, if they only knew it. Just a few years of intelligent voting 
and legislating for better conditions for the many, instead of for the few extremely 
wealthy, would tend to overcome all injustice and inequality. The social evil 
would be weeded out because people would then have time to obey the injunction' 
"Know Thyself." 

According to statistics the average life of a prostitute is four years after enter- 
ing the maelstrom of such a career. The life is never such as to be recommended 
even by its followers. It is moral as well as physical death when followed, and is 
well nigh impossible to escape once having entered to its seeming fascination. 

As to the libertine, "he sells himself for what he buys." He may enjoy pleasure, 
but not happiness. Happiness comes from within, in the consciousness of doing 
right. Pleasure comes from without, in the gratification of self. In addition to the 
hollowness of the enjoyment in the lives of prostitute and libertine, is always the 
danger of loathsome disease which tortures body and brain, lowering them in their 
own minds. It is about the only ill in the category that does not command 
sympathy. 

The evils of drunkenness, theft, or prostitution are on the same basis as far as 
the "necessity" for their existence. All are more or less the result of a badly ad- 
justed economic condition of whatever nation. They can be reduced to a minimum, 
if not eradicated, by removing the cause. 



PAINLESS MIDWIFERY. 

HOW MATERNITY MAY BE MADE A BLESSING. 

The superstitions of a thousand years still cling to the ordinary conception of 
childbirth, and so persistently are they imparted from the elder to the younger that 
even the advanced civilization and independent reasoning of the present time fail to 
overcome them. That childbirth has its dangers would be foolish to deny, 



PAINLESS MIDWIFEKY. 1047 



but to those who know the laws of nature and obey them the dangers are so very 
rare that they are almost infinitesimal. 

The object of this treatise is to place before prospective mothers, in plain 
language, such facts as will enable them to comprehend the true conditions and the 
natural requirements of pregnancy, that it may culminate as a blessing rather than 
a curse. For one of the superstitions ardently adhered to, is the story of the curse 
pronounced on childbirth by the fall of "Mother Eve," causing almost every woman 
to feel doomed to agonizing turture should she fulfil her destiny. It would be bet- 
ter, were we to at all consider the story of Eve, to regard it as an illustration of the 
fact that women's disobedience of natural laws will entail whatever suffering she 
may endure at the bearing of her offspring. 

Reproduction is a universal law, and is consequently fulfilled by a natural 
process, from the moment of conception to the time of completed labor. And, un- 
less interfered with by violations of the laws which govern it, child-bearing will be 
performed in a healthy manner — that is, easily, harmoniously and regularly. But all 
through the process of reproduction, covering a period of nine calendar months, the 
proper influences upon the action, involving the condition and environment and be- 
havior of the mother, should be matters for most careful thought, that natural pro- 
cess may not in any way be hindered. 

To sow grain in a field of weeds and rushes would be useless, for grain cannot 
thrive were the strength of the soil is used for the sustenance of coarser and more 
avaricious plants. Nor can the human embryo develop when the body is taxed to its 
utmost to overcome disease or to fight against repeated violations of the ordinary 
laws of health. 

Pregnancy demands increased vital action. Not only must the mother maintain 
herself but she must also maintain her child. Her vigor cannot be allowed to remain 
stationary or it will soon become exhausted; it must increase, and proportionately 
with the growth and development of the new being, else the completion of the final 
act will consume what should be needed for recuperation. 

Whatever may be ordinarily necessary to a healthy body now becomes more than 
doubly so, and not only that, but everything should be provided that favors its extra- 
ordinarily healthful maintenance. Stint in nothing, but avoid excess. The demand 
and supply should be equalized; over-indulgence is detrimental, for it can be endured 
only at the expense of vitality. 

The great mental influence exerted by the mother upon the future disposition of 
the child does not lie within our present province. But it is of prime importance to 
consider the influence of her mind over her own physical being. During pregnancy 
the whole nervous system is in a state of exaltation. This is a necessity on account 
of the increased amount of work to be performed. But this nervous exaltation is 
not a disease, for it is just as natural as increased pulsations of the arteries or in- 
creased respirations during the performance of extraordinary manual labor. 

Pregnant women become extremely sensitive, both to physical impressions and 
mental influence. Those about her should remember this and make due allowance 
for her peevishness and sometimes trying perverseness. But, at the same time, the 
mother herself , knowing how easily her nerves are "unstrung," should compel judg- 
ment to overcome impulse. Let her realize that when "all things seem to go wrong," 
or others appear to slight her or give offense, that possibly under other circum- 
stances such matters would go unnoticed. Anger and moroseness always disturb 
the equilibrium of the system. They are to be avoided as much as physical injuries; 
and the disposition to sit and think with dread of "the great ordeal" to be passed 



104$ PAINLESS MIDWIFEKY. 



through, is one of the surest means of making 1 trouble. Such a disposition must be 
early overcome. 

Don't try to cross the bridge before you come to it, or imagine that there is no 
bridge for you, but only a rocky ford. Travellers along a well-kept road, over which 
thousands are daily passing, are reasonably certain to find easy means of crossing 
any stream they may come to. But travelling through gloomy woods of despair in 
narrow paths, obstructed by excesses and results of neglected duties, gives no prom- 
ise of an easy exit. It is not necessary to analyze the relationship of mind and 
matter; it exists, and too much stress cannot be laid upon the importance of preserv- 
ing an equanimity of mind under every circumstance. 

In this connection may be mentioned the inevitable over-sensitiveness in pain. 
There must always be a cause for unnatural sensations, and the cause should be 
searched for and removed. The habit of using narcotic drugs is not only foolhardy, 
but absolutely dangerous. 

To tie a handkerchief across the mouth and nostrils to check the rapid respira- 
tion, causing inconvenience during a foot race while wearing a too tight collar, would 
be no more absurd than to indulge in opiates to paralyze the exalted nervous actions 
aroused by physical indiscretions, for paralyzed or weakened nerves cannot perform 
the extra work demanded of them during the months of pregnancy. 

Sleep is "tired nature's sweet restorer," and the pregnant mother should enjoy 
it in abundance. Regular habits in this direction are of importance. Do not wait 
until the mind and body, both, or either one, are weary. Extra work is being done 
and extra rest must be secured. Ten hours out of twenty-four are not too many to 
devote to sleep, and if these cannot be taken all at once, divide the time, and in the 
afternoon secure a nap. But let the sleeping hours be regular, and if possible sleep 
alone and enjoy all the rest which that implies to married women. During the last 
three months of pregnancy this last should be imperative. 

An abundance of fresh air must be admitted to the sleeping room; there is more 
than the usual amount of blood to be aerated; one pair of lungs must perform the 
work of two and that under most unusual circumstances. The child is in the womb 
where its lungs cannot be inflated, and the mother's lungs are, in the later months, 
crowded by that same distended womb, and always given extra work to do, requiring 
more oxygen to carry on the disturbed circulation. 

Let the air that is breathed under every circumstance be pure. It is in the lungs 
that many of the impurities of the blood are discharged, and if there they are car- 
ried away by contact with pure air, they must, in part, at least, be taken back into 
the system, along with such other impurities as enter. Every hour that contamin- 
ated atmosphere is breathed adds its proportion of pain to childbirth. 

But impurities are not thrown off by the lungs alone. Millions upon millions of 
little pores in the skin do service in this line, and to keep them open and active is 
important. Cleanliness has become a relative term, even among the most fastidious. 
Bathing the entire body once a week and the face and hands several times a day is 
usually deemed sufficient. But during the period of pregnancy no woman should be 
content with this, but on the other hand it is well to remember that human beings 
are not amphibiuos, and the matter of bathing should not be overdone. Cleanliness 
alone is not the only object of a morning bath, but the maintenance of a healthy 
action of the skin is to be aided by it. 

The extra amount of work to be done by the internal organs makas the surface 
much more liable to disturbances of circulation, and for this reason extra precau- 
tions should be taken to maintain its natural performance of function. 

Some recommend daily baths in cold water — these are good if agreeable to the 



PAINLESS MIDWIFERY. 1049 



bather, but they should be sponge baths, and only a very limited portion of the body 
at a time should be washed with cold water quickly, and immediately rubbed thor- 
oughly dry before another portion is bathed. The addition of sea-salt, or ordinary 
salt, makes such a bath more stimulating and invigorating. In addition to this 
daily sponge bath, a good hot sitz bath, of short duration, should be taken once a 
week. But under every circumstance have the water pure. It is worse than useless 
to bathe in rain water run into a barrel from the roof and laden with various forms 
of micro-organisms. In a warm water bath taken for cleansing purposes, powdered 
borax (a teaspoonful to two gallons) should be used instead of soap. This will keep 
the skin pliant, and also have upon it a tonic effect. 

During the latter months of pregnancy the skin over the abdomen becomes tense 
and feels most uncomfortable. To relieve this disagreeable sensation lard or vari- 
ous oils are rubbed over the surface. It must be remembered that the skin absorbs 
as well as throws off material, and only the purest oil should be employed. Sweet 
oil is good, if the proper article can be obtained, but nearly all that oil on the market 
is greatly adulterated. Cocoanut oil is by far the best, and if used frequently it will 
entirely relieve the feeling of tenseness, and also cause the skin of the abdomen to 
return more nearly to its former appearance after delivery. 

The surface of the body being so sensitive at this time, the character of the 
clothing worn must be carefully considered. This must be in accordance with the 
atmospheric temperature, and during summer or winter the changes of the weather 
must be accompanied by changes of the clothing. No prescribed amount of clothing 
can be adopted, for persons differ in temperament. But the body must always be 
kept just warm enough, but not too warm. 

Chilling of the surface closes the pores and hinders the egress of impurities; it 
also contracts the minute blood vessels, thereby diminishing the circulation in the 
skin and throwing an extra amount of blood inward upon the internal organs. This 
often brings about disagreeable results. The excessive flow some women experience 
during pregnancy is chiefly brought about in this way — drafts of air causing chilli- 
ness of the surface and an extra amount of secretion from the mucus membrane. 

Another point in regard to the clothing should be assiduously attended to, and 
that is tightness. Many people through modesty, or pride, or sensitiveness, use 
effort and even force to prevent others from knowing their condition, and all sorts of 
methods have been contrived to preserve the shape and compress the abdomen. Any 
woman of ordinary intelligence knows without being told, that such methods are 
harmful and sometimes even dangerous, and whoever thus compresses her body must 
expect to experience the inevitable suffering it will occasion at the time of childbirth. 
There are now so many ways of draping the figure that the discarding of corsets 
need not be a matter of hesitation. Some very wisely wear a heavy corset-waist, 
and others suspend all their clothing from the shoulders. Compression is sure to 
cause damage and suffering. 

The impregnated womb constantly expands, and it must have room for expan- 
sion. Naturally the organ is suspended by ligaments, and there is but slight re- 
sistance to its enlargement. But artificially the walls of the abdomen are so bound 
in by tight clothing as to render assistance to the development of the womb. Neces- 
sarily, then, the structure of its walls becomes more dense than natural, and all 
the structures about share in the unnatural condition. The muscular fibres are less 
yielding than they should be; and when the time comes for them to alternately re- 
lax and contract to aid in the expulsion of the child, they are unable to do so with- 
out great difficulty, and this causes prolonged and painful labor, the delicate nerves 
of the womb being pinched and tortured as the dense muscular fibres contract upon 



1050 PAINLESS MIDWIFERY. 



them. The venous circulation, that is, the return of blood to the heart, is always 
more or less obstructed during pregnancy. This is often made apparent by varicose 
or distended veins, those of the lower limbs being most frequently swollen, and in 
some so much so as to require the wearing of elastic stockings; but this annoyance 
is infrequent with those who carefully obey natural laws. It is evident that all 
things calculated to hinder the flow of venous blood should be avoided. A few of 
them may be mentioned. 

The distention of the venous capillaries, or minute veins, occasions the purplish 
cast to the toper's countenance, giving evidence of the effect that alcohol would pro- 
duce in the circulation of the blood of pregnant women. It is a false stimulant, and 
although it may cause a feeling of exhilaration immediately after being taken, the 
feeling is due to the increased vital action aroused to overcome the injurious effects 
always occasioned by its administration. Letting alone all matters of sentiment 
and ignoring the possibility of fastening a habit by inheritance upon offspring, 
from a purely physical standpoint all pregnant women should scrupulously avoid 
the use of alcoholic liquors. They are not nourishing and their pleasant effects 
are transient. They more they are indulged in, the more will be the dangers of 
delivery. 

Other things may cause equally undesirable disturbances of the venous circula- 
tion by making the blood too rich or sluggish. Among them are the highly seasoned 
and rich foods, which should be placed under the ban during the period of 
gestation. 

It is well known that the urine of pregnant women contains substances that are 
not natural to it under ordinary circumstances. These substances are usually al- 
bumen and sugar, and their presence signify that more of those substances are 
being taken into the system than can be appropriated, consequently the excess be- 
comes manifest in the urine, which is the drainage of the system. Potatoes and 
other foods containing starch are the chief sugar forming foods, and their use should 
be restricted, and some debar them altogether, though if eaten with plenty of fruit, 
or as some are able to do, with drinks of buttermilk, they are more readily assimi- 
lated. The excessive potato eater often complains of difficult breathing on account 
of the lungs being unable to aerate the large amount of carbonaceous material in 
the blood. Unappropriated food of any kind in the system will cause obstructions 
and unavoidably increase the suffering of childbirth. 

Eggs and cheese are albuminous foods and should not be eaten as a rule, although 
those whose family physicians consider able to appropriate them have an excuse for 
their indulgence. Cheese is especially harmful to many, especially those whose kid- 
neys seem at fault. Such persons cannot be too careful. Swelling of the feet and 
limbs is frequent with all pregnant women, but when it is accompanied with dizzi- 
ness and impaired vision and puffiness under the eyes, the kidneys are disturbed and 
great danger is imminent from re-absorption of poisonous material which should pass 
off through the urine. For this reason, that woman is safest who leaves meat and 
cheese alone entirely during the term of gestation. There are abundant vegetables 
and fruits to more than nourish and give variety of food. Too much cannot be said in 
favor of a fruit diet. It is the universal testimony of those who have lived upon it 
that childbearing was easy and the whole period of pregnancy void of unpleasantness. 
Fruits can be obtained at any season of the year and should be the main kind of food. 
Meat eating is largely a habit which can soon be overcome, and if prospective mothers 
could realize the great amount of suffering to be saved by overcoming the habit they 
would not hesitate to live on nature's bountiful supply of vegetables and fruits. 

Of equal importance with what is taken into the body, must be the proper atten- 



PAINLESS MIDWIFEEY. 1051 



tion to the excretions. Disease is sure to follow neglect in this direction, and care- 
lessness will be rewarded by future suffering. Never, under any circumstance, allow 
more than twenty-four hours to go by without a free passage from the bowels. Make 
this an imperative daily duty and let the time of its performance be at regular inter- 
vals. Rigidly give nature this opportunity to rid the body of excrementitiuos mate- 
rial and it will usually be accomplished. 

If a free passage of the bowels cannot be obtained at the specified time, do not 
wait until the next day or for a dose of physic or cathartic pills to take effect, but 
immediately employ a luke-warm water injection to the lower bowel, and cleanse it 
out thoroughly. A three-quart fountain syringe should be the property of every 
pregnant woman. 

Constipation need never occur in pregnancy if all the rules of diet and hygiene 
are observed. The woman who says she has had no passage from the bowels for 
several days acknowledges herself filthy through her own carelessness or laziness, 
and is positively laying up future trouble for herself and in advance, magnifying the 
pains of childbirth. The interruption to free circulation so near the womb caused 
by the presence of impacted material in the lower bowel would, of itself, cause 
trouble, but worse than that is the reabsorption of morbific material. The rectum is 
not simply a leather saok, but it is a part of the human body, and that material 
placed in it is readily absorbed by the system is clearly shown by the rapid action 
which follows the administration of drugs by enemas. Water is plentiful and syringes 
are cheap, and those who fail to use them when needed must expeot to pay the pen- 
alty in the lying-in room. An abundance of fruit and vegetables, plenty of pure water 
and good exercise and regularity of habits will render constipation almost an impos- 
sibility. And yet this difficulty, so easily avoided, has come to be regarded as almost 
an unvoidable accompaniment of pregnancy. 

At this place it may be proper to mention the desirability of drinking an abun- 
dance of pure water, not too cold. Every tissue of the body, except the enamel of the 
teeth, contains water. Its free use will aid in the carrying off of impurities, and Is 
of especial value during pregnancy when the circulation is impeded and obstructions 
are liable to occur. Tea and coffee are not substitutes for water, and that woman is 
wisest who will leave them alone; though during gestation is a poor time to com- 
mence to overcome bad habits, yet it is far better to overcome them then than to 
continue them to the detriment of health. Regularity of life and as few changes as 
possible should be the rule. 

Exercise is an important factor in the maintenance of health; and a large train 
of the so-called diseases of pregnancy are mainly attributed to neglect in this re- 
spect. It is a very foolish notion to entertain that pregnancy means invalidism — the 
fact is just the contrary. All the functions of the body are naturally urged to 
increased action, there is exaltation everywhere, and when there is increased vigor 
there should be increased exercise to maintain it. Walking is excellent, especially in 
the fresh air. It does not do injury to stand on the feet unless it is carried to the 
point of fatigue. Running and rapid walking, of course, would be unsuitable, and 
there is no occasion for it. But a great amount of ordinary walking can be endured 
to great advantage. But during the walk let the figure be erect and the shoulders 
thrown well back. Many women to conceal their form walk with the body bent for- 
ward. Such exercise is worse than none at all. It cramps the body and causes pressure 
on the womb. It is no wonder such women soon tire. It is a habit easily acquired 
and an absolutely dangerous one. When the abdomen becomes very much enlarged 
and walking out doors must be a matter of embarrassment during the day, the eve- 
nings should be devoted to it, and during the day time walking back and forth 



1052 A FEW SUGGESTIONS OF VALUE. 

through the house is of advantage. Working is good; it keeps both the mind and 
body employed. Those women who are compelled to perform ordinary household 
duties until the last moment, provided they are not too onerous, usually recuperate 
the most speedily after labor. 

Riding is enjoyable and beneficial, but those who indulge in it are too prone to 
neglect the more suitable exercise of walking, and in the latter months of pregnancy 
riding may be a source of danger. A sudden jolt of the carriage may be the means 
of twisting the navel cord about the child's neck, and thus cause trouble at birth. 
Bicycle riding in moderation has been found of benefit during the early months, but 
after the third month should be discontinued. Some believe sewing machine work 
unsuitable, but when not carried to excess there is nothing to be feared from it. 

Companionship with sensible people is most desirable, and there should be plenty 
of it, but avoid the chronic croaker like you would a witch. There are a few old relics 
of the superstitious ages still existing who seem to take delight in filling the minds 
of prospective mothers with all sorts of nonsensical fears; and their recitals of dis- 
asters and troubles of all kinds are calculated to disturb an oversensitive person, 
who thinks "their experience" should be of value. But the fact is their woeful tales 
are largely imagined and their experiences exaggerated. Far better is it to be alone 
than to associate with such uncanny folk. "Make it a rule to mingle with women 
younger than yourself/' is good advice. 

Control the thoughts under all circumstances. They can be made subject to con- 
trol the same as actions can. Whenever gloomy forebodings arise, dispel them. "Suf- 
ficient unto the day is the evil thereof". Live correctly, and after the child is born 
and the mother has recuperated, she will realize that the possession of a healthy 
child does not entail a curse. 

A FEW SUGGESTIONS OF VALUE. 

Occasionally a few disturbances arise in spite of the most careful observance of 
the laws of health; though as a rule nearly every pain or kind of suffering during 
pregnancy may be traced to some violation of what was known to be right. 

Vomiting naturally occurs with some women soon after conception. This is sym- 
pathetic in character and should give no cause for alarm. There are innumerable 
nostrums on the market advertised to overcome it. But one of the simplest and most 
efficient remedies is a half cupful of ordinary oat tea, made by steeping a teaspoonf ul 
of oats in hot water for half an hour. A preventive of vomiting, and at the same time 
a most delicious and nourishing drink for use at all times is made by pouring a gal- 
lon of cold water on a pound of oatmeal or rolled oats in a stone crock, stirring well 
and allowing to settle in a cool place. The water from off the top will be found most 
refreshing and will quench the thirst when other drinks fail. It will also be of the 
greatest benefit in the nourishment of both the mother and the child. 

Abdominal pains are sometimes very annoying. The recumbent position usually 
relieves them, though it may be found necessary to rub over the abdomen a slightly 
stimulating liniment at times. It is surprising how much relief from the annoying, 
wandering pains of pregnancy can be obtained by using an injection to the bowels 
of an infusion of boneset, made by pouring a pint of hot water on an ounce of bone- 
set herb and allowing it to cool and then straining. For sleeplessness see that there 
is an abundance of fresh air in the room. If this does not answer, drink one or two 
cupfuls of very hot water just before retiring. The drinking of such water at any 
time is very beneficial. 

For excessive swelling of the limbs or for the relief of varicose veins there is 
nothing better or simpler than drinking an infusion of goldenseal — a teaspoonful 



PAINLESS MIDWIFERY. 



1053 



of the powdered root to a cupful of boiling water. If remedies must be used in the 
way of drugs, let them be simple. But if the instructions laid down in this treatise 
are observed, and the reasons, as given, are comprehended, and acted upon, there 



-J 
CQ 

< 
O 

2 
o 

h 

u 



« 

^ 



t I *, 






* ^ 



* 3 



©CO 
CO 



. CO 

I 

SO CM 



wo 

CM CO 



CM OS 
CM OO 



rH 00 
OO CM 



ON 
CM CM 



1 CM 



CO CO 
rHO) 



iO OJ 

cm 



©n 



os co 

0O tO 
CO CO 

I— 1 

IQ OO 

tH 

rH 

CO o 

CM OS 

rH 00 



CO CO 
CM 



LO CM 
CM 



CO o 
CM CO 

CM OS 
CM 00 

rH OO 
CM CO 

o N 
CM CM 

OS CO 
CM 

00 tO 
t-i CM 

rH CM 

CO CO 
rH CM 

lO CM 
rH CM 



CO 00 
NN 



OS CO OS tH 



00 tO 00 CO 



CO CO CO rH 
H| rH 

tO <M to O 



CO O CO O0 
rH | 

(NONN 

00 rH CO 



CO GO 
rH rH 

Ol N 



OsH^ 
00 CO 



t~ CM 

CO rH 

rH 

tO o 

"^ OS 

COCO 

CMN 

CO 



CM SO 

CMN 

rH "t> 

CM OQ 

OS 



CO O 

H<N 
tO OS 



Tfi 00 

CON 



O "*• O N 



O CO 
CO 



N CO 
CM 



CO CM 
CM 



tH O 
CM CO 



LO 



CO OS 
r-^ rH 

CM 00 CM OS 



OS CO 
00 03 



OS CO 
rH 

CO to 



rH t^TH 

rH| rH 

CO o ,CO CO 

rH rH 

iO OS iO CM 

HH 00 ,TW rH 

CO N ,C0 O 

I ^ 
CM O , CM OS 



S 



CO OS CO o 
CM Ol cm CO 

cm oo 'oo os 

CM Oq 



CM CM 



o «o 

CM <M 



O N 
CM CM 



OS tO 

rH 

CO^cH 



t^ CO 

rH 

CO CM 

tCrH 
rH 

"* O 



OS to 

rH 
00 tO 



r-H-i 

rH 

CO CO 

tO CM 

fH 

-cHrH 



HN H00 



rH CO 
CM OO 



SO 

rH 

00 »o 



CO CO 
tO^ 

HSrH 

CO o 
CM OS 

oo 



rH N 

CO 


O CO 
CO 


OS to 


-OTJH 

CM 


t~- CO 
CM 


CO CM 
CM 


tO rH 
CM 


-H rH 
CM CO 



rH CO 



O N 

OS CO 
CO tO 

rH 

CO CO 

to CM 

rH 

•<CH rH 
CO O 

CMOS 

co 



O CO 
CO 

OS to 



C^ CO 
CM 



CO CM 
O0 



co £ 

CM CO 



Od OS 
CM CM 



OO 



O N 
Os CO 
00 to 
t>> "*• 

rH 
© CO 

iO CM 

rH 

H^rH 
rH 

CO O 
rH 

CM OS 

X 



Ttl O 

CM CO 



CM CO 
CM CM 



O CO 



OS to 

00 "* 

N CO 

CO CM 
rH 

tO T—f 

CO OS 
CM CO 

rH t- 



5 3 



JO 



is* 



«,o Ph<; ^ <s^^ 



CD Ss. 






1) . ; . 



: cu <^ 

3r 



£ cu "f^ 



rH "M 
.2 Oj 



CD CD 



rtrrj pj <D <0 
3 Srg ►*& . . 



r5 03 



rH 3 CL^3rH 

H COO ^ rj 

-HCM^A 

^ Cfl . H CJ 

^ rt n ^ ^ a 

■H r] 0) Otj.rt 

.SoSgHfl. 
h£-M K a ^ o 



rjrrj 

O a 



O a 
" bo 






o^rlr§ 






rH 

h a^ 



in 



w>5 

W^ ►. rH CD <D 

. 2 ^rdrd 

dTJ d ** ^ 






CD ^crj 

ftp.-*"' 
rHH <U 



sea 

Cdrfrd 

S 2 a 
o,d o 

rQ^i 



crj crj 
CD 



P^rd 



s 

en cd 



« r^ 

CD rd 



d d 



d 
. <u 

d 03 biO 



^^6^3 <o'-So 2 

O h -el ^ _rl 03 ^ rd 



03 CJ 

d o 



C r2 



n£ d?S^ 



o 

n^j Td 

03 +J j 



P 3 

drfj J3 

«r^ 



rd . 

c "d 
.2 9 

^^ 

rd fl 

CD ^ 

rdrH 



cd 



tfi o3 fe ^> 

03 rtr ^ 



0^^. 



_^6 CD 

QJrrJ-2 d d 

*3 « o o 

H CJ ^rrj Q dj 

d d fe p^ ar -4 



H^'io 

d (D rH X 



H CD 

2 > 

(1) +J •*-" CD J- L« 



1054 ON CONNECTION AFTER CONCEPTION AND ITS CONSEQUENCES. 

will be no occasion for trouble, and the horrors of child-birth as portrayed by the vio- 
lators of natural laws will never be experienced. 

ON CONNECTION AFTER CONCEPTION AND ITS CONSEQUENCES. 

Some persons suppose that when conception has occurred, no further association 
should take place between man and wife until after delivery. One reason assigned 
for such forbearance is that sexual connection should not be indulged except for the 
purpose of procreation. This notion is, however, manifestly absurd, and impossible 
to be acted upon. There are but few females who can tell when conception has taken 
place till it is considerably advanced, and they must, therefore, either wait a long 
time after each act to see if such be the case, or be continually breaking the rule. 
But, independently of this, there is no doubt whatever that connection is both proper 
and beneficial after conception as well as before, providing it be not repugnant or 
hurtful to the female, and is not carried to excess. In no case, however, should it be 
indulged in if it causes her suffering, or is disagreeable to her, for then it will have a 
most injurious effect upon the nervous system, and may also lead to miscarriage. 
The same evil results may also follow from excessive indulgence, even when not hurt- 
ful or disagreeable, and this must therefore be avoided. 

So far, however, from sexual indulgence being improper in all cases after concep- 
tion, it is often required, and various evils may follow from its denial. When the 
temperament is warm, and the sexual instinct un usually strong, as it often is during 
pregnancy, indulgence is imperatively needed, and if it cannot be had the most inju- 
rious consequences may take place. I have known instances of this kind to result in a 
peculiar nervous frenzy, or partial derangement, and in miscarriage; in short, tho 
indications and obvious requirements of nature should be the guide in this case, as in 
all others, and not the dreams and theories of speculating physiologists. 

Besides these reasons, there are also others, connected with the child, which show 
the important influence of this after-union in many ways. It is a question often 
asked, whether the new being is in any way affected by connection after impregna- 
tion? And a notion prevails extensively that in some way or other it is so. This 
notion, like many others, has probably originated merely from observation, without 
any knowledge of its scientific accuracy, but recently its truth has been demonstrated 
by experiment as well as by observation. Several intelligent breeders of birds and 
other animals had long remarked that the male could influence the offspring after 
conception as well as before, and they acted upon this knowledge, practically, in the 
production" and preservation of particular varieties. Dr. Delfraysse, of Cahors, in 
France, was the first, however, who recorded any special observations of this kind. 
He found that the first connection merely gave life, or impregnated the egg, and that 
the after-connections imparted to the young the colors of the male, and that the more 
this after-connection was repeated, the more closely would the offspring resemble the 
father. In what way this effect is produced it is difficult, in the present state of our 
knowledge, to even surmise; but, notwithstanding this, the fact is one of great impor- 
tance. It has been suggested that the resemblance to the male, observed in such 
cases, resulted from an effect upon the imagination of the female through the medium 
of the sight, the colors being, as it were, impressed upon her mental vision. This, 
however, is certainly not always the case, even if it be so occasionally ; for a friend 
of mine, at my request, tried the experiment upon a hen that had been blind during 
the whole of her laying period, and in her case the chickens produced from her eggs 
invariably resembled the male in color, just in proportion to the frequency with 
which association took place. And in another instance, two heifers when put to the 



ON CONNECTION AFTER CONCEPTION AND ITS CONSEQUENCES. 1055 

male were both blindfolded, one having but one connection, and the other several. 
Each brought forth a calf — that from the mother who had but one connection resem- 
bling both parents, but mostly the mother, while that from the other, with whom 
there had been several connections, resembled the male parent in almost every par- 
ticular of color, marking, and general appearance, though she had been carefully 
blindfolded each time. It is not through the imagination alone, therefore, that the 
paternal influence is exerted, though it may probably be so in some cases, as, for 
instance in that of the mare and the quagga, recorded by Sir Everard Home. The 
quagga is a species of ass striped like the zebra, and one of these, a male, impregnated 
an English mare in the park of the Earl of Morton, in Scotland. There was but one 
connection, and the offspring was a hybrid, or mule, marked like the father. This 
hybrid remained with the mare about four months, and probably she might also have 
seen it again about ten months afterward. After this, during the next five years, she 
had four foals by an Arabian horse, and, strange to say, though she had not seen the 
quagga during this time, they were nevertheless all marked more or less like him. 
Now if this singular resemblance was effected through the imagination of the 
mother, as Sir Everard supposes, the most wonderful circumstance is that the effect 
should endure so long, even after the quagga was removed. It rather makes it prob- 
able, even in this case, in my opinion, that some permanent influence was exerted 
upon th.Q female ovary, as in some other cases that I shall allude to further on, when 
speaking of the permanent influence of the male upon the oTspring of the female. I 
am not disposed, however, to deny the influence of the ims rination altogether, in all 
cases. 

In the human being, it is of course more difficult to make corresponding observa- 
tions, but still it is not impossible. My own professional ministrations have been so 
confidential, and so numerous, that I have enjoyed many opportunities of testing this 
interesting question, and I am fully satisfied that the same rule holds good in regard 
to human beings as with the animals already referred to. In our own species, how- 
ever, it is not in respect to the color of the shin that the influence of the male in after- 
connection is made manifest, so much as in the color of the hair and eyes, and in the 
expression of the features, though the peculiar tint of the father's skin, as to being 
light or dark, is often so imparted. Certain propensities, habits, and modes of 
thought are also given in the same way. I have made many observations of cases in 
which all the necessary particulars were fully known to me, and invariably I have 
found that the child resembled the father in proportion to the frequency with which 
association was practiced after conception. The mere bodily resemblance seems to be 
most readily imparted, especially the color and expression of the eyes, and the color 
of the hair. The mental qualities, and disposition, are more apt to vary, unless the 
connection is very frequent, and then in the majority of cases they will be like those 
of the father. I have known married persons to act upon these principles, in order to 
produce certain characters in their offspring, and with great success. In all such 
cases it has been found that the more frequently connection takes place after concep- 
tion, the more decidedly the child will resemble the father, especially in the partic- 
ulars above mentioned, while if such after-connection takes place but seldom, or not 
at all, it will on the contrary resemble the mother, in the same way. This fact may 
often be of great service to married persons, as it gives them a certain power over 
their offspring, and enables them to insure or prevent the transmission of the character 
of either one at will if it be desirable to do so. 

This influence, it should be remarked, does not, however, extend to the sex of the 
child, which appears to depend upon other causes, and until these causes are fully 
understood, the above facts lose half their value, because it might be advisable to 



1056 ON CONNECTION AFTER CONCEPTION AND ITS CONSEQUENCES. 

impart the character of one of the parents to a male child but not to a female, or the 
reverse. The causes of the difference of sex, therefore, should be attended to like- 
wise, and they will be found discussed in another part of our work. When all these 
matters are fully understood, I have no doubt but that any form of body, any disposi- 
tion, and any given character of mind, as well as either sex, may be given to every 
child before its birth ! Such a statement may seem strange to those who have not 
considered these matters scientifically, but to those who have it will be nothing new or 
surprising. I have known breeders of birds and other animals, for instance, who 
would undertake to produce, in a given number of young, ninety per cent, of either 
males or females, just as might be desired, and alike in color to a hair or a feather, 
besides being all endowed alike with certain prominent traits of character. And 
when the procreation of the human being is as carefully attended to as that of these 
inferior beings, the results will be equally certain, the organic and physiological laws 
being the same in both, in regard to this function. I leave every person of common 
sense to answer the question for himself, whether it is not more important to under- 
stand these laws in relation to the human being than in relation to the inferior ani- 
mals alone? It seems clear to my mind that it is only by attending to such laws that 
the human race can be truly and permanently improved in body and mind, and made 
to attain its fullest perfection of development. By education after birth, we can only 
partially modify and regulate the development of the bodily and mental powers with 
which the individual is born, and very often their natural force successfully resists 
the most powerful influences we can bring to bear upon them, which is the reason 
why education frequently fails either in preventing evil or in leading to good. By 
acting upon those laws, however, which govern the child's organization, mentally and 
bodily, before its birth, every power and quality may be made to have precisely that 
degree of development which may be most desirable, so that education will always 
produce the results we wish from it, and disease and vice be forever removed. At 
present, however, it is scarcely allowable to talk of improving human beings by such 
means, though it is thought quite right, and even praiseworthy, to do so respecting 
dogs, horses, and cows , as if they were of the most consequence. 

My readers will bear in mind that the law I have now been explaining, when fully 
stated is this: That frequent connection after conception causes the offspring to 
resemble the father, and that no connection afterward, or but very little, causes it to 
resemble the mother, This is undoubtedly true in the great majority of cases, and the 
degree of resemblance will usually be proportionate to the frequency in the one case, 
and to the unf requency in the other. If, therefore, no connection took place after con- 
ception, as some would-be philosophers contend should be the case, all children would 
in time resemble their mothers only, and there would be a uniform and unbroken 
transmission of certain fixed characters, without any variation, which of course would 
be a great evil, even if it did not in time extinguish the race. This is another proof of 
the error of such a doctrine. On the other hand, if the after-connection was always 
frequent, children would as constantly resemble their fathers, which is equally unde- 
sirable. To produce a mixture of the characters of both, therefore, when it is best to 
do so, the after-association should occur, if other considerations do not forbid it, to a 
moderate extent, according to the peculiar habits, temperaments, and relative vigor 
and age of both parties. This will, however, be better understood by referring to 
what is stated in another part of this book, on the proper frequency of sexual associa- 
tion. 

An interesting question arises, further, when a female conceives by one man, 
whether connection afterward with another man would cause the child to resemble • 
him, the second partner? Of course, such a question is not easy of solution in regard 



ON CONNECTION AFTER CONCEPTION AND ITS CONSEQUENCES. 1057 

to human beings, buffrom observations made upon animals, it seems certain that the 
second partner can really impart his likeness to the child that was begotten by the 
first, and thus actually exert more influence, or impart more resemblance, than the 
father himself, who only gives life, but'not always form and character ! 

In one instance I knew a widow who secretly married in about three months after 
the death of her husband, and while, as it appeared afterward, she was pregnant by 
him. The child, however, resembled her second husband, though there was almost a 
certainty that no'previous infidelity had been practiced, because the individual was 
at a distance when the conception must Jiave occurred. 

It has even been conjectured, by some philosophers, that if a female have associa- 
tion, at any time, with a man'who exerts^ a strong influence upon her, any children 
she may have afterward, by any one, will be liable to resemble him, even for many 
years afterward. And, indeed, the cases above given prove this. 

This singular fact is explained by supposing that, in the act of sexual union, the 
male not only impregnates the egg, but also exerts a more or less permanent influence 
upon the female organs, owing to which they have a tendency afterward to bring 
forth new beings upon the sameplan, or resembling each other. This was probably 
the case with the mare impregnated by the quagga above referred to, and it explains 
why the foals produced afterward, though begotten by a horse, still resembled the 
other animal. 

Instances of a precisely similar "character are sometimes seen in human beings. 
Thus a female married a second time will have children resembling the first husband, 
and sometimes even in a third marriage, as I have witnessed myself. Such remark- 
able resemblances can be explained only by supposing a permanent 'influence to be 
exerted by the male ; and probably that influence is likely to be exerted most power- 
fully by the first partner. The true explanation of these remarkable^facts should be 
generally known, to prevent improper and unjust suspicions, which I have known to 
be entertained in such cases, and which, in the absence of proper information might 
well be excused. 

Many persons would suppose immediately that these resemblances were simply the 
result of imagination, but I do not think so, at least not always. I have known 
instances of this kind, both in the lower'animals and in human beings, in which the 
influence of the first partner was visible for a long time afterward, and in which I was 
assured the imagination had no share. 

Breeders of animals are aware of many such r facts, and have frequently stated 
them to me. Thus for instance, when a mare has a mule foal by an ass, it will fre- 
quently happen, if she have a foal afterward by a horse, that it will to a certain extent 
resemble the ass. This resemblance is most frequently ^traced in the form of the 
mouth and lips, and in the greater length of the ears. A friend of mine, at my 
request, tried some experiments, on several animals, for the express purpose of testing 
this curious question, and the result was a striking confirmation of the truth of the 
explanation I have given. Many of these experiments were so managed that the 
imagination could not possibly operate, and yet the influence of the first partner was 
distinctly perceptible during several conceptions afterward. We can only come to 
the conclusion therefore ^that the male does often exert a permanent influence on the 
female organs, and especially by the first acts of association. In all probability this 
permanent effect is most likely to be seen when the male is relatively the most vigor- 
ous, or where the association has been very frequent, but it may be manifested even 
after a single act, as was shown in some of the experiments made by my friend. 
Among other singular cases bearing on this subject I may also mention the following, 
which was told me by an old physician in Scotland, who knew all the parties con- 



1058 CONJUGAL PRUDENCE. 



cerned. A young female was forcibly violated by a person whom she did not know, 
and under such circumstances that she could not see him ; it was known, however, by 
her friends who he was, but from a wish to avoid exposure, the occurrence was kept 
secret, though unfortunately she became pregnant in consequence. The child strongly 
resembled its guilty parent, and what was still more singular, she married, and had 
two other children which also resembled him, though by her husband, the young man 
having left the country in consequence of his offence. Every one will see how natu- 
rally unjust suspicions might be entertained in many such cases, if they were not 
explained. 

In the procreation of animals, such facts may be of the greatest importance. Life 
may be given, for instance, by the male that has the most constitutional stamina or 
vigor, and yet particular qualities may also be obtained from others, in which he may 
be deficient. 

CONJUGAL PRUDENCE. 

In the " Centennial year," when patriotic Americans were celebrating the nation's 
progress, the author of & this work was compelled by the laws of his country to expur- 
gate so much of this essay as in any way related to mechanical devices for the pre- 
vention of conception. While joining heartily .with his countrymen in expressions of 
joy over achievements of which we, as a nation, may justly feel proud, he feels it a 
duty to enter a solemn protest as a physician to this piece of meddlesome impertinence 
on the part of the hasty law-makers who have inconsiderately obeyed the behests of a 
handful oPmistaken moralists. The position taken by the author in earlier editions 
was practically this . That many people, in consequence of constitutional ill-health, 
inherited scrofula, predisposition to insanity, physical deformity, indigence and down- 
right pauperism, should be provided with means for regulating reproduction, and that 
among the various methods or means proposed and practiced, certain articles deserved 
to be commended as useful and comparatively unobjectionable. In 1872 the condem- 
nation of the United States postal statutes was placed upon all such articles, by put- 
ting them on the list of "unmailable" things, even going so far as to forbid using 
the mails to tell where to obtain them or how they might be made. In 1896 a similar 
law was added to the United States criminal statutes by which the transportation of 
such articles or information by express companies was made equally unlawful. 
Between the years 1872 and 1896, every State of the Union, except Texas, had included 
in its penal code some law forbidding the manufacture or sale of these articles. 
From one point of view it would seem that legislators have been induced to put pre- 
vention of conception on a par with the crime of abortion, in making the sale of 
articles for either purpose unlawful, but it is worthy of remark that while the act of 
abortion is made criminal by all persons concerned in it, there is as yet no legislation 
to condemn the actual use of some thing or some plan for prevention of conception, 
nor is there any law to suppress the discussion of methods of non-propagative marital 
intercourse without resort to articles. No doubt the main motive of such legislation 
has been to lessen the "vicious employment of preventives" "outside of marriage, 
with the idea that even that virtue is worth guarding which can only be preserved 
through "fear of consequences." As to the propriety, morality, or legitimacy of the 
use of some checks to excessive fecundity in marriage other than strict continence, it 
need only be said that no law discountenances it, while its growing popularity is 
made evident by the gradually decreasing birth-rate in this country and the most 
advanced nations of Europe. Even those who talk the other way and profess super- 
lative virtue are not likely to be credited with it when they show no larger family 
than the average. 



CONJUGAL PRUDENCE. 1059 



Admitting that there is no law divine or human, no "consensus of the competent," 
not even popular sentiment to say "thou shalt not" employ some method of "conjugal 
prudence" for the limitation of the family in the defeat of nature's tendency to excess- 
ive fertility, the question inevitably presents itself— what method is most satisfactory 
reliable, and unobjectionable? The reader will naturally look to the writer of such a 
book as this for the answer, but the reply must be that so long as the laws just described 
continue in force no writer or publisher can be expected to„provide the information 
for which the people are clamoring — to judge by our own correspondence. If citizens 
of this "gloriously free country" were as jealous of their individual rights and as 
vigilant in maintaining a~free press as are their English cousins, they would enjoy 
equal access to books and articles and the right to scientific information now denied 
them by illiberal laws. Meanwhile, i. e., until the indignant citizens arouse themselves 
to effect a repeal of the laws, they will please save themselves postage'and the time of 
the writer by not asking for what he cannot give them. These^United States laws 
are generally enforced, especially against those who publicly oppose them, as we 
have for over twenty years, and so we can least afford to take any risks in attempts to 
evade them. Our office consultants often remind us that the State laws are being 
generally ignored, that a variety of articles are being almost "openly sold," but this 
is perhaps reason enough why they should not look to us for anything of the kind. 
Under this unfortunate state of affairs, it happens, as in other instances where the 
prohibition laws fail to prohibit, that the quality or reliability of the articles clan- 
destinely sold are, like poor liquors, not what they should be or would be under fair 
competition and criticism. It would probably be risky for one who knows, to tell 
wherein they fall short. The inevitable result is that thousands of people are resort- 
ing to injurious methods and unreliable articles ; many are taking unwise risks^ and 
suffering the results in unexpected "accidents" they are in no position to afford; and 
so we see the business of "regular" and "professional" abortionists improved, and an 
increasing number of foundlings or abandoned babies dead and alive. In short, the 
people have that "little knowledge 'which is a dangerous thing," and the only cure 
now is more knowledge, but the laws forbid. Such laws are evidence of the evil and 
hasty and ill-considered legislation. To the same laws it is fair to attribute the 
fact that science has not yet made known a perfect means of prevention, one 
entirely reliable, practical, and unobjectionable physiologically. Unhindered^ it 
might have. 

Among the methods requiring no articles and so possible of mention, probably the 
most ancient is withdrawing, or "conjugal onanism," which is generally condemned 
by the medical profession because injurious to both husband and wife, and for more 
than one reason it cannot be always "safe and sure." 

Dr. J. H. Kellogg, head of the Battle Creek (Mich.) Sanitarium, in his great and 
justly popular book, "Plain Facts for Old and Young," offers only one "compromise" 
for married folks who are not content to be continent, i. e., the "fourteen day" rule, 
without, however, claiming that it is "unobjectionable," and while admitting plainly 
its limitations or unreliability. In short, it is available only for some folks, and 
nothing but experiment, with success or failure, can tell what families may depend 
upon it. It is hardly worth considering. 

The Rev. J. H. Noyes is generally credited with the first public announcement of 
the method he called "male continence," in which self-control of the husband is 
depended upon to avoid the final crisis which completes the propagative act. His 
own detailed version of it may be found in editions of this work prior to 1898, but at 
the present time its merits are being sufficiently made known by its most recent 
adapters in the ranks of "social purity" workers, who think they have found in it the 



1060 CONJUGAL PRUDENCE. 



Solution of the great problem which Huxley has declared to be the "riddle of the 
Sphinx." 

In a book entitled "Karezza, the Ethics of Marriage" (Chicago, 111., 1896), the 
author, Dr. Alice B. Stockham, without naming the originator of what she acknowl- 
edges to be a "new and unique theory of controlling propagation," adopts it as 
the best solution of the problem, except that she advocates female as well as male 
continence, advising a mutual and equally quiet "love communion between husband 
and wife, from which results a mastery of the physical and control of the fecun- 
dating power." This book, together with Geo. V. Miller's "Strike of a Sex" and its 
sequel, have done much to extend a knowledge of this plan, and to present it in its 
best light ; but on the other hand there are writers who oppose its general adoption, 
as a regular thing, both from reasons of theory and experience. They claim that this 
exercise of the sexual functions must be attended with congestion and tension of the 
nervous, muscular, and secretory parts of the sexual system ; that the congestion and 
tension can only be sufficiently relieved in the natural climax with its prompt and 
complete relaxation : and that unless there be at least occasional vent for the secre- 
tions, which, during active stimulus of congestion, accumulate in the prostate and 
other glands, and in the seminal vesicles, their retention, in the course of time, 
would be liable to result in enlarged prostate, seminal vesiculitis, and reflex 
nervous disturbances. Many physicians have observed and reported cases of nervous 
disorder in both sexes as a result of "withdrawing" (one sort of abrupt female con- 
tinence), and it seems plausible that similar troubles might be developed in the male 
from persistent resort to this abridgement of a natural process. When certain nerve 
centres'have been brought to a high state of tension by prolonged grief there is gener- 
ally great relief in the relaxation of "a good cry," and "a flood of tears," and many 
have suffered from the successful effort to suppress this climax. As grief stimulates 
secretion of tears, so conjugal love emotions, proportioned to their intensity, indulg- 
ence, and prolongation, must stimulate seminal secretion, and possibly faster than 
absorbent glands could take them back. 

Whatever success may have attended the plan of the Rev. Mr. Noyes in the com- 
munity of which he was the recognized leader, it will not be adopted to any prevail- 
ing extent in society at large. Indeed, the very ones who ought not to propagate their 
kind at all — the violent and criminal classes— will never listen to any advice requiring 
the exercise of self-denial or restraint. With mechanical means which would not 
interfere with their pleasures they might be induced to avoid the responsibilities of 
parentage, for they are mainly bent upon selfish indulgence. A plan or a device, to 
be successful, must be one which married people in general will be willing to adopt. 
Earnest thought and attention, and the comparing of observations of many physicians 
in extensive practice are only necessary to perfect mechanical means and to in time 
discover the secret Nature has so long locked up in her "Library of Wonders." 
Never, until this shall be found, can the human family make much progress in scien- 
tific propagation ; and, again, never until the laws relating to the latter are under- 
stood and faithfully observed will the moral and physical delinquencies which now 
afflict the race be eradicated. While regeneration may be necessary for those who are 
already born morally and physically accursed, let us so look to the laws governing 
generation that regeneration will be rendered unnecessary. To say nothing of the 
"headachy," the dyspeptic, consumptive, scrofulous, idiotic, insane, blind, deaf and 
dumb ; the inefficient, indigent and squalid ; the pauper generating swarms of pau- 
pers and the beggar at every thrifty door ; the thief and highwayman reproducing new 
broods of their kind and feeding them from the storehouses of the honest and indus- 
trious ; to say nothing, I repeat, of all these which afflict the family and society, every 



CONJUGAL PRUDENCE. 1061 



community is infested with physical weaklings and natural born sinners of less 
marked type who stand in the path of human progress. But our legislators practi- 
cally say that the State^ has need of all this stuff, and that accidental reproduction 
shall goon! 



INDEX 



Abscesses, 77; formation and discharge, 78; 
painting round the margin, 78; external 
and internal remedies, 77. 

Abuse of Purgatives, 190. 

Acetate of Lead Mixture, 679. 

Accidents, Gunpowder, 713. 

Acid, Sulphureous, Use of, on chilblains, 176. 

Acidity, or Heartburn, 78 ; prescriptions, 79. 

Aconite Mixture, 579. 

Aconite, Uses of, 745. 

Act, Education, 896. 

Addison's Disease (see Bronze Skin), 163. 

Administration of Medicine, 641. 

Aerial Disinfection, 989. 

Affections of the Ear, 258. 

Ague or Intermittent Fever, 79 ; Tertian Ague, 
79 — 81 ; how produced, 79 ; the disease on 
the Pontine Marshes, 81 ; phenomena at- 
tending ordinary fits, 81 ; Dumb Ague, 82 ; 
Shaking Ague, 82 ; Ague Cake, 83 ; periodical 
return of the fits, 82, 83 ; rules for the 
maintenance of health in ague districts, 
85 ; the cold and hot stages, 81 ; the sweat- 
ing stage, 85 ; eight general rules of treat- 
ment, 88. 

Air, Necessity of, for children, 674 ; essential for 
man, 950, 956. 

Albuminates, 897. 

Alcohol, 920, 921 ; percentage of, in ordinary 
drinks, 921, 922; the quantity a healthy 
man can sustain, 922 ; results of, 923. 

Alcoholic strength of different beers, 929. 

Alcoholic (Non-), Beverages, 930. 

Alcoholism, another name for Delirium Tre- 
mens, 88 ; predisposing causes, 88, 89 ; the 
disease amongst the higher classes, 90 ; in- 
dications of the disease, treatment imperative 
in chronic alcoholism, 91 ; prescriptions, 91 ; 
Dickens on gin-drinking, 92. 

Alkalies, Uses of, 747. 

Alkaline Lotion, 582. 

Aloes in the Enema, 648. 

Aloes, Uses of, 747. 

Alum Gargle, 582. 

Alum, Uses of, 747. 

Ammonia and Bark Mixture, 578. 

Ammonia and Senega Mixture, 578. 

Anaemia, or Poorness of Blood, 92 ; the classes 
whom it affects, 92 ; the symptoms, 93 ; 
the conditions which give rise to the 



93, 94; Chlorosis intervening, 94; 

advice to sufferers, 95, 96 ; mineral waters, 

97 ; general treatment, 97. 

Aneurism, or Tumour in the Blood, 97 ; Aortio 
Aneurism, 97, 98 ; Aneurism in the Chest, 

98 ; dietetic treatment and internal admin- 
istration of Iodide of Potassium, 99. 

Angina Pectoris, or the Suffocating Breast 
Pang, 99 ; symptoms, 9©, 100 ; the charac- 
ter of the disease, 100 ; the circumstances 
which induce paroxysms, 101; peculiar 
cases, 101; duration of the disease, 102; 
remedies, 103 ; what to be done in the in- 
tervals of attack, 104; gout and dyspepsia 
occurring with the paroxysms, 104. 

Animation, Suspended, 709. 

Anus, Artificial, when the bowels are ob- 
structed, 416. 

Anus, Itching of, 358 ; causes, 359 ; advice as 
to diet, 359 ; medicine, 359 ; outward appli- 
cation, 359 ; Condy's fluid for, 360 ; bone- 
plug recommended, 361. 

Aperient Iron Mixture, 577. 

Aperient Pill, 581. 

Aphasia, or the Loss or Impairment of the 
Faculty of Language, 105 ; singular cases, 
105, 106 ; pretended attacks, 107. 

Aphonia {see Loss of Voice), 370; Hoarseness, 
370. 

Apocynum Cannabinum, a new American plant 
invaluable in Dropsy, 244. 

Apoplexy, 107 ; ordinary warnings acting as 
guides to the coming fits, 107, 108 ; ordinary 
symptoms of the disease, 108 ; difficulty 
of discovering between drunkenness and 
apoplexy, 109 ; remedies at an early stage, 
110; caution to persons predisposed to the 
disease, 111. 

Appetite, Incentives to, 370 ; gin and bitters, 
370 ; tonics, 370. 

Appetite, Loss of, 368 ; causes, 368 ; curiosities 
of, 369; bitters before meals, 370; tonics, 
370 ; recipe for elderly people, 370. 

Arnica, Description and use of, 749. 

Arnica Lotion, 5 S3. 

Arnica Mixture, 583. 

Arrowroot Drink, 365. 

Arsenic, Description and uses of, 750, 751, 76& 

Arsenic Mixture, 579. 

Arteries, Modes of binding the, 694, 696. 

Asiatic Cholera (see Cholera), 177. 

Assafcetida, 648. 



1063 



1064 



I2TDEX 



Asthma, Hay, 301. 

Asthma, 111; sudden attacks, 112; precursory 
symptoms, 112; certain recurrence of the 
disease, 113; phenomena which charac- 
terise attacks, 113; length of time in reach- 
ing the maximum of the disease, 115 ; its 
relation to age, sex, and constitution, 116 ; 
its effect upon youth, 117 ; numerous re- 
medies for the disease, 118, 119, 120, 121, 
122, 123 ; the dietetic treatment, 124, 125; 
circumstances likely to induce attacks, 
125; localities favourable to the disease, 125, 
126 ; asthma produced from animal emana- 
tions, 126; strange effects produced by cats, 
hares, dogs, and other animals on sensitive 
persons, 126, 127 ; asthma produced by the 
inhalation of the pollen of plants and 
grasses, 301. 

Astringent Mixture, 679. 



Balsam, Friar's, Uses ©f, 788 ; of Peru, 788 ; 

of Tolu, 788. 

Banting, system for reducing obesity, 411, 412. 

Bark, 756. 

Baths, 657 ; air and vapour, 658 ; advantages 
and effects of cold, 181, 184 ; German, 981, 
982 ; mineral water, 972 ; various kinds of, 
973. 

Bean, Calabar, description and uses, 627. 

Bed Frame (illustrate), 635. 

Bed Pans (illustrated), 635. 

Bed Rests, 637. 

Bed Tables (illustrated), 638. 

Bed, Water, 627 ; sores, 629. 

Bed- wetting, Treatment of, 3. 

Beef Essence, Recipes for, 656, 657, 862. 

Beef Tea, 660. 

Beer, 927 ; adulterations of, 930. 

Beers, Alcoholic strength of various, 930. 

Belladonna and Chloroform Liniment, 682. 

Belladonna, description and uses, 759, 760 ; use 
of, in bed- wetting, 3. 

Belladonna Mixture, 679. 

Beverages, 920; non-alcoholic, 930. 

Biliary Colic, 283. 

Biliousness and Liver Complaints, 127 ; causes 
of the derangement of the liver, 127 ; in- 
jurious effects of alcoholic drinks, 128; 
excessive eating, high atmospheric tem- 
perature, nervousness, sudden fear, &c, 
favourable to the production of disorders, 
128 ; influence of the liver on animal spirits, 
131 ; what to eat and drink, and what to 
avoid, 131, 132 ; medicinal remedies and 
prescriptions, 133, 134, 135, 136; treatment 
of functional diseases of the liver, 136 ; ad- 
vice to convalescents, 136. 

Binding up Wounds, 694, 695. 

Bismuth, 763. 



Bismuth and Charcoal Powders, 581. 

Bleeding from the Bowels, 136 ; causes of the 
complaint, 136 ; symptoms to be observed 
to find out the cause, 137 ; treatment, 137. 

Bleeding from the Nose, 700. 

Bleeding from the Stomach — Hsematemesis, 
137 ; the different phases of the disease, 137, 
138; a pretended victim, 139; the treat* 
ment of haematemesis, 139, 140. 

Bleeding, Operation of, 658. 

Bleeding Piles, 441 ; remedies, 441. 

Blistering Fluids, 654. 

Blood, Poorness of, 92; classes whom it affects, 
92 ; symptoms, 93 ; conditions giving rise 
to the disease, 93, 94 ; Chlorosis intervening, 
94; advice to sufferers, 96, 96; mineral 
waters, 97 ; general treatment, 97. 

Blood-spitting, 141 ; leading to consumption, 
141 ; whether proceeding from the lungs or 
the stomach, 141 ; symptoms of bleeding 
from the lungs, 142 ; symptoms of bleeding 
from the stomach, 142 ; several rules for ob- 
servance, 142 ; what to be done in the early 
stages, 142 ; energetic treatment in bad 
cases, 143 ; various remedies, 143. 

Blood, Tumour in, 97; Aortic Aneurism, 97, 
98 ; Aneurism in the Chest, 98 ; diet and 
treatment, 99. 

Blue Pill with Opium, 681. 

Blue Vitrol or Sulphate of Iron, 806. 

Body, Growth of, 380. 

Boils, 144 ; what they are ascribed to, 144 ; 
their affection for young people, 145 ; the 
several kinds of boils, 145 ; the best remedies 
to effect a cure, 145, 146. 

Bone Setters and * Bone Setting," 997 ; old 
wives' and herbalists' recipe, 997 ; bone set- 
ting a misnomer, 998 ; the difference be- 
tween a broken bone and a dislocated joint, 
998 ; blows on joints or sprains, 999 ; the 
most successful bone-setter, Mr. Hutton, 
1000 ; the skilled surgeon ever an advantage 
over his empirical rival, 1001. 

Borax Gargle, 582. 

Bottle Feeding, 677, 678. 

Bowel, Falling down of, 23 ; treatment, 23. 

Bowels, Bleeding from, 136; causes, 136; 
symptoms, 137 ; treatment, 137. 

Bowels, Looseness of (see Diarrhoea), 226. 

Bowels, Obstruction of the, 413; causes, 413, 
414; treatment, 415; surgical operations, 
416. 

Box, description and uses, 764. 

Brain, Concussion of, 701; vomiting, 660; 
water on the, 69 ; symptoms and treatment, 
70. 

Brain: the several diseases, 147; congestion, 
148; softening of the brain, 149 ; paralysis, 
convulsions, insensibility, and delirium pro* 
ceeding therefrom, 149; special remedies 
and prescriptions, 149. 

" Brain Fag," 306. 

Bran Cake, 226. 

Bread Pudding, 666. 



INDEX. 



1065 



Breath, Offensive, 416; causes, 416; teeth 
cleaning, 417; remedies when the gases 
proceed from the stomach, 417. 

Bright's Disease, 149 ; special characteristics, 
150 ; the causes from which it arises, 151 ; 
in an acute and chronic form, 151 ; medici- 
nal treatment, 152; advice when con- 
valescence is established, 153 ; clothing and 
diet, 154. 

Brimstone or Sulphur, Uses of, 872. 

Bromide of Potassium, description and uses, 
765. 

Bromide of Potassium Mixture, 579. 

Bronchitis, 154; acute, 154; the causes, 155; 
varying in severity and in character, 155 ; 
capillary bronchitis, 156; care to betaken 
in the early stages. 156, 157 ; simple reme- 
dies, 157, 158; medical prescriptions, 158; 
chronic bronchitis, 159 ; the causes which 
lead to its chronic nature, 159 ; the symp- 
toms, 160 ; alleviation by means of a spray, 
160 ; description of Richardson's spray ap- 
paratus, 160 ; the benefits derived therefrom, 
161 ; Siegle's spray apparatus described, 
162; the Ipecacuanha spray, 162; tonics to 
be used, 163 ; respirators recommended, 163 ; 
careful attention in convalescence, 163 ; the 
climate best suited for sufferers, 163. 

Bronchitis Kettle for moistening a room (illus- 
trated), 382. 

Bronchocele (set Derbyshire Neck), 213. 

Bronzed Skin, or Addison's Disease, 163 ; the 
prominent characteristics, 164 ; not to be 
confounded with Cloasma, or Jaundice, 164 ; 
a remarkable case of a lady becoming as 
black as a negro, 164; a galvanic current 
recommended, 164. 

Broth, Mutton, Recipe for, 662. 

Brow Ague (see Neuralgia), 399. 

Bruises, 164 ; simple treatments, 164 ; applica- 
tion when erysipelas is anticipated, 165 ; 
lotions to be used, 165. 

Bruises and Contusions, 700. 

Bryony Mixture, 580. 

Bunions, 165 ; tight and bad-fitting boots, 165 ; 
hereditary tendency, 166; remedies, 166. 

Burns, 707. 

Bryonia, description and uses, 766. 



Cake, Bran, 226. 
Calabar Bean, 767. 
Calf's Foot Jelly, 668. 
Calendula Lotion, 583. 
Calomel Ointment, 582. 
Calomel Pill, 581. 
Calomel and Sugar Powders, 581. 
Camphor, 769 ; Camphor Plant (illustrated), 770. 
Cancer, 167; not considered hereditary, 167; 
common to all ranks of society, 167 ; mental 



emotions favour its production, 167; no 
precursory symptoms, 168 ; fatty tumours, 
168 ; general treatment, 169. 

Cancer of the Stomach, 169; the predisposing 
causes, 169, 170; symptoms, 170; often 
mistaken for ulcers, 170. 

Cantharides Mixture, 580. 

Cantharides, Spanish Fly, description and uses, 
770. 

Carbo-hydrates, 898. 

Carbon of Charcoal, description and uses, 773. 

Carbonate of Ammonia Mixture, 678. 

Carbuncle, 171 ; far more serious than a boiL 
171 ; often constitutional, 171 ; medicinal 
treatment and external application, 172; 
general diet, 172. 

Carminative Mixture, 578. 

Cascarilla, description and uses, 862. 

Castor Oil, Uses of, 774. 

Cat Asthma, 126. 

Catalepsy, 172; a strange disease, 172; a 
graphic picture of a sufferer a hundred 
years ago, 173 ; modern instances, 173, 174 ; 
prescriptions, 174. 

Catarrh, 182 ; rose, 301. 

Catechu, description and uses, 775. 

Caudle, 666. 

Cayenne Pepper Gargle, 682. 

Chairs for invalids, 639; wicker (illustrctsf), 
640 ; Merlin, 640. 

Chalk Stones (see Gout), 293. 

Chapman's Spinal Ice-bags, 479. 

Chart, Temperature, 691. 

Chaulmoogra Oil, a remedy for Consumption, 
199. 

Cesspools, Middens and, 985. 

Chafing, causes and treatment, 4. 

Chamomile, description and uses, 776. 

Chapped Hands, 176 ; treatment, 176, 177. 

Cheek, Gangrenous Ulceration of, 23; treat- 
ment, 24. 

Chicken Pox, 4 ; treatment, 5. 

Chilblains and Chapped Hands, 5, 174 ; boys and 
girls at school the chief sufferers, 174; want 
of extra care for girls, 175; advice in the 
management of suffering children, 176 ; re- 
medies, 176 ; application to chapped hands, 
175, 176. 

Children, Diseases of, 1 ; old-fashioned notions 
of treatment, 1 ; indications of disease, 2 ; 
Bed-wetting, 3 ; Chafing, 4 ; Chicken-pox, 
4 ; Chilblains, 5 ; Children's Paralysis, 6 ; 
Chapped Hands, 176 ; Crick in the Neck, 472; 
cold baths, 181, 184 ; clothing, 180; Con- 
stipation, 7 ; Convulsions, 8 ; Consumption 
(see Tuberculosis); Croup, 11, 12, 13; False 
Croup, 15, 16, 17 ; Ear-diseases, 262; Run- 
ning from the Ears, 252; Singing in the 
Ears, 254; Deafness, 254, 255; Dentition, 
18 ; Diarrhoea and Dysentery, 20 ; Falling 
down of the Bowel, 23 ; Gangrenous Ulcera- 
tion of the Cheek, 23, 24 ; German Measles, 
24 ; Measles, 25, 26, 27 ; Mumps, 28 ; Night 
terrors, 30 ; Red Gum, 31 ; Rickets, 31, 32, 



lOCG 



INDEX. 



33, 34, 35 ; Ringworm, 36 ; Ringworm of 
the Scalp, 36, 37 ; Ringworm of the Body, 
38 ; St. Vitus's Dance, or Chorea, 38, 39 ; 
Scald Head, 40 ; Scarlet Fever, 41, 42, 43, 
44, 45 ; Scrofula, 46, 47 ; Diseases of the 
Skin, 47 ; Sore Throat, 50, 51 ; Spinal 
Disease, 54 ; Hip Disease, 54 ; Stammering, 
64, 55 ; Strophulus {see Red Gum) ; Thrush, 
65 ; Tonsils, Enlargement of, 56 ; Tubercu- 
losis, 57, 58, 59, 60, 61, 62, 63, 64 ; Colds, 
62, 53, 54 ; Ulceration of the Gums, 62, 63 ; 
Vaccination, 63, 64, 66, 66, 67, 68 ; Water 
on the Brain, 69 ; Whooping Cough, 70, 71 ; 
Worms, 74, 569 ; soothing food after vomit- 
ing, 561 ; nursing of children, general prin- 
ciples and management, 673, 674, 676, 676, 
678. 

Chiretta, description and uses, 862. 

Chloral, 122 ; description and uses, 776. 

Chloroform, 122. 

Chlorosis, or Green Sickness, 94. 

Cholera, Asiatic, 177 ; its spread and develop- 
ment, 177; its causes, 177; not very catch- 
ing from individuals, 178; the symptoms, 
178; mortality, 178; how to avoid the 
disease, seven golden rules, 179 ; precautions 
to be observed by those in attendance on 
the sick, 179 ; mode of treatment when sud- 
denly attacked, 179 ; prescriptions for later 
stages of the disease, 179, 180. 

Cholera, English, 228. 

Chorea, 38 ; treatment of, 39. 

Cimicifuga, description and uses, 778. 

Cirrhosis of the Liver [see Gin-Drinker's Liver), 
290. 

Citrate of Iron and Ammonia, 807. 

Citrate of Iron and Quinine, 807. 

Citrate of Iron Wine, how made, 807. 

Cleanliness, necessity of in sick children, 673. 

Climates for Consumptive Persons, 202. 

Clothing and cleanliness, 968 ; colour of, 970 ; 
underclothing, 970. 

Clothing, Feet, 971. 

Cocoa, 933. 

Cod-liver Oil, Uses of, 781. 

Coffee, Composition of, 932. 

Cold, Causes of, 52 ; treatment, 53, 54. 

Colds, 180; catching cold the most prolific 
source of disease, 180 ; hints upon clothing, 
180 ; common causes of colds, 180, 181 ; the 
various phases of colds, 182 ; simple remedies, 
182 ; preventives to catching colds, 183 ; 
settled on the chest, 183 ; in the head, 183 ; 
specific remedies, 183 ; remedies for diminish- 
ing excessive tendencies to cold, 183. 

Cold baths the best tonic, 181, 184, 208. 

Cold Feet, 184 ; different degrees of suffering, 
184; various remedies, 184, 185. 

Colic, 185 ; the disorder explained, 185 ; predis- 
posing causes, 185 ; the mode of attack, 186 ; 
simple remedies, 186; prescriptions for 
obstinate cases, 187. 

Colic, Biliary, 283. 

Colchicum, description and uses, 781. 



Colocynth, description and uses, 782. 

Coltsfoot, description and uses, 819 ; Plant o^ 
820. 

Concussion of the Brain, 701. 

Condiments, 899 ; value of their various pro- 
perties, 900. 

Condy's Fluid, 360, 417, 634. 

Confection of Sulphur and Senna, 581. 

Constipation in children, 7 ; treatment, 8. 

Constipation, 187; the necessity of regular 
motions, 188; desirability of comfortable 
closets, 188, 189 ; beneficial effects of exer- 
cise, 189; abuse of purgatives, 190; danger of 
habitual constipation, 190 ; the consequences, 
190 ; several modes of relieving the patient 
without medicine, 191 ; defecation an im- 
portant matter, 192 ; regulation of diet, 192; 
medicinal prescriptions, 192 ; Trousseau's 
belief in Belladonna, 193 ; torpidity of the 
bowels, 193; medicines to be used, 193; 
treatment of old people, 193; enemas or 
injections, 194. 

Consumption in children, 57 — 62. 

Consumption, 194 ; occupations which predis- 
pose to the disease, 194 ; other predisposing 
causes, 195; not an infectious disease, 195; 
general symptoms, 196; consumption may 
be cured, 197 ; medicinal prescriptions, 198; 
other remedies, 199 ; diet and exercise, 200 ; 
baths, 201 ; avoidance of draughts, 201 ; 
climates best suited for consumptive persons, 
202; recipes for persons who have been 
practically cured, 202. 

Contusions and Bruises, 700. 

Convulsions, Causes of, 9, 10; treatment, 11. 

Convulsive Fits, 9. 

Corns, 202 ; tight and badly-fitting boots, 202 ; 
hard and soft corns, 203; the excrescence 
sometimes hereditary, 203 ; corns on the 
hands and fingers, 203 ; curvature of the 
spine sometimes caused by corns, 203; 
remedies, 204. 

Corrosive Sublimate Mixture, 580. 

Coryza, one of the Symptoms of Cold, 182. 

Cough, Whooping, 70 ; gradual growth of the 
disease, 71 ; complications of, 72 ; remedies, 
73. 

Coughs, 204 ; a good general cough mixture, 
204 ; mixture when the cough is hard and 
dry, 204 ; prescription for a dry irritative 
cough, 204 ; other remedies, 205, 206 ; 
poultices, 206 ; mucilaginous drinks, 206, 
207. 

Cough Mixture, 204. 

Cramp, Writer's, 572; symptoms, 673; re- 
moving the causes, 574 ; remedies, 676. 

Cretinism, 216. 

Creosotic Mixture with Opium, 678. 

Creosotic Tinctus, 580. 

Crick in the Neck, Causes and Treatment, 472, 

473. 
Croton Oil, Uses of, 774. 
Croup, Symptoms of, 11, 12, 13 ; treatment, 14* 
Croup, False, 13, 15, 16. 



IHDEX. 



106^ 



Croup, Spasmodic, 16 ; treatment, 17. 
Curari, or Woorari,how used by Physicians, 839. 
Curiosities of Appetite, 369. 
Cusparia, description and uses, 862. 
Custard Pudding, 664. 



Dance, St. Vitus's, 38 ; treatment, It. 

Dancing, 965. 

Danger of a Fake Palate, 348. 

Deafness and deaf -mutism, 254, 256. 

Debility, 207; "below par," "seedy,' J * queer 
all over," 207; induced by a variety of 
causes, 207 ; indolent habits, 208 ; overwork, 
208 ; diet and exercise, 208 ; prescriptions, 
208, 209 ; change of air, 209 ; nervous de- 
bility as synonymous with spermatorrhoea, 
210 ; treatment of this complaint, 210. 

Deformities in Children, Treatment of, 1001. 

Delirium Tremens, 210 ; induced by alcoholic 
poisoning, 210 ; terrible symptoms, 210, 211 ; 
difficulty of inducing sleep, 212; treatment 
and diet, 212 ; prescriptions, 212, 213. 

Dentition, 18—20. 

Derbyshire Neck, Goitre, or Bronchocele, 213; 
an enlargement of the large gland, having 
its origin in impurity of water, 213 ; an 
innocent tumour, 214 ; Exophthalmic Goitre, 
or Grave's Disease, 215; its effect on the 
eyes, 215 ; treatment, 215, 216 ; Cretinism, 
a species of Goitre producing a kind of 
idiocy, 217 ; permanent removal necessary, 
218. 

Diabetes, 217 ; Diabetes Mellitus described, 
217; a simple and beautiful test of the 
disease, 218 ; symptoms, 218 ; a chronic dis- 
order, 219 ; what to eat and what to avoid, 
220; bran cake, 220, 221 ; other substitutes 
for bread, 221 ; diet table for people suffer- 
ing from diabetes, 221, 222 ; medicinal treat- 
ment, 222 ; the " skim milk " treatment, 223 ; 
Diabetes Insipidus, 223 ; insatiable thirst, 
223 ; a patient drinking twenty-two quarts 
of water in every twenty-four hours, 224 ; 
anecdote of a man who drank a litre (pint 
and three-quarters) of brandy without in- 
convenience, and for a wager drank twenty 
bottles of wine at a sitting, 225 ; medicines 
which have been attended with success, 225. 

Diachylon Plaster, Uses of, 810. 

Diarrhoea in Children, 20 ; treatment, 21, 22. 

Diarrhoea, or Looseness of the Bowels, 226 ; the 
great diversity in the symptoms, 226 ; an 
essential part of cholera, dysentery, and 
typhoid fever, 227 ; numerous causes, 227 ; 
Summer Diarrhoea, or English Cholera, 228 ; 
White Flux, 228; discharging yellow fat, 
228; Chronic Diarrhoea, 228, 229. The 
most approved methods of treating the 
various forms of the disease, 229. A 

64 



remedy on which the greatest reliance can 
be placed, 229, 230 ; a short description of 
the class of cases to which the several 
prescriptions are suited, 230, 231, 232 ; in- 
jections, 232 ; diet and clothing, 233. 

Diarrhoea Mixture, 579. 

Diet, Full, 659; Invalid, 659; Middle, *59 ; 
Slop, 658. 

Diet v. Exercise, 967. 

Diet Table for people suffering from Diabetes, 
221 ; whatto eat, 221, 222 ; what to avoid eat- 
ing, 222 ; what to drink, 222 ; what to avoid 
drinking, 222. 

Digestion, Influence of the Mental Powers on, 
419, 420. 

Digestion, Physiology of, 340. 

Digestibility of Various Foods, 907. 

Digestive Powders, 581. 

Digitalis, description and uses, 783 ; Flower 
of, 784. 

Diluted White Precipitate Ointment, 582. 

Dinner Pills, 581. 

Dinners v. Gout, 904. 

Diphtheria, 233 ; a diversity of opinion as to its 
true nature, 233 ; proved to be contagious, 
234 ; cases of medical men dying from in- 
oculation from their patients, 234 ; persons 
may have repeated attacks, 235; symptoms, 
235, 236 ; death caused "by suffocation or 
exhaustion, 237 ; duration of the disease, 
237 ; what should be done in the absence of 
a medical man, 238 ; gargles, 239 ; Diph- 
therietic Paralysis, 239 ; injections of strych- 
nia, 239 ; successful tracheotomy, 240. 

Disease, Hereditary, 895. 

Disease, Indication of, see Indication of Disease, 
585. 

Disease, Trichinous, 918. 

Diseases of the Skin, 991. 

Disinfection, 987 ; aerial, 989. 

Dislocations, 705 ; treatise thereon, 706. 

Domestic Surgery, 693; haemorrhage, 698, 
several illustrations of the modes of binding 
up wounds and arteries, 694, 695, 696; 
wounds on the head, 697 ; varicose veins, 697 ; 
bandaging the legs, 698 ; poisoned wounds, 
699 ; penetrating wounds, 699 ; bleeding 
from the nose, 700 ; bruises and contusions, 
700 ; concussion of the brain, 701 ; sprains, 
701 ; remedies for sprains (illustrated), 702; 
fractures, 703; framework to carry a 
wounded man (illustrated), 704 ; the " Sedan 
chair " formed by human nanus (illustrated), 
705 ; dislocations, 705 ; various illustrated 
modes of reducing dislocation, 706, 707 ; 
burns, 707 ; suspended animation, 709 ; 
illustrated means of reviving the partially 
drowned, 710 ; cases of hanging, 711 ; sus- 
pended animation when suffering from foul 
gases, 711 ; sunstroke, 712; frost-bites, 712; 
gunpowder accidents, 713 ; gunshot injuries, 
713; injuries from chemicals, 713; from 
quicklime, 714; teething, 716; lancing the 
gums, 717; care of the teeth, 718; toirth- 



1068 



INDEX. 



ache, 719 ; inflammation of the tonsils, 719 ; 
enlarged tonsils, 720 : ingrowing toe-nail,720. 

Doses of Medicine, 1003 ; table of doses to be 
given to infants and from that to maturity, 
1003, 1004. 

Dover's Powder, 409. 

Drainage and Sewage, 983. 

Drainage of Modern London, 894. 

Drainage of Old London, 891. 

Draughts, Emetic, 579; Rochelle, 679; seda- 
tive, 579 ; tapeworm, 679. 

Drink, Imperial, 66. 

Drops, Nitrite Amyl, 580. 

Dropsy, 240 ; the different phases it assume*, 
240, 241 ; causes which lead to the disease, 
241 ; the principal symptoms, 242 ; methods 
of relief, 242, 243 ; profuse perspiration 
caused by a drug known as Jaborandi 
244 ; removal of patients to a dry and warm 
atmosphere, 244. 

Drowned, Means of reviving the partially, 710. 

Dust and Impurity, 958. 

Dust Fever, 302. 

Dusting Powder, 582. 

Dust in the Eye, 714. 

Dwellings, Modes of Disinfecting, 989. 

Dysentery, 244 ; the scourge of armies, 245 ; 
irritants to the bowels, 245; different 
varieties of the disease, 246 ; a remedy 
almost a specific, 246 ; Chronio Dysentery, 
247 ; injections, 248. 

Dysentery in Children, 20 ; treatment, 21, 22. 

Dyspepsia, see Indigestion, 342; diet recom- 
mended, 346. 



Bar, Diseases of, 248 ; foreign bodies in the ear, 
248 ; Ear Speculum (illustrated), 248 ; insect* 
in the ear, 249; accumulation of wax in 
the ear, 249 ; method of syringing the ear 
(illustrated), 249 ; the Ear Syringe (illus- 
trated), 250 ; earache, 253 ; a poultice afford- 
ing relief, 253; Neuralgic earache, 253; 
remedies and prescriptions, 254 ; singing in 
the ears, 254 ; deafness, 254 ; remedies, 255 ; 
in children, 256 ; the deaf taught to speak, 
256 ; lecture on the education of mutes, 257 ; 
general hints on affections of the ear, 258 ; 
eczema of the, 250 ; remedies in acute and 
chronic disease, 251 ; inflammation of the 
internal ear, 251 ; perforation or rupture of 
the tympanic membrane, 252; treatment, 
262 ; running from the ears, 262 ; treatment 
for children, 253. 

Earliest form of Water Works, 889. 

Easton's Syrup, 807. 

Eau de Cologne, Use of, for chapped hands, 176. 

Eating, Slow, 449. 

Ecstasy closely allied to Catalepsy, 259 ; sin- 
gular instances, 259 ; impostors, 259 ; the 
Welsh fasting-girl, 260 ; remedies, 260. 



Eczema of the Ear, 250 ; remedies in acute and 
chronic disease, 251; inflammation of the 
internal ear, 251 ; perforation or rupture of 
the tympanic membrane, 252 ; treatment, 
252 ; running from the ears, 252 ; treatment 
for children, 253. 

Education Act, The, 896. 

Effervescing Ammonia Mixture, 683. 

Effervescing Iron Mixture, 677. 

Eggs, Properly cooked, 663, 664. 

Egg and Milk Mixture, 202. 

Elecampagne, description and usee, 820. 

Emetic Draught, 679. 

Enemas, 194. 

Enemata, 647 ; injections, 646 ; drugs for, 64*. 

English Cholera, 228. 

Enlarged Glands, 260 ; symptoms and causes, 
261; diet, 261; the medicines to be used, 
261. 

Ennui, 208. 

Epilepsy — Fits — Falling Sickness, 261 ; symp- 
toms constituting a warning of the approach 
of an attack, 262 ; night attack, called Epilep- 
tic Vertigo, 263 ; frequency and duration of 
the fits, 264 ; often created by fright, 265 ; 
feigned attacks, 265 ; popular mode of de- 
tecting a shammer, 266 ; mistaken for faint- 
ing, 267 ; remedies and prescriptions, 268, 
269, 270. 

Epsom Salts, Uses of, 785. 

Ergot, description and uses, 786. 

Erysipelas, 271 ; numerous productive causes, 
271; variety of symptoms, 272, 273; best 
methods of treating the disease, 274 ; the 
most useful medicines, 274 ; ointments and 
cooling lotions, 275. 

Essence of Beef, five recipes, 556, 657, 662, 

Euthanasia (see Old Age), 417. 

Evaporating Lotion, 682. 

Excrements, Human, 985. 

Exercise, 961; amount to be taken, 966; for 
children, 688. 

Expectoration, 275 ; generally produced by a 
cold, 275; examination of the sputa gives 
character to the disease, 276 ; various reme- 
dies, 276. 

Exophthalmic Goitre, 215. 

Extravagant Dinners inducing Gout and other 
diseases, 904. 

Eye, Dust in the, 714. 

Eyes, affected by Exophthalmic Goitre, 211. 



Face, Flushing of the, 281 ; effects on women, 
282 ; remedies and prescriptions for, 282, 
283. 

Facial Paralysis, affecting the muscles of the 
face, 439. 

Fainting, 276 ; common in young ladies* 277 ; 



INDEX. 



10G9 



sometimes hereditary, 277 ; accidental causes, 
277 ; means of preventing attacks, 278. 

Fattening Food, 410. 

Fats, 898. 

Febricula, or Simple Fever, 548 ; symptoms, 
549 ; treatment, 549 ; prescriptions, 549, 550. 

Feeding-bottle, 677, 678. 

Feet, Cold, 184; danger of, 184; remedies, 184, 
185; the ill effects of wet, 180. 

Feet Sweating, 279 ; some directions for the 
treatment of this offensive complaint, 279 ; 
applicable alike to sweating of the hands, 
279. 

Fern root, description and uses, 787. 

Fever, Gaol, 916; causes, 917. 

Fevers: Typhoid, 514, 527, 531 ; Typhus, 542, 
643 ; illustrated chart showing the course 
of the temperature in typhoid fever, 535 ; 
Simple Fever, or Febricula, 548 ; Remittent, 
550 ; Rheumatic, 455 ; Yellow, 552 ; Gastric, 
527 ; Specific, 519 ; Hectic, 517 ; Rose 
Fever, or Rose Catarrh, 301; Hay Fever, 301; 
Dust Fever, 302 ; Scarlet Fever, 41, 42, 43, 
44 ; Gout Fever, 916 {see also under the 
several headings). 

Figs, Uses of, 883. 

Filter, The poor man's, 949. 

Fistula, 443. 

Fits, Alcoholic, 91; Apoplectic, 107, 108; Con- 
vulsive, 9; Cataleptic, 174; Epileptic, 261; 
Hysteric, 329, 333 ; Paralytic, 436 ; Shiver- 
ing, 515 {see also under the several headings). 

Flatulence, or Wind, 279 ; produced usually 
from undigested food, 279 ; many drugs 
useful in the treatment, 280; Windy Spasms, 
281 ; remedies, 281 ; Flatulence in Children, 
281. 

Fluid, Condy's, 360, 417, 634. 

Fluids, Blistering, 554. 

Flushing of the Face, 281 ; its effects on women, 
282; remedies and prescriptions, 282, 283. 

Flux, White, 228. 

Fog, The effects of, 959. 

Fomentations, how made and applied, 651, 652. 

Food, amount required by a man, 905 ; abstin- 
ence from, 906 ; digestibility of different, 
907; fattening, 410; infant, 675; influence 
on the temperature of healthy persons, 987 ; 
purposes for which it is required, 902, 903. 

Food, Parrish's Chemical, 184, 261, 289, 572. 

Foods, Four classes of, 896, 897. 

Foul Gases, 711. 

Fractures, 703. 

Friar's Balsam, description and uses, 78$. 

Frostbites, 712. 

Full Diet, 659. 



Gall Stones and Biliary Colic, 283 ; size and 
weight of gall stones, 283 ; tendency to the 
disease, 283 ; agonising pain, 284 ; obser- 
vances, 284 ; treatment of biliary colic, 286 ; 



means of dissolving and preventing the for- 
mation of gall stones, 286. 

Gall Nuts, description and uses, 839. 

Gallic Acid, description and uses, 839. 

Games, National, Influence of, on health, 964. 

Gaol Fever, 916 ; causes, 917. 

Gargles — Alum, Borax, Cayenne Pepper, Tan- 
nic Acid, 582. 

Gases, Foul, Suffering from, 711. 

Gastric Fever, 527. 

Gastric Juice, 341. 

Gelseminum, description and uses, 791 ; Mix* 
ture, 580. 

Gentian, description and uses, 791 ; and Acid 
Mixture, 578. 

Gentian and Senna Mixture, 578. 

Gentian and Soda Mixture, 578. 

German Baths, Scenes and Amusements, 981, 
982. 

German Measles, 24 ; treatment, 25. 

Giddiness, 287 ; anomalous and distressing sen- 
sations, 287 ; double vision, 287 ; symptoms 
and causes, 288 ; correction of acidity, 289; 
mastication, 289 ; vertigo of old people, 290; 
accompanied by congestion of the face, 290"; 
remedies, 290. 

Gin-Drinkers' Liver (Cirrhosis of the Liver), 
290 ; alcohol passing through the liver, 290 ; 
symptoms of the disease, 290 ; the sufferer's 
want of firmness, 291 ; no cure but temper- 
ance, 291 ; abstinence and attention to ordi- 
nary diet the only remedies, 291. 

Ginger, Oxley's Essence of, 280. 

Glands, Enlarged, 260 ; symptoms and cause, 
261 ; diet, 261 ; medicine to be used, 261. 

Glasses, Medicine, 643 ; minim, 643. 

Glycerine of Tannin, Use of, 841. 

Glycerine, Use of, for chilblains and chapped 
hands, 176. 

Goitre, 213; enlargement of the large gland, 
origin in impurity of water, 213; and 
innocent tumour, 214 ; Exophthalmic 
Goitre, or Grave's Disease, 215 ; effects on 
the eyes, 215; treatment, 215, 216; Cre- 
tinism a species of Goitre, 217; permanent 
removal necessary, 218. 

Gout, 291 ; suddenness of the attacks, 292 ; the 
course of the disease, 292 ; differing from 
rheumatism, 293; irritability a producing 
element, 293 ; chalk stones, 293 ; gout in 
the stomach, 293, 295 ; tending to apoplexy, 
epilepsy, and mania, 294 ; how gout is en- 
gendered, 294, 295; Poor Man's Gout, 295; 
persons affected, 295 ; what to do in case 
of acute gout, 296 ; Chronic Gout, 296 ; the 
treatment recommended to gouty patienti 
in the intervals between their attacks, 297. 

Gout Fever, 916. 

Gravedo, one of the Symptoms of Cold. 

Gravel, 298 ; the complaint hereditary, 299 ; 
caused by an inactive liver, 299 ; general 
treatment, 300 ; anecdote of a Dutch mer- 
chant, illustrating the effects of good living 
in the production of the disease, 300. 



107O 



ENDEX. 



Grave's Disease, 215. 

Green Sickness, Chlorosis, 94. 

Grey Powder and Bhubarb, 581. 

Griffith's Mixture, 806 ; Pills, 806. 

Gruel, Oatmeal, 665. 

Guaiacum, description and uses, 790 ; shrub of, 

790. 
Gum, Red, Treatment of, 31. 
Gums, Lancing the, 717. 
Gums, Ulceration of, 62 ; treatment, 63. 
Gunpowder Accidents, 713. 
Gun-shot Injuries, 713. 



Fair, The, 969. 

L.iinamelis Lotion, 583. 

Hamamelis Mixture, 580. 

Hamamelis Virginica, description and uses, 792. 

Hammock for Invalids (illustrated), 639. 

Haemorrhage, 693. 

Haemorrhoids (see Piles), 440. 

Haematemesis, 139, 140. 

Hands, Chapped, and chilblains, 174; chief 
sufferers, 174 ; want of extra care for girls, 
175; advice in the management of suffering 
children, 175 ; remedies, 176 ; applications 
to chapped hands, 175, 176. 

Hay Fever — Hay Asthma, 301 ; a disease affect- 
ing some persons when the grass is in bloom, 
or during the vernal hay-making, 301 ; its 
effects, 301 ; confined to the educated classes, 
301 ; humorous remarks of an American 
writer, 301 ; Rose Fever, or Rose Catarrh, 
and Peach Cold, affections of a similar nature 
in America, 301 ; Dust Fever, 302 ; advice 
to sufferers, 302, 303 ; tobacco smoking as 
a remedy, 304. 

Head, Scald, 40 ; treatment, 41. 

Headache, 394 ; often the commencement of 
ehronic illness, 394 ; Plethoric or Congestive 
Headache, 305 ; resulting from intoxication, 
306 ; caused by " brain fag," 306 ; its effects 
on women, 307 ; general treatment, 309, 
310 ; Nervous Headache, 310 ; various other 
kinds of headache, 312, 313. 

Headache, Sick, or Megrim, 386 ; varieties known 
as hemicrania, blind, and bilious, 386 ; a 
" family complaint," 387 ; sick headache an 
intermittent affection, 387 ; causes of the 
disease, 389; a conspicuous feature of 
megrim, 390; spectral appearances in, 
391; blindness, or partial blindness, 391; 
irregular forms of the disease, 392 ; causes 
of megrim, 394 ; advice to persons affected, 
396. 

Health, Personal care of, 907. 

Hearing - Trumpets for Deaf Persons (illus- 
trated), 255. 

Heart Disease, 314 ; often the result of rheu- 
matic fever, 314 ; the principal sufferers, 
S14; mistaken for general debility, 315; 



habits which produce the disease, 315; feeble- 
ness of the heart's action, 316; treatment, 

316 ; Fatty Heart, difficult to detect, 316 ; 
often a fancied disease, 317. 

Heart, Palpitations from disease of, 433; the 
smoker's, 436. 

Heartburn, or Acidity, 78, 343 ; prescriptions 
for, 78, 79. 

Hectic Fever, 517. 

Hellebore, description and uses, 793. 

Hemicrania (see Megrim), 386. 

Hemiplegia, a species of Paralysis, 437. 

Hemlock, description and uses, 793 ; plant, 796. 

Hemp, Indian, description and uses, 796 ; effects 
on the constitution, 798. 799. 

Henbane, description and uses, 796 ; plant and 
bloom, 796. 

Hiccup, or Hiccough, 317; troublesome to hyste- 
rical young women, 317; simple remedies, 

317 ; recipe for the hiccup of drunkards, 
317. 

Hip, Disease of the, 54. 

Hoarseness, 370. 

Honey, Uses of, 883. 

Horehound, Uses of, 819. 

House Water and Drainage, 887. 

House Traps, 985. 

House Mixture, 678. 

Hydrastis Lotion, 583. 

Hydrocephalus (see Dropsy), 240. 

Hydrophobia, 318 ; the antiquity of the disease, 

318 ; experimenting on dogs, 318 ; premoni- 
tory symptoms, 319; the disease in foxes 
and wolves, 320 ; graphic account of a 
patient's sufferings given by Sir Thomas 
Watson, 321 ; a human being not able to 
impart the disease to another, 322 ; advice 
concerning dogs, 323 ; immediate remedies 
when bitten, 323 ; further remedies when 
the disease is fully developed, 324 ; the 
Groombridge recipe, 325; the Biring remedy, 
326 ; an old recipe published in 1640, 326 ; 
a simple and successful remedy published 
by Delabere Blaine, a veterinary surgeon, 
in 1807, 325 ; the vapour and Turkish baths, 
326. 

Hygiene: Practical remarks on this science, 
885 ; the neglect of the hygienic principle 
causing disease throughout the various ages 
of the world, 886 ; hygienic arrangements in 
the matter of houses, food, water, and drain- 
age, 887; letter of Erasmus, 888 ; the diet of 
our ancestors, 889 ; earliest form of water 
works, 889; Mr. Thornbury on the water- 
supply of London, 890 ; the drainage of, 
old London, 891 ; improved health of Lon- 
don in modern times, 892 ; Smiles' testimony, 
893 ; the exercise of the art of medicine in 
past ages, 894 ; benevolence of the nine- 
teenth century, 896 ; hereditary disease, 
895 ; the Education Act, 896 ; mens sana in 
corpore sano, 896 ; food, 896 ; four clases of 
food, 897; albuminates, 897, fats, 898; 
carbo-hydrates, 898 ; water and salts, 899 ; 



INDEX 



1071 



condiments, 899 ; the value of their various 
properties, 900 ; in what several foods these 
elements are found, 900 ; the percentage 
composition of foods, 901 ; the purposes for 
which food is required, 902, 903 ; the mix- 
tures taken by rich men, 903 ; extravagant 
dinners leading to gout, dyspepsia, and de- 
rangements of the liver, 904 ; Mr. Buck- 
master's plan of a more liberal use of vege- 
tables, 904 ; the amount of food a man 
requires, 905 ; remarkable instances of 
abstinence from food, 906 ; moderate food 
leading to longevity, 906 ; Dr. Parkes on the 
"Personal Care of Health," 907; digesti- 
bility of various foods, 907 ; interesting 
experiments, 908 ; the effect of ice, 908 ; 
the diet most suitable for robust manhood, 
910 ; the temperate working man in a better 
condition than the rich, 911 ; modes of cook- 
ing meat, 911 ; boiling, stewing, roasting, 
broiling, 912 ; avoiding an excess of starchy 
foods, or of sugars, or fats, 913 ; the value of 
vegetables, 914; gaol fever, 916; bad food 
causing disease, 917 ; trichinous disease, 
918 ; unwholesome milk, 919 ; fungus in rye, 
920 ; beverages, 920 ; alcohol, 920, 921 ; 
table of percentages of alcohol in ordinary 
chinks, 921, 922; the quantity of alcohol a 
healthy man can sustain, 922 ; the results 
of alcohol, 923 ; early symptoms of over- 
dosing, 924 ; tea, coffee, pepper, or mustard, 
925 ; the various qualities of wine, 926, 927 ; 
beer, 927, 928; table of the alcoholic 
strength of different beers, 929 ; adultera- 
tions of beer, 930 ; cider and perry, 930 ; non- 
alcoholic beverages, 930 ; tea, and the way 
to make it, 931; the composition of coffee, 
932 ; cocoa, 933 ; the nutriment contained 
therein, 933 ; practical advice on the beve- 
rages most calculated to produce health, 
934 ; air essential for man's existence, 950 ; 
its weight and pressure, 951; experiments 
in a balloon, 951 ; what air is necessary for 
man's existence, 952 ; the estimated amount 
of carbonic acid in various samples of air, 
953 ; cubic allowance for each person in a 
room, 954 ; direful effects of bad atmosphere, 
955 ; the Black Hole in Calcutta, 955, 956; 
poisonous air to which the world of fashion 
submits, 957 ; dust an impurity, 958 : the 
effects of fog, 959 ; ventilation, 960 ; Exer- 
cise, 961; physical, 961; muscular, 962; 
respiratory functions roused, 961 ; necessary 
intervals of relaxation, 963 ; national games, 
964 ; dancing, 965 ; the amount of exercise 
which should be taken, 966 ; estimates of the 
actual strength involved in a day's labour, 
966 ; diet an important question in relation 
to exercise, 967 ; cleanliness and clothing, 

968 ; sweat, 968 ; the invention of soap, 968 ; 
ophthalmia, 968 ; the hair, 969 ; the mouth 
and teeth, 969 ; necessity of clean clothing, 

969 ; the colour of the clothing, 970 ; head- 
,970; under-clothing, 9 70; feet clothing, 



971 ; baths and mineral waters, 972 ; bene- 
ficial effects of sea- water, 972 ; cold hatha, 
sea-baths, tepid, warm, and hot baths, 973 ; 
sewage and drainage, 983 ; human excre- 
ments, 985; middens and cesspools, 985; 
house traps, 985 ; how to deal with sewage, 
984 ; infection and disinfection, 987 ; various 
modes of disinfecting dwellings, 989 ; dry 
heat, 989 ; water, the basis of all sanitation, 
934 ; the purpose for which water is re- 
quired, 935 ; water supplies in large towns, 
936 ; analysis of the water supplied to Lon- 
don, 937; sewage contamination, 938; 
sewage gas and its danger in a house- 
hold, 986 ; Croton water, 936 ; micro- 
scopic examination, 940 ; how to give a 
pure water supply, 941 ; impurity in some 
districts of London, 945 ; cleanliness of 
towns, 946 ; tests for the purity of water, 
948; the Poor Man's Filter, 949; rain- 
water, 950 ; German baths, 981 ; Ham- 
burg, Kniebis, Schwulbach, Bippoldsau, 
Friersbach, and Petershai, 981 ; scenery 
around and description of the daily routine 
of visitors, 982 ; the bath par excellence where 
extract of pine tops is added, 983 ; Infec- 
tion, 987 ; How infective power may be 
destroyed, 987, 988 ; small-pox and scarlet 
fever infection, 988 ; typhoid fever onlyinfec- 
tious one way, 988 ; typhus fever, measles, 
and whooping-cough, infectious through th6 
air only, 989 ; aerial disinfection, 989. 

Hypochondriasis, 326 ; peculiarity of the com- 
plaint, 326 ; extraordinary instances, 327 ; 
circumstances predisposing to the disease, 
327 ; suggestion for sufferers, 328. 

Hvpophosphate of Lime Mixture, 580. 

Hysteria — Hysterics, 329 ; variation of the 
paroxysms, 329 ; combination of hysteria 
and epilepsy, 330 ; conditions favourable to 
the development of hysteria, 330 ; young 
ladies' fancies, 331 ; illusions and hallucina- 
tions, 332 ; sensations often imaginary, 333 ; 
treatment in hospitals, 334 ; a singular case, 
335, 336; spinal irritation, 337; remedies, 
338, 339. 



Ice-bags, Spinal, 479. 

Indian Hemp, description and uses, 796 ; effects 
on the constitution, 798, 799. 

Indian Hemp Pills, 581. 

Indication of Disease, 585 ; temperature, 585 ; 
thermometer, 585 ; clinical thermometer, 
586 ; thermometer scale illustrated and ex- 
plained, 586 ; instructions in taking the 
temperature, 587 ; rules for taking the 
temperature under the arm-pit, 588 ; rules 
for taking the temperature in the bowels, 
688, 589 ; when the temperature should 
be taken, 589; temperature taken under 



.072 



INDEX. 



the tongue, 590 ; chart showing*how to re- 
cord the temperature at stated periods, 591 ; 
chart showing the diurnal temperature in 
health, 592 ; influence of food on the tem- 
perature, 593 ; menstruation, 594 ; aid of 
the thermometer in classifying diseases, 
695, 596, 597 ; the pulse, 598 ; irregularity, 
699 ; jerking, 599 ; fever in the pulse, 599, 
600; the tongue, 600; the strawberry, 
601 ; the furred, 601 ; the smooth and red, 
602 ; the urine, 602 ; urinometer (illus- 
trated), 602 ; the various colours and deposits 
in urine, 603, 604, 605 ; blood and albumen 
in the urine, 606, 607; pain, 607; the 
various degrees, 608, 609 ; facial expression 
as an indication of illness, 609 ; coldness of 
the ear and tip of the nose, 610 ; nursing 
and the care of the sick, 611 ; rules of treat- 
ment, 611 ; nursing, a practical matter, 612 ; 
qualifications for a nurse, 612, 613; her 
dress, 614; a diary, 614; night report, 615; 
a record of duties, 615; useless talk, 616; 
management of the sick-room, 617 ; tempera- 
ture, 619; disinfectants, 619; light, 620; 
quiet, 621 ; consultations out of hearing of 
the patient, 622, 623; practical details of 
nursing, 624; beds, 624; wire mattress, 
(illustrated), 625 ; changing linen, 626 ; lift- 
ing a patient, 626 ; lift and rack bedstead 
(illustrated), 627 ; water-bed, 627; method of 
filling a water-pillow (illustrated), 627; in- 
valid cushions, 628 ; water or air mattress 
(illustrated), 628 ; bedstead with mattress 
and general tubes (illustrated), 628; air 
pillow (illustrated), 628; bed sores, 629; 
bed-ridden persons, 630 ; prevention of bed 
gores, 631 ; india-rubber urinals, 631 ; cir- 
cular water or air cushion, 633 ; horse-shoe 
water or air cushion (illustrated), 633 ; 
double oblong water or air cushion, 633 ; 
cleanliness essential, 633 ; disinfectants ap- 
plied to wounds, 634; bed-pans, 635; slipper 
bed-pan (illustrated), 636 ; urine bottles, 
636; bed frames (illustrated), 636 ; bed cur- 
tains, 637; back rest (illustrated), 637; 
Salter's leg swing (illustrated), 637; bed 
rest (illustrated), 637 ; literary machine 
(illustrated), 637 ; bed tables (illustrated), 
638 ; invalid carriage (illustrated), 638 ; 
hammock (illustrated), 639 ; carrying chair 
{illustrated), 639 ; moving a patient, 640 ; 
wheel chairs (illustrated), 640 ; undressing a 
patient, 640; sand bags, 641 ; bottles of warm 
water, 641; administration of medicine, 641 ; 
medicine glasses (illustrated), 642, 643 ; doses 
of medicine, 643 ; metrical system of weights 
and measures, 644 ; pills, powders, &c, 645, 
646 ; enemata, or injections, 646, 647 ; the 
drugs used in the enemata, 648 ; nutritive 
matters injected, 649 ; evaporating lotions, 
850; fomentations, 651; poultices, 652, 
653 ; blisters, 654 ; plasters, 655, 656 ; lini- 
aients, 656 ; baths, 657 ; bleeding and 
feeches, 658 ; invalid diet, 659, 660 ; recipes 



for beef tea, 661 ; mutton broth, 662 ; purees, 
663 ; plain omelette, 664, 665 ; arrowroot and 
arrowroot drink, 665 ; pearl water and 
lemonade, 666 ; oatmeal porridge, 667 ; 
knowledge necessary in a nurse, 669, 670, 
671, 672. 

Imperial Drink, 66. 

Improved Health in London Districts, 892. 

Indigestion, or Dyspepsia, 340 ; physiology of 
digestion, 340 ; experiments on the process 
of digestion, 341 ; symptoms of dyspepsia, 
342, 343, 344; treatment, 345; plan of 
diet recommended, 346 ; regular meals, 
347 ; hygienic conditions and exercise, 347; 
hints upon false teeth, 348 ; general treat- 
ment of dyspepsia, 349, 350 ; prescriptions, 
350, 351. 

Infant Food, 675—682. 

Infants, Weaning of, 682 ; food after, 684 ; 
management after, 687; sleep, 687; edu- 
cation, 690. 

Infection, 987 ; from small-pox and scarlet 
fever, 988 ; from typhoid fever, 988 ; from 
typhus fever, 987. 

Influence of Food on the Temperature of 
Healthy People, 987. 

Influence of Mental Powers over Digestion, 
419, 420. 

Influenza, 342 ; its spread over Europe in 1837, 

353 ; the regular course it follows, 353 ; the 
epidemic in London and Paris in 1847, 353 ; 
the causes which lead to its development, 

354 ; the symptoms, 355 ; not regarded as a 
serious disease, 356 ; no means of preven- 
tion, 357 ; treatment, 357, 358. 

Injections, Administrations of, 646 ; drugs for, 
648. 

Injuries, Chemical, 713 ; Gunshot, 713. 

Insipidus, Diabetes (see Diabetes), 223. 

Intertrigo, Causes and Treatment, 4. 

Invalid Chairs, 639 ; wicker, 640 ; merlin, 640 ; 
hammock, 639. 

Invalid Diet, 659. 

Iodide of Iron Mixture, 577. 

Iodide of Potassium Mixture, 679. 

Iodine — Iodide of Potassium — description and 
uses, 800, 801. 

Ipecacuanha and Squib Mixture, 580. 

Ipecacuanha, description and uses, 802 ; plant, 
803. 

Iron, description and use, 805 ; moist peroxide 
of, 806 ; citrate of ammonia, 807 ; citrate 
of, and quinine, 807 ; phosphate of, 807 ; sul- 
phate of, 806; syrup of iodide of, 807; 
tartrated, 807 ; wine, citrate of, how 
made, 807 ; effervescing form of, 808. 

Iron and Aloes Pills, 581. 

Iron and Digitalis Mixture, 677. 

Iron Mixture, 577. 

Iron Powders, 582. 

Iron and Quassia Mixture, 577. 

Irons for Deformities, Objections to, 1001. 

Itch, or Scabies, 994 ; certain cure, 994. 

Itching of the Anus, 358 ; causes, 359 ; advice M 



INDEX. 



1073 



to diet, 359 ; medicinal regime, 359 ; outward 
application, 359 ; Condy's Fluid, 360 ; a bone 
plug recommended, 361. 
Irrigator, Use of, 650. 



Jalap and Scammony, 810. 

Jaundice, 361 ; derangement of digestion the 
chief cause, 362 ; obstruction of the bile 
duct, 363 ; the disease in children, 363, 364 ; 
general rules of diet, 364; other remedial 
measures, 364, 365 ; medicinal treatment, 
365, 366. 

Jelly, Calf's Foot, 668. 

Joints, Diseases of, 367 ; medical advice indis- 
pensable, 367 ; chronic affections, 367 ; 
recipe for stiffness arising from over-exer- 
tion, 368. 

Juice, Gastric, 341. 



Kidneys v. Bright's disease, 149 ; t. Gravel, 

299, 300 ; v. urine, 605. 
King's Evil, 48 ; treatment, 49. 
Kino, description and uses, 775. 



Labour, Strength Involved in a Day's, 966. 

Language, Loss of the Faculty of, 105 — 107. 

Laudanum, How to act in case of Poisoning 
by, 845. 

Lead, Matters contaminated by, 812. 

Lead or Diachylon Plaster, 810. 

Lead, Oxide of, 810. 

Leeches, Application of, 658. 

Lemonade, 666. 

Lettuce and Hops, Uses of, 815. 

Lice, 994 ; sure mode of destruction, 994. 

Linseed Tea, 666. 

Limbs, Neuralgia in the, 401 ; steps to ward 
off the disease, 401 ; remedies when fully 
developed, 402, 403, 404 ; mode of alleviat- 
ing the pain, 405 ; blisters and external 
applications, 506 ; electricity, 407. 

Lime-water and Chalk, Uses of, 816. 

Liniment for Neuralgia, 682. 

Liniments : Belladonna and Chloroform, 682 j 
Neuralgia, Turpentine and Ammonia, 682. 

Liniments, Uses of, 656. 

Liquorice, 819. 

liver Complaints and Biliousness, 127 ; causes 
of the derangement of the liver, 127 ; inju- 
rious effects of alcoholic drinks, 128 ; what 
it favourable to the production of disorders 



of the liver, 128 ; influence of the liver oa 
animal spirits, 131 ; dietary, 131, 132 ; medi- 
cinal remedies and prescriptions, 133, 134, 
135, 136; treatment of functional diseases 
of the liver, 136 ; advice to convalescents, 

. 136 ' 

Liver, Gin-drinkers', 290 ; alcohol passing 
through the liver, 290; symptoms of the 
disease, 290; sufferers' want of firmness, 
291 ; no cure but temperance, 291 ; the onlj 
remedies, 291. 

Lobelia, description and uses, 815. 

Lobelia Inflata, 123. 

Lock Jaw, 507. 

Locomotor Ataxy, loss of control over the legs, 
438. 

London, Drainage of Modern, 894 ; of Old, 891 ; 
improved health in, 892 ; impurity in some 
districts of, 945. 

Loss of Appetite, 368; frequent causes, 368; 
curiosities of appetite, 369 ; bitters before 
meals, 370 ; tonics recommended, 370 ; recipe 
for elderly people, 370. 

Loss of Voice (Aphonia), Hoarseness, 370 ; Gal- 
vanism, 371 ; singular cases, 371 ; simple 
remedies for hoarseness, 372. 

Lotion: Alkaline, Sulphur, Evaporating, 582; 
Arnica, Hamamelis, Hydrastis, Calendula, 
583. 

Lotions, Application of, 650. 

Lozenge Pills, 581. 

Lumbago, 469. 

Lungs, Diseases of, 372 ; the winter cough, 
373 ; night sweating, 374 ; change of climate, 
375; exemption of butchers, 376; conditions 
favouring the development of chest disease, 
377 ; hints to debilitated persons, 378, 379; 
table showing the growth of the human body 
from eighteen to thirty years of age, 380 ; 
nutritious foods and practical recipes, 381 ; 
cod-liver oil, 382 ; moistening the room, 382; 
bronchitis kettle (illustrated), 382; Inflam- 
mation of the lungs, 3S3; Pleuro-pneumonia, 
382 ; premonitory symptoms, 384 ; hints af 
to treatment, and prescriptions, 385, 386. 



Magnesia, description and uses, 818. 

Man, Amount of Food required by a, 905. 

Manna, description and uses, 883. 

Marsh Mallow, Uses of, 819. 

Malaria, 80. 

Materia Medica : An instructive commentary 
upon the various medicines used in the several 
diseases, their nature and purpose. The fol- 
lowing medicines are explained: — Aconite, 
745 ; Alum, 747 ; Arnica, 749 ; Arsenic, 
750, 751, 752; Alkalies, 746; Aloes, 747; 
Bark, 766 ; illustration of the Chincona 
Bark tree; Belladonna, illustration of the 



4 



1074 



INDEX. 



plant, 759, 760 ; Bismuth, 763 ; Box, 764 ; 
Bromide of Potassium, 765 ; Bryonia, 766 ; 
Calabar Bean, 767 ; CalumLa, 768; Camphor, 
769; Camphor Plant (illustrated), 770; Can- 
tharides, or Spanish Fly, 770 ; description 
of the Cantharis vesicatorium, 770 ; Carbon 
of Charcoal, 773; Castor Oil— Croton Oil, 
774 ; Catechu — Kino — Rhatany Root, 776 , 
Chamomile, 776 ; Chloral, 776 ; Cimicifuga, 
778 ; Cod-liver OH, 778 ; Coffee, 780 ; Col- 
chicum, 781 ; Colocynth, 782 ; Digitalis, 
783; the digitalis flower (illustrated), 784 ; 
Epsom Salts, and other saline purgatives, 
785 ; Ergot, 786 ; Fern Root — Pomegranate 
— Spirits of Turpentine, 787 ; Friar's Balsam 
— Balsam of Peru — Balsam of Tolu, 788; 
the Tolu plant (illustrated), 789; Gentian, 789; 
the gentian flower (illustrated), 790; Guaia- 
cum, 790 ; the shrub (illustrated), 790 ; 
Gelseminum, 791 ; Hamamelis Virginica, 
792; Hellebore, 793; Hemlock, 793; the 
bemloci plant (illustrated), 794; Henbane, 
796; the plant and bloom (illustrated), 796; 
Indian Hemp, 796 ; singular effects of thia 

flant on the human constitution, 798, 799 ; 
odine — Iodide of Potassium, 800, 801 ; Ipe- 
cacuanha, 802 ; the ipecacuanha plant, 803 ; 
Iron, 805, Moist Peroxide of Iron, 806; 
Griffiths's Mixture, 806 ; Griffiths' s Pills, 
806 ; Tincture of Steel, 806 ; Blue Vitriol, 
or Sulphate of Iron, 806 ; Syrup of Iodide 
of Iron, 807 ; Phosphate of Iron, 807 ; 
Parrish's Chemical Food, 807 ; Easton's 
Syrup, 807 ; Citrate of Iron and Ammonia, 
807 ; Citrate of Iron Wine, how made, 807 ; 
Tartrated Iron, 807 ; Citrate of Iron and 
Quinine, 807 ; an effervescing form of Iron, 
808; Tincture of Steel, 809; Jalap and 
Scammony, 810 ; Lead — Oxide of Lead, 
810 ; Lead or Daichylon Plaster, 810 ; what 
to do in poisoning by Sugar of Lead, 811 ; 
the various matters contaminated by lead, 812; 
Lobelia, 815 ; Lettuce and Hops, 815 ; Lime- 
water and Chalk, 816; Magnesia, 818; 
Marsh Mallow — Horehound — Elecampagne 
— Coltsfoot — Liquorice, 819; the plant 
technically known as Altheea officinalis 
(illustrated), 819 ; the Marrubium vulgare y 
or Coltsfoot plant (illustrated) — Mercury, 
or Quicksilver, 820 ; the danger of an escape 
of mercury, 822 ; Grey powder, 824 ; Blue 
pill, or Mercurial Pill, 825 ; Mercurial Oint- 
ment, 825 ; the best antidote in case of 
poisoning by corrosive sublimate, 827; 
White Precipitate, or Ammoniated Mercury, 
827 ; Red Iodide of Mercury, 827 ; Mercury 
Plaster, 826 ; Black Wash, 826 ; the various 
uses of mercury, 828, 829, 830; Mustard, 
831 ; Nitro-glycerine, or Glonoine, 832 ; 
Nitrite of Amyl, 833 ; Nitre, or Saltpetre, 
and Chlorate of Potash, 834; Nux 
Vomica, 836 ; what to do in poisoning by 
■trychnia or nux vomica, 838 ; the Curari, 
«r Woorari, employed by physiologists in 



the performance of experiments on animala 
— the effects of this plant, 839 ; Oak-bark 
— Gall-nuts — Tannic Acid — Gallic Acid, 
839 ; extracted from the British oak, 839 ; 
Glycerine of Tannin, 841 ; Opium, 842 ; the 
Opium Poppy (illustrated), 843; what to 
do in poisoning by laudanum or opium, 
846; effects of opium on the system, 846, 
847; opium eating, 848, 849, 850; direful 
effects, 852, 853; opium smoking, 853; 
Phosphorus — Phosphate of Lime — Hydro- 
phosphate of Lime, 856 ; Phosphorus, 857 ; 
Podophyllum, 858 ; Prussic Acid, or Hydro- 
cyanic Acid, 859 ; treatment of poisoning by 
prussic acid, 860; Pulsatilla, 861 ; Quassia, 
Chiretta, Cusparia, and Cascarilla, 861 ; 
Rhubarb, 863 ; Sal Ammoniac, 863 ; Sali- 
cine and the Willow, 864; Sal Volatile, 

865 ; Sarsaparilla, 866 ; Senega and Squills, 

866 ; Senna, 867 ; Stavesacre, 868 ; Stra- 
monium, 868 ; fruit of the stramonium 
(illustrated), 869 ; Sulphate of Zinc and 
Oxide of Zinc, 869 ; two preparations ad 
ministered internally, Sulphate of Zinc, or 
White Vitriol, and the Oxide of Zinc, 869; 
Sulphide of Calcium 871 ; Sulphur, or 
Brimstone, 872 ; confection of sulphur 873 ; 
sulphur lotion, 873 ; Tar and Creosote, 874 ; 
Tartar Emetic, 876 ; Tea, 877; Hypericum 
Scrforatum, or tea plant (illustrated), Sift; 
Tobacco, 880 ; the effects produced by 
smoking, 881 ; Treacle — Tamarinds — Figs 
— Prunes — Honey— Manna, 883. 

Measles, 25 ; not confined to the young, 25 ; 
the infectious nature, 25 ; symptoms, 26 ; 
complications of the disease, 27 ; mistaken 
for other complaints, 27 ; treatment, 28. 

Meat for Invalids, 662, 663 ; modes of cooking, 
911, 912. 

Medicine, Rules for administering, 641, 650. 

Medicine, External, 650—659. 

Medicine, Table of Doses, 1003, 1004. 

Medicine Glasses, 643. 

Megrim, or Sick Headache, 386; several 
varieties, known as hemicrania, blind head- 
ache, and bilious headache, 386; a "family 
complaint," 387; sick headache, an inter- 
mittent affection, 387 ; several causes of the 
disease, 389 ; a conspicuous feature of 
megrim, 390 ; spectral appearances in 
megrim (illustrated), 391 ; blindness, or 
partial blindness, 391 ; irregular forms of 
the disease, 392; an eminent divine's 
experience, 392, 393 ; the causes of megrim, 
394 ; general advice to persons affected, 
396. 

Mellitus, Diabetes, 217. 

Mercurial, or Blue Pills, 825. 

Mercurial Ointment, 825 ; antidote in case ol 
poisoning by corrosive sublimate, 827. 

Mercury, or Quicksilver, Uses of, 820 ; plaster, 
826 ; red iodide of, 827 ; white precipitate 
or ammoniated, 827. 

Mercury, Various uses of, 828, 829, 830. 



INDEX. 



1075 



Metastasis, a marked feature of Acut6 Kheuma- 
tism, 457. 

Middens and Cesspools, 985. 

Middle Diet, 659. 

Milk and Suet, 667. 

Milk, Composition of, 675; condensed, 680; 
imitation, 681 ; rice, 665 ; unwholesome, 
919. 

Mixtures : Acetate of Lead — Aconite, 579 ; Am- 
monia and Bark — Ammonia and Senega, 
678 ; Aperient Iron, 577 ; Arsenic, 579 ; 
Arnica, 580 ; Astringent, 579 ; Belladonna, 
279 ; Bismuth, 578 ; Bromide of Potassium, 
679 ; Bryony, 580 ; Carbonate of Ammonia 
— Carminative, 678 ; Cantharides — Corro- 
sive Sublimate, 580; Citrate of Iron, 677; 
Creasote with Opium, 578 ; Colchicum, 579 ; 
Diarrlujea, 679; Effervescing Ammonia, 
683 ; Effervescing Iron, 577 ; Gelseminum, 
680 ; Gentian and Acid— and Senna— and 
Soda, 578; Hamamelis — Hypophosphate of 
Lime, 580 ; House, 578 ; Iodide Iron — Iron 
— Iron and Digitalis — Iron and Quassia, 
677 ; Iodide of Potassium, 579 ; Ipecacuanha, 
580 ; Ipecacuanha and Squills, 578 ; Nux 
Vomica, 580 ; Quinine and Iron, 578 ; Pare- 
goric, 578 ; Pulsatilla, 580 ; Saline Iron, 
677 ; Salicine— Strong Quinine, 578 ; Sal 
Ammoniac — Saline or Purgative White, 
679; Sulphuric Acid, 579; Tartarated 
Antimony, 580 ; Tonic, 577. 

Moist Peroxide of Iron, Uses of, 806. 

Morphia Tinctus, 580. 

Mouth and Teeth, 669. 

Mouth, Ulceration of, 63. 

Mumps, 28 ; not confined to the young, 25 ; the 
infectious nature of the disease, 28 ; predis- 
posing causes, 29 ; symptoms, 29 ; mild 
treatment, 30 ; medicinal remedies, 30, 31. 

Mustard, Uses of, 831. 

Mutton Broth, Becipe for, 662. 

Myalgia, or Pain in Muscles, 424. 



N 



Neck, Crick in the, causes and treatment, 472, 
473. 

Neck, Derbyshire (see Goitre), 213. 

Nervous Palpitations, 434. 

Neuralgia, 399; Tic-douloureux, 400; agonis- 
irg pain often cured by the dentist's art, 
40; Neuralgia of the Limbs, 401 ; steps to 
ward off the disease, 401 ; remedies when 
fully developed, 402, 403, 404 ; mode of alie- 
nating the pain, 405 ; blisters and external 
applications, 506 ; electricity, 407. 

Neuralgia Liniment, 582. 

Neuralgic Earache, 253. 

Nightmare, 496. 

Night-sweating, 408; capricious nature, 408; 
mode of treatment at Brompton Hospital, 
409 , various remedies, 409. 



Night Terrors, 30 ; remedies for children, 31. 
Nitre or Saltpetre, 834. 
Nitrite of Amyl Drops, 680. 
Nitrite of Amyl, Uses of, 833. 
Nitro-glycerine, 832. 
Nose, Bleeding at the, 700. 
Nurse in the Sick-room, The, 670. 
Nursing of Children, 673. 
Nux Vomica, Uses of, 836 ; what to do In 
case of poisoning by, 838 ; mixture, 580. 



Oak-bark, Uses of, 839. 

Oatmeal Gruel, 665. 

Oatmeal Porridge, 667. 

Obesity, 409 ; fattening foods, 410 ; Banting's 
principle to reduce the evil, 411, 412; the 
plan of dietary adopted by Mr. Banting, 
412; reduction of food suitable to the con- 
stitution, 413. 

Obstruction of the Bowels, 413 ; causes, 413, 
414; treatment, 415; surgical operations, 
artificial anus, 416. 

Odontalgia (see Toothache), 609. 

Offensive Breath, 416 ; conditions when it 
occurs, 416 ; teeth cleaning, 417 ; remedies 
when the gases proceed from the stomach, 
417. 

Ointment, Calomel — Dilute "White Precipitate, 
• 582. 

Ointment, Oxide of Zinc — Kesin, for Chilblains, 
6. 

Old Age, 417; Euthanasia — oblivious trance into 
oblivion, 418; diet for the aged, 419; in- 
fluence of mental powers over digestion, 419 ; 
useful remedies for torpidity of the bowels, 
420 ; the number of years no guide to real 
age, 421 ; overwork producing premature 
age, 422 ; rest, 423. 

Omelettes, Plain, 663. 

Ophthalmia, 968. 

Opium, 842 ; Poppy of, 843. 

Opium, What to do in cases of poisoning by, 
845. 

Opium-eating, 848, 849, 850; Effects of 861, 
853. 

Opium, effects on the system, 846, 847. 

Opium Smoking, 853. 

Orgeat, 667. 

Orthopaedic Surgery, 1001. 

Oxide of Zinc Pills, 581. 

Oxide of Zinc, Use of, in Chafing, 4. 

Oxley's Essence of Ginger, 280. 



Pain in the Muscles, or Myalgia, 424 ; com- 
monly the result of over- exertion, 425 ; 
Muscular Pains in various parts of tl» 



INDEX. 



Body, 420—427 ; Stitch in the Side, 427 ; 
mistaken for other diseases, 428 ; easy stays 
for women, 429; taking a false step, 430; 
remsdies, 430, 431. 

Palate, Dangers of a false, 348. 

Palpitation, 432 ; irregularity in the heart's 
action, 432 ; often dependent on a disordered 
condition of the stomach, 433 ; tables show- 
ing when palpitation arises from diseases of 
the heart, and when it arises from other 
causes, 433; Nervous Palpitation simply 
treated, 434; specific remedies for the 
disease, 435 ; smoker's heart, 436. 

Palsy, Shaking, 482 ; causes, 482 ; its insidious 
nature, 482; when fully established not 
amenable to treatment, 483 ; alleviating 
remedies, 483. 

Panada, 668. 

Pans, Bed, 635. 

Paralysis, Children's, 6 ; treatment, 6, 7. 

Paralysis, 436 ; two kinds — hemiplegia and 
paraplegia, 437 ; hemiplegia a form of palsy, 
437 ; paraplegia, paralysis of the lower half 
of the body, 437 ; Locomotor Ataxy, loss of 
control over the legs, 438 ; Facial Paralysis, 
when the muscles of the face are affected, 
439 ; specific treatment, 440. 

Paraplegia, a species of Paralysis, 437. 

Paregoric Mixture, 578. 

Parkes, Dr., on Personal Care of Health, 907. 

Parrish's Chemical Food, 184, 261, 289, 672, 

Peach Cold, 301. 

Pearl Barley Water, 666. 

Peru, Balsam of, 788. 

Phosphate of Lime, 856. 

Phosphorus, 856, 857. 

Phosphorus Capsules, 580. 

Phosphorus Solution, 580. 

Phthisis {see Consumption). 

Physiology of Digestion, 340. 

Piles, or Haemorrhoids, 440; Bleeding Piles, 
441; remedies, 441; Fistula, 443; diet and 
alleviating specifics, 443. 

Pills, Aperient, 581 ; Belladonna, 3 ; Blue with 
Opium — Dinner — Indian Hemp — Iron and 
Aloes — Lozenge — Oxide of Zinc, 581 ; Podo- 
phyllum, 134; Sulphate of Iron— Tar, 681. 

Pills, How to take them, 645. 

Pilules, Sulphide of Calcium, 581. 

Plaster, Diachylon, 810 ; Mustard, 655. 

Pleurisy, 444 ; the seat of the disease, 445 ; some- 
times confounded with inflammation of the 
lungs, 446 ; treatment of the disease, 447 ; 
tapping the chest, 448. 

Pleuro Dynia, 431. 

Pleuro-pneumonia {see Lungs), 283. 

Podophyllum, Description and Uses, 858. 

Podophyllin Solution, 680. 

Pomegranate, Uses of, 787. 

Poison by Laudanam, How to Act in Cases of, 
845; by corrosive sublimate, 847; by 
strychnia, 838 ; by sugar of lead, 811. 

Porridge Oatmeal, 667. 

Posset, White Wine, 667. 



Poultice-charcoal, Making of, 653 ; Chlorinated 
Soda-Hemlock, 653 ; Linseed, 652 ; Mustard, 
655. 

Poultices, 652 ; how to apply them, 663. 

Powders : Bismuth and Charcoal — Calomel and 
Sugar — Digestive-grey and Rhubarb— Sugar 
and Grey, 581 ; Compound Jalap and Bi- 
tartrate ; Compound of Potash, 583 ; Dusting, 
682 ; Iron — Santonin — Sulphide of Calcium 
— Phosphate of Lime and Lron, 582 ; Dover's, 
409. 

Powders, How to administer them, 645. 

Prunes, Uses of, 884. 

Prussic Acid, or Hydrocyanic Acid, 859. 

Pudding, Custard, 644 ; Bread, 665 ; Rice, 66* ; 
Tapioca, 665. 

Pulsatilla Mixture, 580 ; Uses of, 861. 

Pulse, The, 598. 

Purees, 663. 

Purgatives, Abuse of, 190. 

Purification of Rooms, 989. 

Pyrosis, or Waterbrash, 448 ; character of tbp 
disease, 448; diet and treatment, 4! , a 
ruminating apprentice, 449. 



Quassia, Description and Uses, 861. 

Quicklime, Injuries from, 714. 

Quinine and Iron Mixture, 578. 

Quinsy, Inflammatory Sore Throat, or Tonsil- 
litis, 450 ; the nature of the disease, 450, 
451 ; the remedy par excellence, 451 ; dif- 
ferent forms of Sore Throat, 451 ; remedies 
in various stages of the disease, 452, 453. 



Recipes for Hydrophobia, 326, 326. 

Red Gum, Treatment of, 31. 

Red Iodine of Mercury, 827. 

Red Wash, 582. 

Relaxed Sore Throat, 453; local applications, 
454 ; Dry and Glazed Throat, 454 ; Chronic 
Sore Throat, 455. 

Remarkable Instances of Abstinence, 906. 

Remittent Fever, Character of, 550 ; treatment, 
551. 

Resin Ointment, used for chilblain!, 6. 

Respirators for Colds, 184. 

Rests, Bed, 637. 

Rhatany Root, description and uses, 863. 

Rheumatic Fever, or Acute Rheumatism, 456; 
the ordinary duration of attacks, 456 ; peri- 
carditis, 457 ; the shifting nature of the 
disease, 457; tables showing, the differences 
between Gout and Acute Rheumatism, 745 ; 



INDEX. 



1077 



epecific for the acute disease, 458; other 
remedies for Rheumatism generally, 459. 

Rheumatic Gout, 461 ; in a chronic state, 461 ; 
the malady spreading from joint to joint, 
462 ; difficulty of discovering between Gout 
simple and Rheumatic Gout, 462 ; special 
directions and prescriptions, 463, 464. 

Rheumatism, Chronic, 464 ; often the sequel of 
Rheumatic Fever, 464 ; a very obstinate 
complaint, 465 ; valuable medicines, 465 j 
" Cold " Rheumatism, 466 ; a valuable 
specific called the " Chelsea Pensioner," 
466 ; external applications, 467 ; Gonorrhceal 
Rheumatism, 468. 

Rheumatism, Muscular, 469; the principal 
varieties, Lumbago and Crick in the Neck, 
469; remedies for Lumbago, 470, 471; 
remedies for Crick in the Neck, external, 
472; internal, 473. 

Rhubarb, Uses of, 863. 

Rice Milk, 665 ; Pudding, common, 666. 

Rickets, 31, 32; causes, 33, 34 ; treatment, 34, 
35, 36. 

Ringworm, 36 ; scalp, 36 ; treatment, 37. 

Ringworm, body, 38 ; treatment, 38. 

Rooms, Purification of, 989. 

Rose Fever, 301. 

Rye, Fungus in, 920. 



Bal Ammoniac Mixture, 579. 

Sal Ammoniac, Uses of, 863. 

Sal Volatile, Uses of, 865. 

Salicine and the Willow, Uses of, 864. 

Salicine Mixture, 578. 

Saline Iron Mixture, 577. 

Saline, or Purgative White Mixture, 578. 

Saltpetre and Chlorate of Potash, Uses of, 

834. 
Sanitation, Water the basis of, 934. 
Santonin Powders, 682. 
Sarsaparilla, Uses of, 366. 
8cabies or Itch, 994 ; certain cure for, 994. 
Scald Head, 40 ; treatment, 41. 
Scarlet Fever, 41 ; its epidemic nature, 41, 42 ; 

symptoms, 42, 43 ; treatment, 44 ; general 

instructions to nurses, 45 ; prescriptions, 

46. 
Scrofula, 46 ; the various stages of the disease, 

47 ; King's Evil, 48 ; treatment, 49. 
Scurvy, 473 ; causes, 474 ; lime juice partially 

abolished the disease, 475 ; nature of the 

complaint, 476; a list of measures to be 

adopted when fresh vegetables are scarce, 

given by Dr. Parkes, 478. 
Sea Sickness, 478 ; " Chapman's Spinal Ice 

Bags," 479 ; illustrated, 480 ; other remedies, 

480. 
Sedative Draught, 679. 



Senega and Squills, Uses of, 866. 

Senna, Uses of, 867. 

Sewage and Drainage, 983 ; how to deal with 
984. 

Sewage Contamination, 938. 

Sewage Gas, Danger of, 986. 

Shaking Palsy, or Paralysis Agitans, 482 ; the 
causes, 482; its insidious nature, 482; 
when fully established not amenable to 
treatment, 483; alleviating remedies, 
483. 

Shingles: remedies for cure, 996. 

Sick-room, Temperature of, 668. 

Sickness, Green, 94 ; falling, 261. 

Side, Stitch in, 427. 

Skin, Diseases of, in Children, 47. 

Skin Diseases, 991 ; the Scarf-skin, cuticle, or 
epidermis described, 991 ; nails and hairs, 
992 ; causes of the complaint, 992; vege- 
table fungus, or skin parasites, 992, 993 ; 
the several forms of animal parasites which 
afflict the body, 993 ; relief of Skin Diseases 
without applying to doctor, 994 ; remedy 
for Itch, or Scabies, 994 ; remedy for Lice, 
994 ; remedies for Freckles, 995 ; for 
Shingles, 996 , Fowler's Solution of Arsenic, 
996 ; tonics for Skin Diseases, 996. 

Sleep, 659 ; Infants, 687. 

Sleep — Sleeplessness, 483; phenomena of sleep, 
484 ; singular instances of the somnolent 
power, 485 ; the different effects of sleep, 
487 ; dreams, 488 ; sleeplessness, 489, 490 ; 
the best mode of curing sleeplessness, 491, 
492 ; medicinal remedies, 492, 493. 

Slop Diet, 658. 

Slow Eating, 449; a ruminating apprentice, 
4*9. 

Small-pox, 514 et seq. 

Soap, Invention of, 968. 

Soda Water and Milk, 666. 

Somnambulism, 493 ; strange acts performed" by 
somnambulists, 494, 495 ; nightmare, 496 ; 
morbid dreams, 497 ; measures for the cure 
of somnambulism, 497 ; treatment for night- 
mare, 498. 

Sores, and Ulcers, 501 ; the several varieties, 
501 ; general remedies, 502. 

Sore Throat (Clergyman's), 498; how caused, 
499 ; an easy remedy, 499 ; wearing the 
beard and moustache, 500. 

Sore Throat (ordinary), 600; medicinal treat- 
ment, 501. 

Spanish Fly, description and uses, 770. 

Spasm Tonic, 507, chronic, 607, causes and 
treatment, 508. 

Specific Fever, 519. 

Spectral appearances in Megrim, 391. 

Speculum, Ear, 248. 

Spinal Ice-bags, Chapman's, 479. 

Spinal Diseases, 54. 

Spirits of Turpentine, Uses of, 787 

Splints for deformities, 1001. 

Sprains, 701 ; remedies, 702. 

Squill and Opium Tinctures, 686. 



1078 



INDEX. 



Squills and Senega, 866. 

St. Vitus' s Dance, Chorea, 38; treatment, 
39. 

Stammering, 54 ; cure of, 55. 

Stavesacre, 868. 

Steel, Tincture of, 806. 

Stomach, Bleeding of the, 137; phases of the 
disease, 137, 13S ; treatment, 139, 140. 

Stomach, Cancer in the, 169 ; predisposing 
causes, 169, 170. 

Stomach, Ulceration of the, 553 ; symptoms, 
654 ; gastric ulceration, 555 ; dietary regime, 
656 ; German treatment, 558. 

Stomach, Vomiting of the, 660; treatment, 561. 

Stones, Chalk (see Gout), 293. 

Stones, Gall, 283; size and weight of, 283; 
tendency to the disease, 283 ; agonising 
pain, 284 ; observances, 284 ; means of dis- 
solving and preventing the formation, 286. 

Stramonium, Uses of, 868 ; fruit of, 869. 

S' rong Quinine Mixture, 578. 

Stiophulus, 31. 

Stiychnia, how to act in cases of poisoning by, 
838. 

Stores, 656. 

Suckling, 675. 

Sugar and Grey Powders, 581. 

Sugar of Lead, How to act in cases of poisoning 
by, 811. 

Sulphate of Iron Pills, 581. 

Sulphate of Zinc, or Oxide of Zinc, 869 ; pre- 
parations of, 869. 

Sulphide of Calcicum Pilates, 681. 

Sulphide of Calcicum, Uses of, 871 ; powders, 
582. 

Sulphuric Acid Mixture, 579. 

Sulphur, or Brimstone, 872; Confection of, 
873 ; Lotion, 873. 

Sulphur Lotion, 582. 

Sunstroke, 503 ; Indian sufferers, 604 ; symp- 
toms and treatment, 505; prevention of 
sunstroke, 606 ; brief guide to soldiers and 
travellers, 506. 

Sargery, Domestic, 693 ; hemorrhage, 693 ; 
modes of binding wounds and arteries, 694, 
695, 696 ; wounds on the head, 697 ; vari- 
cose veins, 697 ; bandaging the legs, 698 ; 
poisoned wounds, 699 ; penetrating wounds, 
699 ; bleeding from the nose, 700 ; bruises 
and contusions, 700 ; concussion of the brain, 
701; sprains, 702; fractures, 703; disloca- 
tions, 705 ; modes of reducing dislocations, 
706, 707 ; burns, 707; suspended animation, 
709; means of reviving the partially 
drowned, 710; cases of hanging, 711; sus- 
pended animation from foul gases, 711 ; 
sunstroke, 712; frostbites, 712; gunpowder 
accidents, 713; gunshot injuries, 713; 
injuries from chemicals, 713; from quick- 
lime, 714 ; teething, 716 ; lancing the gums, 
717 ; care of the teeth, 718 ; toothache, 719 ; 
inflammation of the tonsils, 719 ; enlarged 
tonsils, 720 ; in-growing toe-nail, 720. 

Sweat, 968. 



Sweating Feet, 279 ; treatment of, 279 ; appJJ 

cable to sweating hands, 279. 
Syringe, An Ear, 250. 
Syrup, Easton's, 807, 809. 
Syrup of Iodide of Iron, 807. 



Table of medicinal doses given to children and 

adults, 1003, 1004. 
Table showing the Growth of the Human Boay 

from 18 to 30 years of age, 380. 
Tamarinds, 667 ; uses of, 883. 
Tannic Acid Gargle, 579. 
Tapeworm Draught, 579. 
Tapioca Pudding, 665. 
Tar and Creosote, Uses of, 874. 
Tar Pills, 581. 
Tartar Emetic, Uses of, 876. 
Tartarated Antimony Mixture, 677. 
Tea, Coffee, Pepper, and Mustard, 925. 
Sfea, 877; plant, 878; way to make, 931. 
Tea, Beef, 660, 661. 
Tea, Linseed, 666. 

Teeth, Care of, 718; Cutting in children, 18 — 20. 
Teeth-cleaning, 417. 
Teething, 716. 

Temperate Working Men, 911. 
Temperature and the Clinical Thermometer, 

585. 
Temperature for a Sick-room, 668. 
Terrors, Night, 30; remedies for, 31. 
Tetanus, 507 ; one form called Tonic Spasm, 

another Chronic Spasm, 507 ; producing 

causes, 508 ; general treatment, 508. 
Thermometer Scale, 586. 
Thornbury on the Water Supply of London, 

890. 
Throat, Sore (Clergyman's), 498; how caused, 

499 ; easy remedy, 499 ; wearing beam and 

moustache, 500. 
Throat, Sore, in children, 50, 51 ; treatment, 

52. 
Throat, Sore, Inflammatory, 450; nature of, 450 ; 

remedy, 541 ; different forms of sore throat, 

451 ; remedies, 452, 453. 
Throat, Sore (Ordinary), 500 ; medicinal treat- 
ment, 501 ; relaxed, 453, 454 ; dry and 

glazed, 454 ; chronic, 455. 
Thrush, 55 ; treatment, 56. 
Tic-douloureux, 400. 

Tinctus Creosotic, 500 ; of Steel, 806, 809. 
Toast and Water, 666. 
Tobacco, 880 ; effects of smoking, 881. 
Toe-nail, In-growing, 720. 
Tolu Balsam, 788 ; plant, 789. 
Tonic Quinine Mixture, 577. 
Tonsils, 120; enlarged, 66; treatment, 67; 

inflammation of, 719. 
Toothache, 509, 719; decayed teeth, 509; wisdoM 

teeth, 609 ; the various remedies for alle- 



INDEX. 



1079 



viating pain, 510, 511 ; Neuralgia arising 
from decayed teeth, 512; hints for preserv- 
ing the teeth, 513. 

Towns, Cleanliness of, 946. 

Traps, House, 985. 

Treacle, 883. 

Trichinous Disease, 918. 

Trumpets, Ear, 255. 

Tuberculosis, 67 ; the causes in children, 57 ; 
general advice to parents when children 
suffer, 58,59; treatment and prescriptions, 62. 

Turpentine and Ammonia Liniment, 682. 

Turpentine, Spirits of, Uses of, 787. 

Typhoid, Typhus, and other Fevers, 514; 
various premonitory symptoms, 514 ; shiver- 
ing fits, 515 ; rapidity of the heart's action, 
616; confusion of ideas, 516; Continued 
Fever, 517 ; Hectic, 517 ; Poisons which give 
rise to fevers, 618; causes which operate 
to modify the severity of the disease, 
618 ; remedy for Specific Fever, 619 ; 
duration of different fevers, 520 ; symptoms 
by which the several fevers may be known, 
520, 521 ; curative drugs, 521 ; directions to 
fever attendants, 522 ; rule for the use of 
stimulants, 523; restlessness and opiates, 
624 ; delirium, 525 ; disinfecting rooms, 526 ; 
stage of convalescence, 526; preparation 
for restoring the lost hair, 527 ; Typhoid 
Fever, 527; Gastric, 527; Typhus, 628; 
danger of affecting the sewage, 529 ; brooks 
and water carry contagion, 519 ; symptoms 
of Typhoid Fever, 530, 531 ; progress of 
the disease, 532, 533 ; tracing the tempera- 
ture, 533 ; complications and sequels of 
Typhoid, 534 ; illustrated chart showing the 
course of the temperature in Typhoid 
Fever, 535 ; the best treatment of Typhoid, 
637 ; advice to nurses, 638 ; diet, 639 ; 
reducing the temperature of the body, 
540 ; the use of Quinine, 541 ; Opiates, 542 ; 
Typhus Fever, 542 ; differs materially from 
Typhoid, 643; the symptoms of Typhus, 544; 
the distinctive rash, 644 ; the duration of 
the attack, 545 ; table comparing the symp- 
toms of Typhoid and Typhus, 646 ; adminis- 
tering alcohol, 547 ; general directions, 548; 
Simple Fever, or Febricula, 648 ; symptoms, 
649 ; simple treatment, 649 ; prescriptions, 
649, 550 ; Remittent Fever, 550 ; character 
of the disease, 550 ; special treatment, 551 ; 
how to avoid fever in hot climates, 651 ; 
Yellow Fever, 652 ; Black Vomit, 652 j 
treatment, 653. 



Ulcer of the Stomach, 653 ; symptoms, 554 ; 
Gastric Ulcer, 555 ; dietary rtgime, 556 ; 
five recipes for making essence of beef, 656, 
657 ; German mode of treatment, 658 ; for- 
mula for injections, 659. 



Ulceration, Gangrene of the Cheek, 24 

treatment, 24. 
Ulcers and Sores, 501 ; remedies, 602. 
Urine, 602. 
Urinals, India Rubber, 6S1. 



Vaccination, 63 ; a tribute to Jenner, 64 ; tho 
epidemic in former periods, 66, 66 ; tha 
various stages of the disease, 66, 67 ; vac- 
cination a great protection, 68, 69. 

Vegetables, Buckland's plan for the use of, 
904 ; value of, 914. 

Vegetable fungus, or skin parasites, 992, 993. 

Ventilation, 960. 

Veins, Varicose, 697. 

Vertigo, Epileptic, 263 ; of old people, 290. 

Voice, Loss of, 370. 

Vomiting, 559 ; whether caused by disease of 
the brain, or stomach disorder, 559 ; symp- 
toms of Brain Vomiting, 560 ; symptoms of 
Stomach Vomiting, 560 ;. treatment, 501 ; 
food for suffering children, 561; a remark- 
able case cured by Dr. William Hunter, 
562, 663, 564. 



Warts, 565 ; their origin, 566 ; remedies, 566. 

Wasting Palsy, 666 ; characterised by wasting 
of the muscles, 566 ; symptoms, 567 ; a 
singular case, 568 ; remedies, 669. 

Wash, Red, 582 ; black, 826. 

Water, Analysis of the London Supply, 932 ; 
basis of all sanitation, 934 ; purposes for 
which it is required, 935 ; rain, 950 ; sea, 
972 ; supply in large towns, 941; tests for 
the purity, 948. 

Water and Salts, 898. 

Water, Pearl Barley, 636. 

Water, Toast and, 666. 

Water Works, earliest form of, 889. 

Water on the Brain, 69 ; symptoms and treat- 
ment, 70. 

Waterbrash, 448 ; character of, 448 ; treatment, 
449. 

Weaning, 682; process of, 683; food after, 
684. 

Whey, Tamarind, 667 ; treacle, 667 ; white 
wine, 667. 

White Flux, The, 228. 

White Precipitate, 827. 

Whooping Cough, 70; the gradual growth of 
the disease, 71 ; complications of the disease, 
72; remedies, 73. 



1C30 



INDEX 



Wind (see Flatulence), 279. 

Wine, Various Qualities of, 926, 927. 

Worms, 569 ; Kound Worm (illustrated), 560 ; 
how to destroy them, 570; Tape Worm, 
570 ; joints of Tape Worm (illustrated), 571 ; 
remedies for its expulsion, 571 ; Thread 
Worms, 572; the Worms (illustrated), 5? 2; 
injections and other treatment, 572. 

Wounds, Binding of, 694, 695; head, 697; 
penetrating, 699 ; poisoned, 699. 



Writers' Cramp, 572; symptoms, 573; removing 
the causes, 574 ; alleviating remedies, 676. 



Yellow Fever, 552; black vomit, 552; treat- 
ment, 553. 

Z 

Zinc, Sulphate and Oxide of. 869 ; preparatiow 
of, 869. 



ADDITIONAL INDEX,, 

Love and Marriage 1013 

Courtship 1015 

Marriage 1017 

Duties of Married Life 1021 

The Sexual Organs of Human Beings 1023 

The Determination of Sex 1024 

Sexual Isolation 1030 

Prevention of Conception and Constitution 1036 

Prostitution , 1040 

Painless Midwifery , 1046 

A Few Suggestions of Value , .....♦.,., ••• 1052 

Ely's Obstetrical Table 1053 

On Connection After Conception and Its Consequences 1054 



LIBRARY OF CONGRESS % 

022 169 929 4 



